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)

Position Statement

Position Statement on

Planned Home Births with a

Midwife

Adopted by APMA: 29 October 2009

Introduction

Australian Private Midwives Association (APMA) represents the majority of privately practising midwives in Australia, who are also the responsible professional attendants at the majority of homebirths in this country. APMA aims, through representing private midwives at national professional discussions, to support women through promoting and protecting continuity of midwifery primary care. APMA is a key stakeholder in any professional discussion about homebirth.

Many APMA members are active professionally in the Australian College of Midwives (ACM), as well as in groups that establish partnership between midwives and consumers, such as Australian Society of Independent Midwives, Midwives in Private Practice, Maternity Coalition, Homebirth Australia, Home Midwifery Association (Qld), Homebirth Access Sydney (NSW), Birth Matters (SA), and Birthing and Babies Support (BaBS).

The following statement represents the view of APMA on planned home births with a midwife. APMA reserves the right to revise and update this Position Statement as time passes. APMA encourages ACM and other stakeholder organisations to endorse this statement and adopt it without change as their Position Statement on Home Births with a Midwife.

Position Statement on

Planned Home Births with a

Midwife

1. We support home birth with a midwife in attendance for women who have uncomplicated labours.

1. Midwives practising in any setting are responsible and accountable for their decision making about their own scope of practice and referral and transfer of care.
2. We support the use of the National Midwifery Guidelines for Consultation and Referral (ACM 2008) as a guide in midwifery referral decisions.

2. We support and adopt the International Confederation of Midwives’ (ICM) Definition of the Midwife (2005) (attached below), which is foundational to all midwifery practice, including homebirth. The ICM Definition of the Midwife establishes the following principles which apply in this statement:

1. The principle of ‘partnership’: “The midwife … works in partnership with women …”
2. The principle of professional responsibility: “The midwife is recognised as a responsible and accountable professional …”
3. The principle of continuity of carer (‘caseload’) – primary care: “The midwife … works … to give the necessary support, care and advice during pregnancy, labour and the postpartum period, …”
4. The principle of primary care – on the midwife’s own responsibility: “… to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.”
5. The principle of health promotion: “This care includes preventative measures, the promotion of normal birth,…”
6. The principle of detection of complications, consultation, referral, and carrying out emergency measures: “This care includes … the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.”
7. The principle that midwifery care has broad community health implications: “The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.”
8. The principle of ‘any setting’: “A midwife may practise in any setting including the home, community, hospitals, clinics or health units.”

3. We support the right of every woman to access a midwife as the primary maternity caregiver who works in partnership with the woman throughout the episode of care, who is able to be the responsible professional in attendance at the birth either at home or hospital, and who is able to make appropriate referral and transfer of care when required.

1. We support a woman’s right to self-determination and control over her body and her pregnancy, including the right to give birth in the place of her choice.
2. We support and value the woman’s ability to make informed decisions about place of birth, and other choices as her pregnancy and labour progress, in partnership with a known and trusted midwife of her choice.

4. We support the right of a midwife to practise privately¹ in a fee-for-service or funded relationship with the client, or to take up employment.

5. We support only those regulatory restrictions that are able to pass the ‘public interest’ test: “How does this promote health and wellbeing in the mother and baby?”²

6. We support an expectation of equity, including equal pay for equal work throughout a midwife’s scope of practice. Midwives who provide primary maternity care are entitled to the same public funding, the same opportunity to charge a fee-for-service, the same access to hospital referral, and publicly supported indemnity insurance, as medical practitioners providing the same maternity services.³

7. We support processes by which midwives are able to gain experience and mentoring in order to commence and demonstrate continuing competence in homebirth practice.

8. We support seamless and reliable processes by which midwives are able to make hospital bookings for women planning homebirth, and arrange transfer to the hospital in a timely way when needed.

Definition of the Midwife

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.

A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

Adopted by the International Confederation of Midwives Council meeting, 19th July, 2005, Brisbane, Australia

Supersedes the ICM “Definition of the Midwife” 1972 and its amendments of 1990