The government have published guidelines for midwives re insurance. 53 days to go with women not knowing what is happening for their midwives and the product will be available in a few weeks!! Summing it up for 7500 bucks we can have antenatal and postnatal insurance, birth not included. We can collaborate in a yet unknown manner and do as we are all told, then everyone is a winner.
Collaboration
Q: Will midwives who have this insurance be required to work in collaborative arrangements with other health professionals?
A: Yes. Like other professional indemnity policies of this nature, this insurance requires the practitioner to comply with the relevant College guidelines – in this case, the Australian College of Midwives’ Guidelines, or the guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. These guidelines broadly provide for the circumstances in which a midwife should consult with, refer to and transfer patient care to another health practitioner. If a midwife does not comply with the guidelines, and an incident happens which results in a claim, then the policy will not respond to this claim.
Q: Doesn’t this pre-empt the Regulations for MBS/PBS purposes which are yet to be made, requiring midwives to collaborate if they wish their patients to have access to benefits under these schemes?
A: No. These Regulations for the MBS/PBS are still under development. They need to be finalised by 1 November 2010, which is when access to MBS and PBS benefits become available. However, the midwife insurance product needs to have effect from 1 July 2010, to enable privately practising midwives to meet the requirements under the National Registration and Accreditation Scheme, under which all registered health practitioners must have appropriate professional indemnity insurance.
I think this says it all. We have to hope that we get access to insurance outside this commonwealth deal ACM or ANF. Heresay from me but it appears ANF are putting together a package to be included in membership price. That would be ideal if the long awaited and yet to be produced QSF is passable.
There is a glitch, please correct me if you think I’m wrong but this statement -All privately practising midwives who wish to provide private midwifery services in NSW, QLD, Victoria and the ACT will need appropriate insurance cover from 1 July 2010. This is because the National Law governing requirements for registration under the new National Registration and Accreditation Scheme will be in effect in those jurisdictions from 1 July 2010. For other jurisdictions (i.e. SA, WA, Tasmania and the NT) which have not yet passed the National Law, the pre-existing registration requirements will continue until such time as the National Law is passed in that jurisdiction.- seems to imply that until the law goes through SA parliament we don’t require insurance. I wonder when it comes up here.
I also wonder with the above green highlighted statement that if insurance is nul and void outside the guidelines will our registration be nul and void too. who if anyone will police that? . They are trying to remove the midwife’s right to remain with her client without fear.
We assume the rights of the mother to refuse care for her and her unborn baby, however this is being questioned in the NSW courts in a case about advanced care directives . (These are requests about care made before the care is required. e.g. I may say I definitely do not want chemotherapy for my cancer even though it is a reliable treatment). An interesting point made in the transcript.
“What if a pregnant patient refuses treatment that puts the viability of her foetus in jeopardy?
The judgment in A raised the possibility that a competent patient’s right to refuse treatment (or ACD refusing treatment) may be qualified, or overruled if the decision made by the patient threatens the life of a viable foetus. Although the case was not required to decide this question and, in general, the law in Australia to date has been that a foetus has no rights at law until it is born, the judgment creates uncertainty around this issue. Should there be a case where an obstetric patient is refusing to consent to medical treatment, and the refusal to undergo the treatment may result in the death of her viable foetus, it is strongly recommended that Hospital and/ or practitioner contact NSW Health Legal Branch for advice. Legal Branch will take an appropriate case to the Supreme Court for further guidance on this issue.”
if upheld, this turns women into incubators with no rights to decide anything. Surgery could be enforced in the name of speaking for the baby, or a pregnancy forced to continue even though it is detrimental to the health of the mother. Funnily enough this was something that came up at my Virtual conference talk on wednesday. THAT is a whole other post.
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I have nagged and warned all along about personhood of the foetus coming via these laws. And there it is. It makes my blood run cold that my rights could be removed from me like that. Of course the notion that women own their own bodies is always a difficult one for most people to grasp. Women aren’t people, obviously.
Gotta be able to refuse treatment. My view: Of course a fetus is a ‘person’ – but that doesn’t mean it can’t be aborted.
But if the foetus is a person, the woman becomes an incubating meatsock. That’s how it works. You can’t have it both ways. And once the foetus is a person, women can be forcibly cut open under the banner of “protecting the foetus”as they are across the US and in Australia just under slightly different banners. Women (should) have rights. One of those is to be recognised as a legal person with the right to expect or refuse anyone who wants to touch their body in any scenario. Birth is no different. Forced caesareans, inductions, episiotomies, drugs, they are all human rights abuses. If they were performed outside of hospitals everyone would be up in arms about it but slap on a green smock and you’re free to do whatever you like to women’s bodies with no fear of recourse.
