Wednesday, June 29, 2011

Collaborative arrangements

Midwives providing services eligible for Medicare rebates are required to have evidence of a collaborative arrangement with a specified medical practitioner for each woman in their care. In essence, the midwife is required to have written records of:
(a) the name of at least one collaborating medical practitioner;
(b) that the midwife has told the woman ["patient"] about the arrangement;
(c) acknowledgement by a named medical practitioner that the practitioner will be collaborating in the woman’s care;
(d) plans for the circumstances in which the midwife will consult, refer, or transfer care to that medical practitioner.

Midwives who have contacted the Department of Health and Ageing (DoHA) have given examples of situations in which collaborative arrangements have been difficult to obtain. The hurdle that is proving particularly difficult is (c) acknowledgement by the doctor that he/she will be collaborating. Doctors who have for many years worked collaboratively alongside midwives have baulked at the idea of putting their signature on a collaboration document.

Many midwives attending homebirths privately have for many years had good collaborative arrangements with public maternity hospitals. If a woman or baby in the midwife’s care requires transfer to hospital, or referral for specialist assessment in pregnancy, the process of consultation, referral and transfer is straight-forward, which is in the interest of the wellbeing of mother and baby.

For example, when the woman and midwife have completed the hospital booking-in process, the hospital gives the woman paperwork with the woman’s name on it, clearly marked ‘HOMEBIRTH BACK-UP’. This is evidence of the collaborative arrangement, but at present this sort of arrangement cannot be used as evidence of collaboration for the purposes of Medicare rebates.

In response to midwives' letters to the DoHA, Rosemary Bryant (Chief Nurse and Midwife) wrote:
The Australian Government, through this Department is continuing to monitor these difficulties through a range of activities including monitoring correspondence received- including your email, calls to our hotline and data from Medicare. We will also be undertaking surveys of midwives, obstetricians and GP obstetricians in the coming months to ascertain what is working, what is not working and then we’ll develop responsive action accordingly. Through our evaluation activity we’ll also be talking to pregnant women, women planning pregnancy and their families, about their experiences and awareness of the reforms to maternity services more generally.

I can assure you that the Government is committed to increasing choice of and access to maternity services in Australia, and maintaining our high standards of safety and quality through supports for workforce and infrastructure.

With reference to reports that doctors are reluctant to enter collaborative arrangements with midwives because of indemnity insurance concerns, Ms Bryant stated:
The Government has put in place arrangements that allow eligible midwives to obtain solid and affordable professional indemnity insurance cover that provides peace of mind for midwives and their clients. The Commonwealth-supported cover, which is provided through insurer MIGA ( is, in effect, unlimited. It covers eligible midwives for their full scope of practice, except intrapartum services in relation to planned home births. Obstetricians, GPs who provide obstetric services and hospitals can be confident that the Commonwealth-supported MIGA product provides strong, reliable professional indemnity cover for privately practising midwives. Therefore, from an insurance perspective, collaborating with a midwife who has the benefit of Commonwealth-supported cover is no different from collaborating with another medical practitioner who holds their own medical indemnity insurance cover.

Comments are welcome

1 comment:

Anonymous said...

It's also worth pointing out that these women won't be randomly assigned to c-section/vaginal groups but choose which group they are in. There may (or may not) be significant differences between the types of women who want an elective c-section without medical indication versus those who want to attempt vaginal birth which may in turn influence how they respond to breastfeeding/early parenting etc.