Doctors to gain veto powers over midwives and birth choices

Doctors to gain veto powers over midwives and birth choices
Maternity Coalition brief

On 5 November the Government announced that the “Medicare for midwives” Bills would be amended to require midwives to have “collaborative arrangements”with “medical practitioners” before being eligible for professional indemnity insurance or Medicare rebates:
Doctors must approve each midwifeʼs entry to private practice:

Midwives will be required by Commonwealth law to have “collaborative arrangements” with“one or more medical practitioners” before being eligible for Commonwealth-subsidised professional indemnity insurance (PII).

PII will be a prerequisite for a midwife to enter private practice, under new national registration laws, being enacted state by state. Doctors will be able to unilaterally withdrawal from collaborative agreements with a midwife, rendering her uninsured, and legally unable to practice in a private professional capacity. This legally mandates medical control over midwives’ ability to register and work in private practice.

This will be set in Commonwealth law, which can only be changed by Commonwealth Parliament. These provisions are contained in the Health Legislation Amendment (Midwives and Nurse practitioners) Bill 2009. Doctors must approve womenʼs access to Medicare rebates for midwifery care:

Midwives will also be be required by Commonwealth law to have “collaborative arrangements”with “one or more medical practitioners” before their services are eligible for Medicare rebates. This allows medical control of individual women’s access to midwifery care.

This is potentially defacto “parallel regulation” of the midwifery profession: Medical practitioners will control the registration status of midwives, despite their being a discrete, separately regulated profession.

Medical professional organisations could set guidelines for collaborative arrangements, potentially forming defacto regulatory standards for midwifery endorsement and practice. This gives doctors right of veto over womenʼs choices in birth care: Any model of care – women’s choices in birth care – using private practice midwives, or developed under the Commonwealth’s new arrangements, will be subject to medical control or veto. This gives medical practitioners inprecedented control over women’s choices and access to care.

The proposed legislation is anti-competitive:

One group of providers will be able to control consumer access to another group of providers of the same business service, e.g. antenatal care. “Collaborative arrangements” may be legally restricted to privately practicing doctors:

The amendments do not specifically include hospitals as able to form collaborative arrangements with midwives. They require medical practitioners to be “of a kind or kinds specified in the regulations”.

It is unclear whether a hospital, health service district or authority may be included within the definition of “one or more medical practitioners”, but it appears unlikely.

Doctors who are employees of public hospitals can’t make “collaborative arrangements” as employees of the hospital they work for. They work for the hospital, attend their workplace when rostered on and collaborate in line with hospital policies.

A range of very serious consequences would flow if these arrangements were restricted to privately practicing doctors. Consequences could include:

No new midwifery models in public hospitals.
No private midwifery practice.
No homebirth care from midwives in private practice.
Practice midwives in private obstetricians rooms could be the only viable model of private practice or Medicare-funded midwifery.
The amendments do not improve “safety” or “continuity” for Australian mothers:

Midwifery is a profession with standards, guidelines and codes of practice developed to ensure the safety of midwifery care in any setting. Doctors, who are trained in a different skill-set, do not midwifery practice.

Continuity of care has been a fundamental goal of the midwifery reforms. These amendments make this continuity much more difficult to deliver.

No provision is made in the amendment specifying that collaborative arrangements will be based on patient safety or continuity of care. Medical practitioners will have veto on their own terms. This brief represents the best information available to Maternity Coalition on 9 November 2009. We are actively seeking ongoing clarification and dialogue with Government in order to ensure women and families have access to accurate information.

For more information contact: Bruce Teakle 07 3289 0231, teakle@maternitycoalition.org.au

MEDIA RELEASE

MEDIA RELEASE
Australian Private Midwives Association
Contact: National President Liz Wilkes 0423 580585
Medical veto impacts women’s access to care: Women Rally.
The Federal government may stall on the blocks of its first major initiative in health as the reform of maternity services hits stumbling blocks and criticism. Women will rally around Australia tomorrow to ensure choices are not lost in the wash up. Liz Wilkes, National President of the Australian Private Midwives Association, will join women and midwives outside Kevin Rudd’s electorate office in Brisbane. Women are seeking assurances that new legislation around private midwives registration and practice will not reduce options for care. “Midwives are educated and regulated to provide care for pregnancy, labour and birth on their own responsibility under the International Confederation of Midwives definition of a
midwife,” Ms Wilkes stated “Suddenly we are told that doctors control the ship and that doctors will be able to decide who can do what.”

Legislation due before the Senate was amended on Thursday by the Government to require midwives to work at all times in formal collaborative arrangements with doctors as a condition of insurance. Doctors will be able to veto these arrangements effectively giving the medical profession the ability to control which midwives can be insured and register. “The reform of maternity services is the first test of the Governments health reform agenda. It looks like the medical lobby may stall these reforms before they even get started.” Ms Wilkes said today “Placing one profession at the complete mercy of another for registration makes a mockery of professional regulation in this country.” Women at the centre of the scuffle are concerned that the amendment may erode rather than expand choices as doctors make decisions about what types of care to support. Many choices such as homebirth, vaginal birth after caesarean and care in rural areas may be lost if doctors do not form the formal agreements with midwives. “For the midwives who are currently self-employed it is no longer a matter of referring a woman who needs care to the appropriate person. Formal agreements with doctors will determine which of these educated, experienced and skilled midwives can actually register.” Ms Wilkes added “Regulators should control midwifery professional standards, not how a doctor feels about a particular midwife. This takes midwifery back 50 years.”

Women are worried about the choices in birth and are calling on the Prime Minister to make sure that in implementing this first serious reform in health, options for choice are not lost. Women rally at 10.30am November 9 at electorate offices of Kevin Rudd Brisbane, Julia Gillard Melbourne, Tanya Plibersek Sydney and Stephen Smith Perth.

Contacts: Liz Wilkes 0423 580585 (Brisbane and national)
Marie Health 0407266004 (Sydney)
Sally Westbury 0422 894 496 (Perth)
Clare Lane 0416 130291 (Melbourne)