Upon graduating from Midwifery in early 2009, after a very hard year training in hospital, I set out to do what I had planned from the beginning, set up business as a private midwife and attend women choosing to birth at home. It had always been the plan, I didn’t know how I was going to do it, but I knew I didn’t want to continue working in a hospital. So there I was 24 years old, fresh out of my training and no idea where to go. I got a tip to call Robyn Dempsey who had a reputation for giving new midwives a leg up into private practice and she welcomed me with open arms, not long after Jane Palmer offered her time and expertise also. For 6 months I followed them around like a little duckling, learning everything I could, establishing my business systems, trying to understand the industry, gaining new midwifery skills, and learning how to be with women at home. They filled me with confidence and by the end of the year I had an established business with enough bookings to keep me busy. All seemed well in the world of private practice, I felt organised and competent and able to meet the legal and administrative requirements expected of me by the governing bodies and my clients. When I started out all you had to do was get registered, buy a kit and start providing midwifery care, and that’s what I did.
As 2010 went on, the grape vine started talking about registration and insurance reform and the world of private practice became uneasy, conspiracy theories abounded and angry letters and campaigns flew back and forth. For the most part I kept my head in the sand hoping that my happy little world would not collapse and it would all blow over, I signed petitions that were sent to me and attended protests as they occurred, always with the assumption that this would all just pass. As the July 2010 date loomed the campaign to save homebirth intensified and I realised that things would be changing, there was going to be a new world order and for private midwives and it would be a sink or swim scenario. My husband asked me, ‘what if homebirth becomes illegal, will you go back to the hospital’, I knew in my heart that I just couldn’t and I wouldn’t. I needed a plan to survive myself and to help other midwives survive too.
In July 2010, after the changes to midwifery registration occurred and the need for personal indemnity insurance was realised and the possibilities for private practice increased, I hosted a brainstorming meeting to ‘send out the feelers’ to midwives who might be interested in joining together to form a private group practice as a way of navigating the changes to private practice midwifery. After some further meetings, discussion and collaboration, in September 2010 Robyn Dempsey, Jane Palmer, Hannah Dahlen and I formally collaborated to form ‘Midwives at Sydney and Beyond’, private midwifery group practice. Robyn and Jane contributed their many years of experience both in and out of private group practice and were pivotal in the direction ‘Midwives @ Sydney and Beyond’ would go and provided the scaffolding on which our group practice is based.
It has been approximately a year and a half since Midwives @ Sydney and Beyond formed and since that time we have developed a standardised set of hand held notes for our clients, streamlined reporting systems to ensure speedy and effective communication to each other and to other health care providers, gained Medicare eligibility and referral rights, developed a mentoring system designed to integrate midwives into private practice and have used this to expand our practice to 6 midwives, maintain a full client load, set up effective business management and finance strategies and fully comply with all the legislative requirements without compromising our approach to care or our clients autonomy. The care we provide is the same as it was when we worked in sole practice, but our business strategies, paperwork and approach to administration is streamline and sophisticated.
The formation of a midwifery group practice was not initially designed to be for our clients, while we were sure they would benefit none-the-less, ultimately the group practice was formed as a support for its midwives so that we could stay strong, competent, equipped and effective in caring for our clients amongst the sea of change that was swelling around us. We meet monthly and communicate daily to be a constant support to each other and practically assist where needed, like the day we simultaneously hosted a pregnancy and parenting network meeting for our clients, attended 2 births, an antenatal visit and flew abroad to a conference; that was quite a day! Upon reflection Robyn said to me, ‘this is where group practice comes into it’s own’, she was right. We have been able to do more for our clients together then we would have ever been able to do apart.
In 2010 the face of Private practice midwifery changed. Privately practicing midwives went from having no access to indemnity insurance, Medicare or PBS, to then gaining access to all of these along with national registration requirements and a more formalised Quality and Safety Framework for privately practising midwives, which included the arrangement of collaborative agreements between collaborating hospitals and maternity care providers. With these changes came more accountability and transparency for privately practicing midwives and much more regulation and paperwork. While Midwives @ Sydney and Beyond believe that these changes will ultimately benefit women and children by expanding birth choices, the changes have been confusing, tedious and time consuming for midwives attempting to conform to the new regulations.
Our aim was to join together so that as private midwives we could thrive under the new legislation without compromising the quality of care we wish to provide to our clients. We see ourselves as a buffer for our clients against the increased legislative requirements on private practice and on homebirth and seek to absorb any disturbance this might cause to our clients. I won’t lie, the legislative changes are confusing, annoying, time consuming and generate a lot of paperwork and stress and I would have loved for things to have stayed the way they were, but the fact is, they aren’t how they used to be and it will never be that way again, so instead of resisting, giving up and fighting on against these changes we have put our energy into embracing and move on with them. We can see both positives and negatives to the changes but as a group practice we work together to adapt to them and expose our clients to the all the benefits like not needing to see a GP for a referral and Medicare rebates, and protect them from the negatives.
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Thanks so much for sharing this story. I am currently a midwife student and my goal is to go into private practice so hearing this story is truly inspiring knowing there are midwives with so much knowledge willing to help the newbies and all of you supporting each other. I have a question- how many women per year would a private practice independent midwife care for on average presuming she is working full time? Thanks again :-)