It is just one year since the formation of Aitex Private Midwifery Services (APMS), and I am reflecting on the question, "How has APMS performed in the past 12 months?"
[The business model I had prior to 2009 was that I was self-employed. The difference with the APMS business model is that I now employ other midwives, as well as personally being employed by APMS]
The goals for the year 2009-2010 were:
APMS intends to establish a robust business model for achieving its purposes. Prior to July 2010, APMS aims to:
• provide primary maternity care for (x) women
• employ and mentor two midwives as primary maternity care providers, and as ‘second midwife’ for planned homebirths
After 1 July 2010, with changes in legislative arrangements for midwives, APMS aims to
• find ways of providing ongoing private midwifery services
• provide support for women and midwives affected by the legislative changes
Long term goals include midwife education in caseload primary maternity care practice and homebirth; consumer education; and mother to mother peer support.
The following notes are condensed from the APMS Annual Report.
1. The business model has been developed.
2. Midwives employed by APMS have signed employment agreements, submitted time sheets for hours worked, and are paid by APMS. Superannuation has been paid when midwives have earned $450 or more in a month.
3. Clients have been receiving primary maternity care through their pre, intra, and postnatal episode.
4. The three midwives have been employed and mentored.
5. Plans for AFTER 1 July: One midwife has indicated her interest in continuing as a midwife in private practice, and has agreed to working as the first APMA 'partner'. Another midwife has spoken to me about coming under a mentorship agreement.
6. Midwives in private practice are required to have professional indemnity insurance to cover prenatal and postnatal services after 1 July 2010. Homebirth is exempt. All APMS midwives will confirm that they have appropriate indemnity insurance.
7. At present two insurance products are available [see MiPP blog]. The APMS fee for primary care has been increased by $100 to pass on that extra cost to the clients.
8. Midwives who attend women for homebirth are required to inform their clients of the lack of indemnity insurance for homebirth. An agreement form which clients and midwife sign acknowledging the lack of insurance has been developed.
APMS employment model
Since a midwife in private practice works with individual women, the APMS employment model links the midwives to the women who engage us for private midwifery services.
This model enables midwives to be employed either as a partner/colleague, or at an agreed rate of pay that compares favourably with the rate that midwife would be paid as a casual employee in a hospital, but is the same regardless of weekends or public holidays.
Vision for the future
I envisage growth in APMS, with increasing numbers of women receiving maternity care, and increasing numbers of midwives being supported and mentored through this practice.
I envisage good birthing outcomes in the care of APMS midwives.
I envisage a robust midwifery workforce, developing strong midwife identities, engaging in ongoing learning and professional development, and reflective, critical practices.
I envisage midwives who are located distant from Melbourne coming under the APMS employment and mentoring model.
I envisage expanded opportunities for peer support by mothers and midwives through APMS
I envisage midwife partners mentoring others, as part of their roles in this practice.
Note: Part 1 of this review is at the villagemidwife blog
Sunday, June 27, 2010
Monday, June 14, 2010
what midwives will NOT accept
The obstacle that has been obvious to midwives throughout the maternity reform process is to do with the requirement for a 'collaboration' agreement between a doctor and the midwife.
OF COURSE midwives want collaboration. We do it all the time.
BUT we will not agree to another professional (a doctor or anyone else) being given authority to sign off on a midwife's professional decisions. That is not collaboration, it's control.
In recent weeks an announcement has been made by the Health Minister Nicola Roxon that a government-supported insurance policy is now available for midwives to purchase. This MIGA policy, as it stands, does not meet the needs of private midwifery practice, and is unacceptable.
Professional Indemnity insurance, which is not available for homebirth, is mandatory from 1 July this year - with an exemption for homebirth. Midwives whose field of practice centres on women who intend to give birth at home, employing a midwife privately to provide a professional service, do not want an insurance that covers birth in hospital. Hospital visiting access is simply not available for midwives, so why would they want to buy an expensive insurance product that covers hospital birth, if they have no opportunity to attend their private clients in hospital?
For more discussion go to the MiPP blog.
