Where are the midwives who practise privately?

[The following brief overview of private midwifery options is anecdotal, incomplete, and reported in good faith, knowing that situations change constantly.]

Western Australia

There are currently 11 Medicare-eligible midwives in WA, but how many are actually practising at the moment I’m not sure.  Some will do homebirths but others are only doing intrapartum care in hospital. 

There are currently no admittance/access rights for eligible midwives, so care in hospital is usually achieved through an arrangement by which the midwife is casually employed by WA health when she does the intrapartum care in hospital. WA Health are currently developing an access agreement.

There are 3 or 4 other privately practicing midwives in Metro Perth and two in the South West. I don’t think any are currently doing VBACs at home.  Some are only taking repeat clients. 

South Australia

The options in SA are limited because almost all of the midwives live in a similar geographical area. Most of us travel but it still is limited. Of the 9 working and taking on clients, 6 live in the Adelaide Hills and the next one coming into it also live up here.  There are 3 who are Medicare eligible, 1 eligible midwife about to start, 3 who are not eligible but are registered. 

Homebirth SA Blog
Facebook

Victoria
Midwives in Private Practice (MiPP) is a collective of midwives, and a participating organisation in Maternity Coalition. MiPP members work in Group Practices, partnerships, and solo practices, providing private midwifery services for women planning homebirth, as well as hospital births. MiPP members also mentor other midwives who are commencing private practice. Although Victoria is a relatively small State, there are areas where no private midwifery services can be accessed.

Recent government-funded homebirth programs have been offered for selected women through Sunshine and Casey Hospitals.

One Victorian Medicare-eligible midwife has completed a medications course which has been accepted by AHPRA. However, Victorian legislation needs to be changed before midwives are able to take up the PBS reforms.

In Melbourne more and more doctors are saying "no" to women who request referral or another pathway so that the woman can receive the Medicare rebate.  The government’s reform is pretty empty if women can’t even access Medicare rebates.   An obstetrician at the local hospital told me “I don’t support that model”

MiPP blog
List of MiPP midwives

New South Wales

Northern NSW - there were about 8 midwives attending homebirths a few years ago, with maybe 3 being private practice (PPM) only, and the other midwives also working in public hospitals. Now there are no PPMs-only in this region, but there is one midwife who attends some homebirths and is also employed in a hospital, and one other midwife who is Medicare eligible and attends some homebirths and is also a caseload midwife. There is another PPM who lives on the Gold Coast Qld and travels to the region. We have also had a govt funded homebirth program approved here which should be up and running shortly. That may impact further on numbers of births available for PPMs. 

Marie Heath (Goulburn)

Queensland

Toowoomba-Ipswich My Midwives offer women the choice of 4 midwives in Toowoomba and 2 in Ipswich.  We also have a lactation consultant who just does lactation privately but is an eligible midwife (provides antenatal and labour as an employee in hospital).  Women can choice place of birth (home, birth centre, public hospital).  They only receive a Medicare rebate for birth for birth centre or public hospital.  They receive Medicare rebates for antenatal and postnatal care no matter where they have their baby.  Many of the private funds provide a rebate for some element of the woman’s care as well if the woman has private health insurance. 

We bulk bill completely women attending Young Women’s Place for antenatal and postnatal care and we can attend women admitted as public patients under a fractional employment model with the hospital.  The tendency though is not to admit women as public patients unless we have to because we do find that having them admitted as the primary client of the midwife rather than as a public patient makes a difference in terms of autonomy in the woman’s care.

We have a signed collaborative agreement with Toowoomba public hospital obstetricians.  In practice one of us [midwives] meets with them fortnightly to discuss any issues we have or we book women in at a specific time for a referral or consultation.  At the time of admission the women are admitted in the care of (or “under”) the primary midwife and we consult if/as required with one of the obstetricians.  For women birthing at home, we just attend as normal and let the hospital know if we have any dramas.

My Midwives

For more links to websites of privately practising midwives, go to Midwives Australia

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