Insurance for private midwives big step in the right direction

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Home births, collaboration and visiting rights in hospital are the stumbling blocks of otherwise positive legislation giving private midwives access to professional indemnity insurance.

The NSWNA welcomes the introduction of legislation giving private midwives access to professional indemnity insurance from 1 July 2010, but is concerned about some aspects of the new laws.

The Federal Government has made provisions for eligible midwives to be covered by insurance through the Medical Insurance Group (MIGA), which applies to antenatal and postnatal care for home and hospital births, and care of the birth in hospitals. It does not, however, cover the midwife providing birth care at home.

‘We support safe practice for childbirth and support a woman’s right to choose a birth setting, including the right to choose home birth, so while these achievements are a really good start, they have not solved the issue of choosing home births with a private midwife,’ said NSWNA Assistant General Secretary Judith Kiejda.

Private midwives will not be in breach of their registration if they give care during a home birth, provided they satisfy the requirements of the National Quality and Safety Framework.

The NSWNA is also concerned about a lack of clarity over collaboration between midwives and other health professionals. A story in the Sydney Morning Herald in June revealed that several GPs had refused to fill prescriptions for pregnant women referred to them by private midwives. Without these prescriptions the midwives could not proceed with a safe home birth service, so several women faced a loss of that choice.

‘The new legislation doesn’t fully define collaboration and it leaves collaboration located with individual doctors rather than health services,’ said Judith Kiejda. ‘It doesn’t go far enough to recognise a midwife as an autonomous practitioner who will always choose to work collaboratively. We want midwives to work collaboratively but this isn’t true collaboration as it stands.’

One of the major benefits of the new arrangements for private midwives is the reinstatement of visiting rights at hospitals – although this may not be a practical option for several months.

‘Before we lost our insurance in 2001 I had visiting rights at Royal Prince Alfred Hospital, which meant women under my care could give birth at RPA with me as their primary carer,’ private midwife Jane Palmer told The Lamp. ‘This enabled me to have access to a specific obstetrician and I could refer directly to him through the hospital. If we get our visiting rights back and can access obstetricians again, this will make the consultation process smoother for antenatal and postnatal care and birth in hospitals easier.’

But as private midwife Melissa Maimann found out, a major stumbling block is that hospitals do not have the mechanisms in place to activate visiting rights for private midwives.

‘The arrangements come into place 1 July and the insurance policies support us to provide care in hospital and to have collaborative relationships with obstetricians but hospitals don’t have any protocols in place for us to have visiting rights,’ she said. ‘I have spoken to several Clinical Midwifery Consultants and they have advised me that these decisions have to made at the Area Health Service level, not at the individual hospital level – and this could take six months to a year.’

On a more positive note, midwives are no longer required to have signed collaborative agreements in order to access the MIGA insurance policy. Initially they were required to have them, but after negotiations, it was recognised that it was not possible because hospitals and obstetricians refused to sign such agreements.

‘So it is now acceptable for midwives to share a maternity care plan with the hospital at which the woman is booked. This is a significant change and makes fulfilling the requirements of the MIGA insurance policy entirely possible,’ said Melissa.

The NSWNA agrees that changes need to go further in the following areas:

  • private midwives should be able to work with full insurance protection, including for providing home birth services
  • collaborative arrangements should be between the private midwife and health service, not with individual medical practitioners
  • protocols must be put in place quickly for private midwives to have visiting rights to hospitals.