You’re free to recognise your own babies as people, Joan, but no one else’s. That call is up to each woman.
It is disappointing that the case raised these issues but the judge’s comments in this respect are in no way binding and he is also incorrect. The case (which can be read here: http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/nsw/NSWSC/2009/761.html?stem=0&synonyms=0&query=title%28%222009%20NSWSC%20761%22%29) dealt with advanced care directives and concerned a man who was being kept alive by mechanical ventilation and kidney dialysis. It was not about a pregnant woman.
In his discussion about the right of a competent adult to refuse medical treatment the judge noted that there may be an exception to this in a case where a choice might result in the death of a viable foetus. In his brief discussion on this question he referred to a 1993 UK case where the mother’s refusal to consent to a c-section that was considered necessary to save her life and that of the foetus.
The judge concludes his discussion on this issue by saying: “Since the question does not arise in this case, it is neither desirable nor necessary that I should explore it further.”
Which is a shame because if he had done a little more research he would have found that the case he referred to has been overturned and there is in fact no uncertainty about the fact that pregnant women have the right to make decisions about their own bodies in the UK or here.
The cases which have clearly settled this question in the UK are as follows:
Re MB [1997] 38 BMLR 175 CA where the Court said:
The law is, in our judgment, clear that a competent woman who has the capacity to decide may, for religious reasons, other reasons, or for no reasons at all, choose not to have medical intervention, even though … the consequence may be the death or serious handicap of the child she bears or her own death … The court does not have the jurisdiction to declare that such medical intervention is lawful to protect the interests of the unborn child even at the point of birth.
St George’s Health Care NHS Trust v. S, R v. Collins and others ex parte S [1998] 3 All ER 673 where the Court held that:
An unborn child, although human and protected by the law in a number of different ways, is not a separate person from its mother. Its need for medical assistance does not prevail over her rights and she is entitled not to be forced to submit to an invasion of her body against her will, whether her own life or that of her unborn child depends on it.
Although there haven’t been cases on this issue in Australia there is no reason why we would not follow these decisions. The fact that the judge in this case last year asserted there is uncertainty does not create that uncertainty particularly when the question has been clearly settled for 13 years!
I would hope the NSW Department of Health did their own legal research before embarking on expensive and futile litigation to settle a non-existent question.
I don’t think many MIPP’s will be able to afford $7500 for insurance, we’ll see a rapid decline the the last few that are currently practicing in Australia.
Lisa, thank you for keeping us updated. I have to say I’m totally confused trying to figure out what to do to get my VBAC ideally at home in October. Correct me if I am wrong, but even if IMs bought this insurance package it still doesn’t cover the actual birth at home? So how is that any different to the current state of homebirth which most women happily undertake without insurance already? Is insurance a necessary aspect to your continued registration? As for the details of the collaborative arrangements, my baby will be well & truly earthside before November, so if the collaborative arrangements that might be imposed on IMs and VBACers such as myself are non-existent up to that point, does this in fact work in my favour? I think I just need to meet you one of these days & have a chat. Best regards, Laura
Insurance with the exemption for birth at home is necessary for us to get onto the new national register. Until the QSF comes out (any day) we can’t really be totally sure what is happening. it’ll be all according to where you are and what the midwife is willing to take out outside the guidelines. We have been told that if women are willing to sign to say they know they are outside ACM guidelines then they will not persue the midwife. However without that in writing I doubt it will be true. I am at the moment being investigated for birthing outside the SA homebirth guidelines and they don’t even apply to independent midwives. I can’t being to think what will happen when they do. With 53 days left pregnant women should be flooding the health dept with demands to ensure the availability of their midwife after the 1st July.
Thanks Ann, I already saw the 1997/8 case which the judge completely ignored. You would always hope that Australian people would see sense but personally I will not be holding my breath.
I’m not surprised to read, “Like other professional indemnity policies of this nature, this insurance requires the practitioner to comply with the relevant College guidelines … If a midwife does not comply with the guidelines, and an incident happens which results in a claim, then the policy will not respond to this claim.”
as all insurance policies work this way – eg my car insurer won’t respond to claims if I was drunk at the time of the accident. It makes you wonder what the obstetricians’ insurance policies say!
Re the cost of insurance – on the one hand, MBS (for pregnancy and postnatal) will bring the cost down for women … but then we’ll have to ask them to pay more to cover insurance! Women may not end up saving any money whrere HB is concerned.