Notation on the Register

The notation on my registration states:

Mrs Joyce Johnston is an eligible midwife competent to provide pregnancy, labour, birth and postnatal care and qualified to provide the associated services and order diagnostic investigations required for midwifery practice, in accordance with the relevant State and Territory legislation. Eligible midwife, but NOT qualified to obtain endorsement under section 94 to prescribe Schedule 2, 3, 4 & 5 medicines required for midwifery practice in accordance with State & Territory legislation.

I had applied for this eligible status last December, so it is with a considerable sigh of relief that I acknowledge this achievement.

Anyone reading this post who is not familiar with current maternity care in Australia may question the wording of the notation. I am now an 'eligible midwife'. I am now "competent to provide pregnancy, labour, birth and postnatal care" - care that I have been providing on my own authority, independenty, for most of the past 20 years.

So what's new?

The main new feature of my practice is that some women in my care will, as a result of this notation on the Register, be able to claim rebate from Medicare on my fees: women who have Medicare cards, and for whom I am able to set up sutiable collaborative arrangements with a doctor. As soon as I can organise the software and other technology, I hope to be able to process Medicare rebates from my office directly to a woman's nominated bank account.

Another new feature is, as the notation states, that I am now able to order diagnostic investigations required for midwifery practice. In the past I have asked women to have routine blood tests and any other investigations requested by their GPs.

I am not yet able to prescribe medication. I have signed an undertaking to complete a medication course for midwives , within 18 months of being recognised as an eligible midwife. However, to date the Board has not approved a program of study in prescribing, so I am waiting for that approved course to be announced.

Another feature of the government's midwifery reform package that is yet to be realised is the ability for midwives to attend women privately in hospitals. At present, when a midwife goes to hospital with a woman for whom she has provided prenatal care, the midwife's status is a sort of support person who has no professional role, and who can be seen as persona non grata. Midwives' ability to provide professional intrapartum care in hospitals is part of the government's Midwife Professional Indemnity Scheme.

In the 2009-10 Budget, the Government announced the 'Improving Maternity Services Package'. The package provides for the introduction of Medicare supported services to provide greater choice for women during pregnancy, birthing and postnatal maternity care, including the provision of professional indemnity for midwives. The Midwife Professional Indemnity Scheme (MPIS) includes a Commonwealth contribution initiative designed to assist with claims made against eligible midwives and encourage the provision of indemnity insurance policies for private independent midwives. The Midwife Professional Indemnity Scheme provides financial assistance to eligible Insurers who provide indemnity to eligible midwives.

There are now a handful of Medicare-authorised midwives. In Victoria, you can get Medicare rebates for private midwifery from a midwife in Echuca, and from a few midwives in Melbourne.  There is no Medicare rebate, or indemnity insurance for home birth.  Midwives are exempt from being required to have insurance for homebirth until the end of June 2013.

You can search for a midwife on Google, or go to Midwives Australia .

Thankyou for your comments

continuity of carer

Pic: Ash labouring in hospital - used with permission

A mother-to-be who I will call Jenny came to my office for a pre-natal check.  Jenny is planning to give birth to her first baby in hospital, and I am providing shared antenatal care*, and planning to be with her in labour, birth, and continuing the care after her baby has been born, and visiting her at home.

Jenny has read the blogs I have written in the past week or so, and newspaper reports, about the emerging situation when a midwife is with woman in a hospital.  Jenny asked me for more information about these matters.  Jenny's questions were particularly focused on how the insurance/ reporting issues would affect my plan to be with her as her known and trusted midwife.  Jenny reiterated, without any prompting from me, that the reason she wants her own midwife to be with her in labour is her need for continuity.  

Continuity of carer refers to “a model of care providing relational continuity between each woman and midwife by continuity of midwifery carer throughout the full process of pregnancy, birth and the postnatal period, responsive to the needs and preferences of the individual woman." (Fontein 2007, p37- see full reference below)

In an ideal world that midwife would be the responsible, accountable primary care provider, who attends and 'conducts' uncomplicated births in the setting of the mother's choice, and refers to and collaborates with specialist obstetric and nursing providers when and if the need arises, all the time maintaing a unique professional relationship with the woman, regardless of the level of complexity or simplicity encountered. We clearly don't live in the ideal world, but we try to make the best of what we have.

If women were to lose the right to continuity and not be able to access personal support and interaction with their own midwife in hospital; the midwife with whom they have formed a special relationship - dare I say friendship - over a substantial period of time, those women will be the ones most adversely affected.  The old-fashioned word 'confinement' which used to be applied to childbirth is an apt description of such a situation, bringing with it the loss of liberty in personal association, and loss of freedom to choose.  It sounds like the other type of confinement, imprisonment.

But the important point to remember here is that the concept of  "offering continuity of care, and where possible carer, as a key element of quality care": a key principle agreed upon by federal and state health ministers, and published in a 2008 statement by Australian Health Ministers Advisory Council (AHMAC), Primary Maternity Services in Australia - A Framework for Implementation.  These key principles for primary maternity services have been carried through into current regulatory documentation for midwives, such as the Safety and Quality Framework for Privately Practising Midwives attending homebirths, which can be downloaded as a .pdf at the NMBA website.


STOP PRESS: 4pm, 2/9/11
A statement has just been circulated by the Nursing and Midwifery Board of Australia, concerning the role of the midwife who supports a woman admitted to a public hospital.  If you would like the full statement contact me joy[at]aitex.com.au
 

... The midwife may choose to withdraw when the care of the woman is assigned to the health facility’s health care professionals. However, should the woman request it, the midwife may choose to remain as a support person to the woman either as paid or unpaid as agreed between them. The Board recognises that the midwife has no obligation to stay with the woman and that it is an individual decision for the midwife.

If the midwife chooses to stay with the woman - and therefore take on a support person role - the midwife must articulate the change in role to the woman, who should then consent to the midwife’s involvement as a support person only. The midwife should also clarify her change in role from midwife to support person with the health service.

The decision by the midwife to remain as a support person is linked to the woman’s right to choose the person(s) whom she wishes to be with her during birth. ...

*Note: (Shared antenatal care means that Jenny has a few key reviews at the hospital, and that I provide the other antenatal checks.)

Reference: Fontein Y, 2007. Making the transition from ‘being delivered’ to ‘giving birth’. A literature review and reflections on the potential for introducing the UK model of ‘caseload midwifery’ to the Netherlands. MIDIRS Midwifery Digest, vol17, no1, March 2007, pp35-40.