Monday, November 16, 2009

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,