The Australian College of Midwives (ACM) has issued a press release supportive of the MIGA insurance, and hospital birth attended privately by a midwife. ACM spokeswoman, midwife Tina Pettigrew states that:
“To be able to look after a woman throughout her pregnancy, follow her into the hospital to have her baby and follow her home again afterwards to help her settle into being a new mother is what I’ve always wanted to do. Now I can to do all this with full indemnity cover”
ACM also claims that:
"The provision of insurance cover for private midwives is one of the necessary precursors to midwives gaining access to Medicare funding for their care from 1 November this year.
"Medicare funded midwives will be able to work in practices in the community, with other midwives, with doctors and with allied health professionals as well as in hospitals to offer more women the choice of having one-to-one care from a known midwife throughout their pregnancy, labour, birth and early parenting."
The deadline, 1 July, is approaching. Many midwives in private practice have indicated in discussion that we we plan to buy the cheapest insurance product that meets the requirements of the new national registration and accreditation legislation.
Insurance does not protect the mother and baby in our care. Good midwifery practice, and promotion of health in pregnancy, birth, and mothering does. As I wrote in August last year, the insurance debate is more about smoke and mirrors than safety.
It's more about business at the top end of town than protecting the little person.
Until our government provides a no-fault insurance product that deals equitably and fairly with all consumers who suffer loss or disability in health care, the insurance industry, and the law industry, will be the only ones who benefit.
OF COURSE midwives want collaboration. We do it all the time.
BUT we will not agree to another professional (a doctor or anyone else) being given authority to sign off on a midwife's professional decisions. That is not collaboration, it's control.
In recent weeks an announcement has been made by the Health Minister Nicola Roxon that a government-supported insurance policy is now available for midwives to purchase. This MIGA policy, as it stands, does not meet the needs of private midwifery practice, and is unacceptable.
Professional Indemnity insurance, which is not available for homebirth, is mandatory from 1 July this year - with an exemption for homebirth. Midwives whose field of practice centres on women who intend to give birth at home, employing a midwife privately to provide a professional service, do not want an insurance that covers birth in hospital. Hospital visiting access is simply not available for midwives, so why would they want to buy an expensive insurance product that covers hospital birth, if they have no opportunity to attend their private clients in hospital?
For more discussion go to the MiPP blog.
The Australian College of Midwives (ACM) has issued a press release supportive of the MIGA insurance, and hospital birth attended privately by a midwife. ACM spokeswoman, midwife Tina Pettigrew states that:
“To be able to look after a woman throughout her pregnancy, follow her into the hospital to have her baby and follow her home again afterwards to help her settle into being a new mother is what I’ve always wanted to do. Now I can to do all this with full indemnity cover”
ACM also claims that:
"The provision of insurance cover for private midwives is one of the necessary precursors to midwives gaining access to Medicare funding for their care from 1 November this year.
"Medicare funded midwives will be able to work in practices in the community, with other midwives, with doctors and with allied health professionals as well as in hospitals to offer more women the choice of having one-to-one care from a known midwife throughout their pregnancy, labour, birth and early parenting."
The deadline, 1 July, is approaching. Many midwives in private practice have indicated in discussion that we we plan to buy the cheapest insurance product that meets the requirements of the new national registration and accreditation legislation.
Insurance does not protect the mother and baby in our care. Good midwifery practice, and promotion of health in pregnancy, birth, and mothering does. As I wrote in August last year, the insurance debate is more about smoke and mirrors than safety.
It's more about business at the top end of town than protecting the little person.
Until our government provides a no-fault insurance product that deals equitably and fairly with all consumers who suffer loss or disability in health care, the insurance industry, and the law industry, will be the only ones who benefit.
Monday, June 7, 2010
"not for the faint-hearted"
Private midwifery practice is reaching a watershed. Many midwives who have in the past practised privately, providing a vital professional service for women who want to protect and work in harmony with their bodies' natural processes in birthing, are quitting.
Midwives who are continuing are arranging insurance policies that will comply with the new laws (NRAS). The cost of insurance will be passed on to the consumers. Midwives are likely soon to be less available and more expensive.
This may sound pessimistic when the spin from the Health department is that "Private midwives to be covered by insurance".
Health Minister Roxon is reported as saying "This will make a real difference to expectant mums, who can now elect to see a private midwife who will have government-subsidised insurance and, from November 1, have the cost of those services covered by Medicare," Health Minister Nicola Roxon said.
