By Jane Palmer
As a privately practicing midwife I feel life is on a merry-go-round. My levels of anxiety have increased as another deadline is approaching that threatens women’s right to birth at home with a private midwife. I’ve been attending homebirths as a private midwife for the last 16 years and I am passionate about supporting women in their choice of birth place. Women have a right to birth at home in a safe environment with a qualified and experienced midwife. But yet again women’s right to birth at home with a midwife is being threatened. Unless the Australian Government comes up with a solution, any women planning to give birth at home after the 31st December 2016 will not have access to a privately practicing midwife.
The ability to obtain professional indemnity (PI) insurance is the issue and to understand what is going on today we need to take a step back in time. When I first started practicing as a midwife I was able to obtain PI insurance for my practice and I attended women giving birth at home and at Royal Prince Alfred Hospital (RPAH) as a visiting midwife. I could attend women birthing in the birth centre at RPAH and those women who required a transferred into hospital from a homebirth. It was wonderful being able to provide this continuity of care and to have access to appropriate back up as needed. Then HIH insurance collapse occurred in 2001, insurance companies went into a tail spin and the end result was that private practice midwives lost their professional indemnity insurance we were deemed too risky.
Many homebirth midwives stopped practicing as they did not want the financial risk associated with practicing without insurance. Personally I chose to take on that risk and continue to practice as I strongly believe women have the right to be attended by a midwife at home. I continued to practice this way for many years, while it wasn’t ideal for me personally it was something I was committed to. Then on 1st July 2010 the National Registration Scheme through the Australian Health Practitioner Regulation Agency (AHPRA) came into place requiring all health professionals, including midwives, to have PI insurance to cover all aspects of their practice. In the lead up to the National Registration Scheme a lot of campaigning by women, community groups and midwives occurred. The reasons for the passionate campaigning was that a registered midwife without PI insurance could not be in private practice nor could they attend any births. I wrote about this at the time – see ‘The Campaign So Far’.
The end result of all the campaigning in 2010 was the the Australian Government funded a PI insurance scheme supporting private midwives that covered antenatal care, birth in hospital as a private patient and postnatal care. No PI insurance was offered for homebirth. To get around the registration requirements of PI insurance by AHPRA an exemption was put in place that allows midwives to attend homebirths without PI insurance. Since 2010 we have been promised that a solution to the issue of PI insurance and homebirth will be found. The exemption for PI insurance was initially for two years and this exemption has been extended a number of times. The next deadline for the PI insurance deadline is 31st December 2016. We were told that there would be no further extensions to the exemption.
What does this mean for women? Essentially it means no midwife attended homebirths after 31st December 2016 in Australia unless a solution can be found. If you were planning a homebirth you need to be pregnant now or this option may not be open to you. It is time to campaign again. Women have been asking me what they can do. Campaigning works best when we work together. If community groups such as the homebirth groups, midwifery groups and maternity coalition could work together and coordinate a campaign this would be the most effective way to go. Individual ideas include:
- Visit your local member of government
- Write or sign a petition
- Write a letter to the editor
- Phone a talk back radio station
- Attend or organise a rally
- Form your own local support group
These are just some ideas. But we need to take action now!
Jane Palmer is a private practice midwife and international board certified lactation consultant. Through her company Pregnancy, Birth and Beyond Jane provides midwifery, childbirth education and lactation services. For over 22 years, Jane has supported women and their families from preconception to the year following birth. Registering as a midwife in 1997 Jane went on to be one of the first Medicare-eligible midwives in Australia, Jane currently provides midwifery care in collaboration with the group practice Midwives @ Sydney and Beyond, caring for women planning to give birth at home or in hospital. In March 2012 Jane opened the PBB Health Centre in North Parramatta when midwives, general practitioners and allied health professionals provide services to the local community.