Thursday, April 15, 2010

Midwifery Legislation Update from Maternity Coalition

Update from Maternity Coalition about Health Care Legislation.

The Senate passed the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 on Tuesday 16 March. This legislation should give Australian women greater access to affordable, continuity of care with a known midwife.

It marks the beginning of a new era of maternity care for Australia’s maternity consumers. It is a huge achievement; and thanks to the work of generations of women and to you.

In recent months, much of our focus in the birth community has been on the aspects of the maternity reforms we are unhappy with including the collaborative arrangement and the threat to births at home. But we should remember that this legislation is a giant step forward in the right direction to woman-centred maternity care.

What this means

We don’t know how it will all work in practice yet as Health Minister Roxon still needs to make decisions on a number of things including definitions for ‘eligible midwife’ and ‘collaborative arrangement’ and details around Medicare and prescribing are still not finalised.

But what we do know is that:
• Consumers, from November 2010, will be able to choose (in theory) their own midwife for their pregnancy, birth care in a hospital and post-natal care. How intrapartum care in hospital will work still needs to be sorted with visiting/admitting rights. This care will be more affordable as they can get Medicare rebates for it. This has the potential of increasing the numbers of Australian women who can access continuity of care with a known midwife from less than 5% to a New Zealand figure of around 80% or higher.
• Midwives will have access to
o Medical Benefits Scheme
o Pharmaceutical Benefits Scheme
o Professional Indemnity Insurance (excluding birth at home) and the Government will also pay any insurance claims that exceed $1 million. Note: The need for a collaborative arrangement to be in place before a midwife could access this indemnity was dropped in the Bills.

What MC is doing?
MC is working hard. We have:
• representatives at all working groups of the Department of Health and Ageing involved in implementing these reforms.
• given evidence at two Senate enquiries.
• attended consultations and made submissions to provide the consumer perspective on maternity issues.
• engaged in strategic conversations with other stakeholders.

MC and a range of midwifery and nursing organisations have agreed on a consensus for collaborative arrangements and took this proposal to the Minister’s office. We’re feeling optimistic about this. Senator Joe Ludwig (ALP) clearly stated in the Senate it was not the Government’s intention in the legislation to give one professional group control over another. We need to keep the Government accountable to this.

What about homebirth?
There is nothing in the Bills for homebirth – the Bills neither support nor outlaw homebirth. However Health Minister Roxon has made it clear that she intends women to be able to continue to access midwifery care for homebirths. To hear it straight from the Minister, see this video:
http://www.youtube.com/watch?v=iK_Vt18eq0s

MC, along with the Australian College of Midwives, has developed an alternative proposal for the Quality and Safety Framework midwives will need to work to in order to qualify for the two year exemption from professional indemnity insurance. As the whole purpose of this exemption was to secure women’s access to homebirth care, MC expects an outcome which will work.

We have asked that this framework be finalised by 1 April 2010 giving women and midwives 3 months in which to make plans. The final version of the framework will be released in the next few days. Look to the website for a link to it shortly.


MC’s perspective of an ideal outcome for homebirth (in terms of what’s going on at the moment) is that midwives providing homebirth care will be:
• registered as a midwife and able to practice
• exempt from professional indemnity insurance for the first two years of national registration (from July 2010)
• working in much the same way they do now.

Some homebirth midwives might also choose to become an ‘eligible midwife’ with access to MBS and PBS. In which case they will need to have a collaborative arrangement in place so that their clients can receive Medicare rebates for their pregnancy and post-natal care.


What you can do right now?

• The National Health and Medical Research Council has released its draft ‘Guidance on Collaborative Maternity Care’. This is a very important document. They are asking for feedback on this document and want it by Friday 27 April. For more information go here: http://www.nhmrc.gov.au/guidelines/consult/consultations/ngcmc.htm. When you read it, ask yourself how these arrangements would work for you as a consumer. SEND YOUR COMMENTS TO l.metcalfe@tpg.com.au for incorporation into a response to the NHMRC.

• If you haven’t written/visited your Federal MP for awhile, get back in touch and tell him/her that birth and birth care really matter to women and families, and we expect governments to take responsibility for the quality of care and choices available to women [how do you see this yourself?]. Remind them that they need to find a long-term solution for indemnity for midwives providing homebirth by June 2012 and that the clock is ticking.

• Keep up your membership to Maternity Coalition and other consumer and midwifery groups. In numbers we have strength. Without you, we are nothing. To renew your membership with MC and find out when and where the next meeting is close to you, go to our website www.maternitycoalition.org.au



Lisa Metcalfe
President Maternity Coalition
Em: president@maternitycoalition.org.au
Web: www.maternitycoalition.org.au

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