The government-subsidised insurance covers midwives attending birth privately in a hospital. At present we know of no hospital that is willing to extend visiting access to midwives. We will be interested to know of developments in this direction.
Details of the government-subsidised insurance, and links, are at the mipp blog.
The second insurance option, called 'Mediprotect' and available through insurance agency VERO, provides cover for private midwifery services in pregnancy and postnatally, EXCLUDING birth.
A letter from the Victorian branch of the nurses and midwives union, ANF, received by a member today, informs us that the ANF Vic members insurance policy is also with VERO. VERY interesting. To date ANF Vic has responded negatively to requests from members to find an insurance policy that also covers private midwifery services in pregnancy and postnatally, EXCLUDING birth.
Back to the title of this post, "Not for the faint-hearted."
There are a number of midwives in private practice who are currently awaiting formal hearings by the statutory body, into complaints about their professional practices. One well known midwife in a rural Victorian setting has, a couple of days ago, had her registration suspended pending a hearing.
It appears that there is an escalation in the number of complaints that are being made about private midwives.
The mandatory reporting requirements of the new NRAS define notifiable conduct as (the usual impairments, sexual misconduct, ...) and
"(d) placed the public at risk of harm because the practitioner has practiced the profession in a way that constitutes a significant departure from accepted professional standards."
We midwives must be prepared to gather credible evidence and define accepted professional standards. It doesn't say "in the local hospital" or even "according to the professional body".
Midwives in private practice stand out like sore thumbs, and can expect to be reported.
We can also report. Can our community accept midwifery that results in 50% of primipara having caesarean surgery, with the subsequent increased risk to the mother and future children?
There is a huge theory-practice gap. Everyone involved in education knows that. We have to use that theory-practice gap to declare what is acceptable, and what's not. We have to be prepared to question what we see and hear, gather information, and write reports to the Board. Even if they are dismissed, the concerns that we all talk about need to be put on the record.
Midwives who are continuing are arranging insurance policies that will comply with the new laws (NRAS). The cost of insurance will be passed on to the consumers. Midwives are likely soon to be less available and more expensive.
This may sound pessimistic when the spin from the Health department is that "Private midwives to be covered by insurance".
Health Minister Roxon is reported as saying "This will make a real difference to expectant mums, who can now elect to see a private midwife who will have government-subsidised insurance and, from November 1, have the cost of those services covered by Medicare," Health Minister Nicola Roxon said.
The government-subsidised insurance covers midwives attending birth privately in a hospital. At present we know of no hospital that is willing to extend visiting access to midwives. We will be interested to know of developments in this direction.
Details of the government-subsidised insurance, and links, are at the mipp blog.
The second insurance option, called 'Mediprotect' and available through insurance agency VERO, provides cover for private midwifery services in pregnancy and postnatally, EXCLUDING birth.
A letter from the Victorian branch of the nurses and midwives union, ANF, received by a member today, informs us that the ANF Vic members insurance policy is also with VERO. VERY interesting. To date ANF Vic has responded negatively to requests from members to find an insurance policy that also covers private midwifery services in pregnancy and postnatally, EXCLUDING birth.
Back to the title of this post, "Not for the faint-hearted."
There are a number of midwives in private practice who are currently awaiting formal hearings by the statutory body, into complaints about their professional practices. One well known midwife in a rural Victorian setting has, a couple of days ago, had her registration suspended pending a hearing.
It appears that there is an escalation in the number of complaints that are being made about private midwives.
The mandatory reporting requirements of the new NRAS define notifiable conduct as (the usual impairments, sexual misconduct, ...) and
"(d) placed the public at risk of harm because the practitioner has practiced the profession in a way that constitutes a significant departure from accepted professional standards."
We midwives must be prepared to gather credible evidence and define accepted professional standards. It doesn't say "in the local hospital" or even "according to the professional body".
Midwives in private practice stand out like sore thumbs, and can expect to be reported.
We can also report. Can our community accept midwifery that results in 50% of primipara having caesarean surgery, with the subsequent increased risk to the mother and future children?
There is a huge theory-practice gap. Everyone involved in education knows that. We have to use that theory-practice gap to declare what is acceptable, and what's not. We have to be prepared to question what we see and hear, gather information, and write reports to the Board. Even if they are dismissed, the concerns that we all talk about need to be put on the record.
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