Pregnancy, Birth and Beyond

http://www.pregnancy.com.au/midwifery/midwifery-resources/midwifery-campaigning/the-determination-governing-collaboration.shtml

The determination governing collaboration for private practice midwives has changed – It’s about time

Ministers recommended an extension of the professional indemnity insurance exemption for privately practising midwives until June 2015, enabling midwives providing homebirth services to have assurance that they would not be forced to abandon women or face prosecution for violating registration requirements.

Hands showing unity

ACM MEDIA RELEASE
August 13th 2012

The Australian College of Midwives congratulates the Australian Health Ministers on timely recommendations for private midwives.

“The Australian College of Midwives (ACM) congratulates the Australian Health Ministers on the excellent and timely recommendations coming out of the Standing Council on Health (SCoH) regarding privately practising midwives,” said Sue Kruske, President of the Australian College of Midwives.

Ministers recommended an extension of the professional indemnity insurance exemption for privately practising midwives until June 2015, enabling midwives providing homebirth services to have assurance that they would not be forced to abandon women or face prosecution for violating registration requirements. There has been no insurance available for birth at home since 2001 when HIH collapsed, and the current exemption was due to expire in June 2013. All efforts must now be made to access affordable insurance for midwives providing homebirth services before the new 2015 deadline.

At the SCoH meeting the Commonwealth also agreed to vary the Determination on collaborative arrangements to enable agreements between midwives and hospitals and health services. The ACM has been fighting for this outcome for two years. “In September 2010 the ACM met with the former Minister for Health’s office, Minister Roxon, asking for changes to be made to collaborative arrangements by removing the words with a ‘named medical practitioner’ and replacing them with a ‘health provider organisation.’ At the time this request was not heeded but ACM was given assurances that if medical professionals were reluctant to enter into arrangements then the Determination would be changed. The Federal Health Minister has recognised that the current arrangements are not working and been true to the undertaking given in 2010, one the AMA was fully aware of. Contrary to their claims the AMA was consulted about both these issues again at a recent roundtable organised by the Federal Health Minister in June of this year,” said President Kruske.

Midwives for the past two years, in good faith, have sought collaborative arrangements with obstetricians, with only a couple being successful in the entire country. Some midwives have written to every obstetrician in the State they live in seeking a collaborative arrangement, only to have either no response or negative responses.

“The vast majority of midwives practising today collaborate without the requirement to have a formal arrangement with a ‘named doctor’. The only time a collaborative arrangement is required under legislation is when women want to access Medicare rebates for private midwifery services. It is women who have suffered due to the current arrangements. There is misinformation being put out that this change is about homebirth. There are no Medicare rebates for birth at home so changing the Determination will have no impact on midwifery care for homebirth at all,” said President Kruske.

The largest randomised controlled trial in the world (2314 women), undertaken in Australia and published this month in BJOG, involved women receiving all their care from a primary ‘known midwife’ compared to women receiving standard fragmented care. The study showed much better outcomes under ‘known’ midwife led care, including a 22% reduction in the caesarean section rate. This is an example of the high degree of safety and quality that can come when midwives are able to collaborate with a whole health service and everyone in it.

“Midwives are committed to collaboration with all health service providers and this variation in the Determination will ensure this can now occur. It will not be a ‘hospital administrator’ midwives will be collaborating with, as claimed by the AMA, but an entire health service team, of which obstetricians are an important part. This is how the majority of health care is undertaken today and how 99% of midwives work. These changes will make sure 100% of midwives can now work in this optimal model of collaboration and hopefully open the doors of hospitals to private midwives through clinical privileging arrangements which to date have been slow,” said President Kruske.

Published 15th August 2012