Eligible midwifery came into being on 1 November 2010 after huge pressure on the Australian government to introduce Medicare rebates for midwifery services. An eligible midwife is a midwife who has been endorsed by the Nursing and Midwifery Board of Australia (NMBA) after meeting certain standards. This endorsement of eligibility enables the midwife to apply for a Medicare provider number and to prescribe a range of medications, once an approved course on prescribing is successfully completed.
Midwives are one of the professional groups regulated under the National Registration and Accreditation Scheme. The Nursing and Midwifery Board of Australia (NMBA) are the authority that oversees the regulation of midwifery practice for the National Registration and Accreditation Scheme. NMBA are responsible for ensuring consistency of midwifery practice and safe practice.
A midwife is an individual who has successfully completed a midwifery education program that is duly recognised in the country where it is located, and that is based on the International Confederation of Midwives Essential Competencies for Basic Midwifery Practice and the Global Standards for Midwifery Education. It addition thus individual must:
In Australia a midwife must also hold current registration with the NMBA.
An eligible midwife is a midwife who has been endorsed by the NMBA after fulfilling the following requirements:
Once endorsed, an eligible midwife can apply for a Medicare provider number enabling women to claim Medicare for midwifery services. An eligible midwife can also order tests and investigations such as blood and ultrasound tests. Further, endorsement as an eligible midwife enables that midwife to refer to an obstetrician or paediatrician as required.
Until July 2012 midwives were not able to undertake an accredited course of study in for prescribing midwifery medications in Australia. No courses were approved prior to this time.
At the time of writing this article Flinders University is currently the only university in Australia that is offering a midwifery prescribing course. Midwives across Australia are currently undertaking this course and will shortly be able to prescribe a range of medications relevant to midwifery practice.
At the conclusion of the prescribing course midwives will submit an application to the NMBA to apply for endorsement to prescribe medications. Once endorsement for prescribing medications is received, midwives then apply to Medicare Australia for a prescriber number.
Eligible midwives with prescribing rights are able to prescribe a limited number of medications. This range of medications will increase overtime. The current list of medications midwives are able to prescribe are listed on the NMBA website in a document called Prescribing Formulary for Eligible Midwives with a Scheduled Medicines Endorsement. Only a few of these medications are subsidised by the Pharmaceutical Benefits Scheme (PBS). These are listed on the PBS website. The Midwife PBS prescribing list of medications will also grow over time.
The NMBA has developed specific registration standards for midwives. Two of these standards which relate specifically to eligible midwives are:
• Registration Standard for Eligible Midwives
• Registration Standard for Scheduled Mpedicines for Eligible Midwives
The NMBA lists these standards and other documents relevant to eligible midwives on the webpage Endorsements and Notations.
Other Benefits for Midwives
Midwives who are endorsed as an eligible midwife are able to purchase a government subsidised insurance package through Medical Insurance Group Australia (MIGA). For more details see the MIGA website. This insurance offers professional indemnity insurance for midwives for prenatal care, birth in hospital and postnatal care. MIGA is the only company providing midwives with insurance for labour and birth care. Unfortunately to date no professional indemnity insurance is available for homebirths.
While the number of eligible midwives in Australia is currently small, this number is growing. What is exciting to see is the new midwifery practices starting to appear across the country taking midwifery out of the hospital system and into the community. Eligible midwives are able to provide valuable services to women. Having Medicare rebates is making private midwifery care a more affordable option for all.