I would like to share an email that came from the College of Midwives on the stark reality of our situation.

Houston we have a problem.

As you know the exposure draft of Bill B for the national registration scheme has been released for public comment. We are working closely with the APNMF member organisations on responses to governance issues that we have previously raised, like the make up of the Nursing and Midwifery Board of Australia, having one clinician from each state, etc. There are more than 200 pages to the Bill so we are still going through them to identify all the issues on which we might need to respond/lobby.

The most significant problem posed in the draft legislation we have found to date lies in the combination of clauses 69 and 101(1)a.

I have copied these in below:

69 Eligibility for general registration

(1) An individual is eligible for general registration in a health profession if:

(a) the individual is qualified for registration in the health profession, and

(b) the individual has successfully completed:

(i) any period of supervised practice in the health profession required by the National Board established for the health profession, or

(ii) any examination or assessment required by the Board to assess the individual¹s ability to competently and safely practise the profession, and

(c) the individual is a suitable person to be registered in the profession, and

(d) there is, or will be, in force in relation to the individual appropriate professional indemnity insurance arrangements, including a policy held, or arrangements made, by the individual’s employer that will cover the individual

As we have been expecting, this clause means that midwives will not be able to register without evidence of professional indemnity insurance. But Clause 101 (1)a ii is the real barrier in the absence of indemnity for midwives offering homebirth care privately:

101 Conditions of registration

(1) If a National Board decides to register a person in the health profession for which the Board is established, the registration is subject to the following conditions:

(a) for a registered health practitioner other than a health practitioner who holds non-practising registration:

(i) that the registered health practitioner must complete the continuing professional development program required by the National Board, and

(ii) that the registered health practitioner must not practise the health profession unless professional indemnity insurance arrangments are in force in relation to the practitioner’s practice of the profession.

(b) for a registered health practitioner who holds non-practising registration, that the person must not practise the health Profession,

Note. A failure by a registered health practitioner to comply with a condition of the practitioner¹s registration does not constitute an offence but may constitute behaviour for which disciplinary action may be taken.

This clause suggests that if this Bill becomes law, midwives will not be able to offer care for planned homebirth on any terms, even if they are eligible for the federal government’s indemnity support, unless insurance is found between now and 1 July 2010.

I have talked today to several of the public servants involved in the national registration project. The conversations have only served to underline the gravity of this situation. It would appear that health ministers at state level (in particular) are fully aware of the impact these provisions will have on private homebirth midwifery, and are as a group, not concerned about the impact on women or on these midwives (my reading of what has been said not what I have been told directly). I have been told that some states health ministers see publicly funded homebirth care by midwives who are ‘integrated’ into hospital based maternity care as a preferable option to the continuation of ‘independent’ homebirth care.

I will be making more representations to officials and to the federal health Minister early next week. I think we are going to need to mount a concerted campaign aimed at both state health ministers and doctors organisations (AMA, RANZCOG, NASOG and RDAA) if we are to have any hope of this clause being amended.

I think we need to be clever in how we mount the argument. There are several arguments we can use:

• if midwives offering homebirth care are unable to access indemnity safety for women making this choice is likely to be affected
• we are better off having homebirth care provided by regulated midwives who are up to date with CPD, working within professional standards, etc etc, than having such care being offered by unregulated carers who may not have the appropriate skills and knowledge to ensure safety for mother and baby
• I have alos been pointing to the underlying policy question this raises – is health care to be decided upon by actuaries in London working for medical indemnity underwriters or is it to be determined by education accreditation standards, and professional practice standards as determined by each professional Board? If every aspect of the care by every health professional must be indemnified then there are bound to be lots of examples where consumers might be disadvantaged – including but not limited to women planning birth at home.

This unexpected clause in the draft Bill certainly cuts across the potential that I had been discussing with policy makers from the Minister’s office down that an MBS eligible midwife might be able to care for a woman planning homebirth but without MBS rebate or coverage by the indemnity policy. Short of getting a legal opinion on the meaning of this clause that says otherwise, or finding indemnity, it now seems likely that this will not be possible.

On a separate matter to do with the national registration – the Bill also provides for there to be a status attached to the Register of Midwives called ‘Midwife Practitioner’. I have had absolutely no advice from anyone in government that this was coming. I guess it’s not so surprising since it is likely the government will want the NMBA to have a role in identifying midwives who are eligible to provide Medicare funded services. The key thing will be to influence the definition of eligibility for this status of midwife practitioner. And to ensure it is not tied up in hoops that are neither necessary nor accessible for midwives (like a masters degree).

We have much work to do.

regards Barb.

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