A brave new world for midwives and women

After more than 20 years of campaigning by the Australian College of Midwives and the NSWNA, major reforms have been won in maternity services. The Lamp celebrates a brave new world for midwives and Australian women, and examines the obstacles we still need to overcome.

A revolution is happening in maternity services. After 20 years of campaigning by the Australian College of Midwives and the NSWNA, the Rudd Government is enacting major reforms to maternity services that boost the role of midwives and give women more choice and continuity of care during pregnancy, birth and postnatal care.

In the May Budget, the Federal Government provided for women to receive Medicare rebates for private midwifery care, as well as providing access to the Pharmaceutical Benefits Scheme for midwives. In June 2009, Federal Health Minister Nicola Roxon introduced the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related bills to Parliament, and the new provisions are expected to come into effect in November 2010.

This means Australian women will have access to Medicare funding for a midwife of her choice, who will deliver expert midwifery care throughout her pregnancy, labour and birth, and at home afterwards in the early weeks of caring for a newborn baby. The legislation will also support eligible midwives to access professional indemnity insurance.

Hannah Dahlen, member of the NSWNA Midwifery Reference Group and Associate Professor of Midwifery, The University of Western Sydney, said what was proposed in the May 2009 Budget is ‘nothing short of major social reform. And mothers and midwives are clearly the winners’.

‘These reforms will not only give women greater choice than they currently have, they will also give most midwives more choice about how and where they provide care to women, thereby helping to reduce stress and loss of midwives to the maternity care workforce,’ said Professor Dahlen.

‘We’ve seen the closure of more than 120 rural maternity services in the past 10 to15 years, which has left thousands of women with little or no access to local maternity care and even less access to continuity of midwifery care. These reforms will together make it much easier for women living anywhere in Australia – from the middle of our largest cities to remote communities – to access continuity of care by a known midwife.

‘Evidence confirms that women who receive continuity of care from a known midwife have shorter labours, less need for surgical interventions during birth, reduced rates of admission to special care nursery for their babies, reduced vulnerability to postnatal depression and higher rates of breastfeeding,’ she said.

‘Midwives who provide Medicare-funded care will have visiting access to hospitals, and clear referral pathways for women in their care who need obstetric or other health care during their pregnancy, labour and/or postnatal care. Midwives will work collaboratively with doctors and other health professionals to ensure the individual needs of each woman and baby are fully met.’

The latest reforms build on other developments over the past five years that provide a robust quality framework for midwifery practice. This framework includes national competency standards, Codes of Ethics and Professional Conduct for Midwives, evidence-based consultation and referral guidelines, a national continuing competence framework, and Midwifery Practice Review (a form of professional credentialing).

According to NSWNA Assistant General Secretary Judith Kiejda, the Government is to be applauded for recognising the professional skills of midwives. ‘This new legislation recognises for the first time that midwives have professional expertise and make essential contributions to maternity care.

‘These reforms are not only huge gains for midwives and maternity services in Australia, they are gains for women, their babies and families. Women will have greater access to maternity services and benefit from continuity of maternity care.

‘These wins have been achieved after long and determined campaigning by the NSWNA, midwives and the Australian College of Midwives. But we still have some way to go. While eligible midwives can access professional indemnity insurance if they are working in the hospital system, private midwives will be unable to access indemnity insurance if they are attending a home birth. We need to keep up the pressure to broaden the scope of midwifery practice and ensure that women have choices in maternity care,’ said Judith.

Midwives, women are winners

In the May 2009 Budget, the Rudd Government provided for:

  • mothers to receive Medicare rebates for midwifery care;
  • access to PBS for midwives;
  • national collaborative maternity care guidelines;
  • increased access at state level to birth centres;
  • indemnity insurance for midwives;
  • measures to enhance the access of rural and remote women to maternity care as close as possible to their home community;
  • a national telephone support service for pregnant women and mothers of newborns.

These reforms will come into place in November 2010 and together they will make it much easier for women living anywhere in Australia to access continuity of care by a known midwife.