Thursday, June 2, 2011

How is the private midwifery profession faring?

Midwives have had six months since the federal government's Medicare reforms became effective (1 November 2010). Midwives, and the women who employ us, have a mere thirteen months before the exemption from professional indemnity for attending births in homes expires (1 July 2012). It's a good time to take stock of our situation.

There is a handful of midwives around the country who are 'eligible' to provide pre-and post-natal services for which Medicare refunds apply. Another handful of midwives are at various places in the application process. Other midwives continue to provide private midwifery services without seeking Medicare provider numbers.

Approval for notation as 'eligible' is granted by a State Board of the Nursing and Midwifery Board of Australia.

Midwives are able to purchase indemnity insurance that covers antenatal and postnatal care. No indemnity insurance is available for attending home birth. There is an insurance product that has Treasury support to provide cover for intrapartum private midwifery care in hospital. However we are not aware of any hospital yet that will award visiting access/clinical privileges to a midwife. The response that many midwives have received when making inquiries about being granted clinical privileges has been far from positive.

A person considering employing a midwife privately may wonder how to find an 'eligible' midwife, and thereby take advantage of the Medicare rebate. While there is no publicly available listing of these midwives, here are a couple of links and suggestions:

A: If you know the name of a midwife, a search of the public register at the AHPRA site will give information including 'notation' - curiously listed with 'conditions', 'undertakings' and 'reprimands'
Endorsements: No
Conditions: No
Undertakings: No
Notations: Yes
Reprimands: No

Then click 'view details' for that midwife, and you will be informed that:
Ms XX is an eligible midwife competent to provide pregnancy, labour, birth and post natal care and qualified to provide the associated services and order diagnostic investigations required for midwifery practice, in accordance with 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 and Territory legislation.

B: If you are searching for a midwife, and don't have a specific name to search, you may find a site that lists 'find a midwife'. After finding a midwife in your area, follow the instructions A above to check if that midwife has the Medicare notation on the register.
For example:
Midwives Australia
Midwives in Private Practice (Victoria)
Pregnancy, Birth and Beyond
Independent midwives and birth workers in South Australia
Homebirth Access Sydney
Home Midwifery Association (HMA) (Qld)

Confusion abounds about homebirth as a choice. New laws and regulations for midwives are poorly understood in our communities, and even amongst health professionals.

Readers are welcome to leave inquiries in the comments section of this blog, or to send an email message to Midwives Australia via the online contact form.

1 comment:

Joy Johnston said...

Discussion amongst a group of midwives has questioned the relationship between Medicare eligibility for midwives and homebirth.

A midwife can (at present) provide private services for anyone and charge (or not charge) as agreed between the woman and midwife. This agreement has nothing to do with Medicare.

There is no Medicare rebate item number for the 'birth' item in homebirths, even though the midwife may have a Medicare provider number, and a collaborative arrangement with a hospital to which the woman will transfer if needed.