Maternity Coalition Update.

I haven’t blogged these updates as the whole thing is very depressing, it’s also terrible some midwives would be willing to give up the right of women to birth with anyone or noone in the comfort of their own home,

IMPORTANT update from Maternity Coalition:
The medical veto over Medicare for midwives is now law.
Sun 25 July 2010

The Government’s $120 million national Maternity Reform Package is currently being implemented. From 1 November 2010 Medicare rebates will be payable for care from eligible private practice midwives, subject to certain conditions.
For the last nine months consumer and midwifery groups have been lobbying hard around the one crucial point of these reforms – how midwives and doctors will work together. The government stated from the outset that the midwife would be required under legislation to work in a “collaborative arrangement”. Consumers and midwives have argued for the definition of these arrangements to be one which supported women’s choice and access, and which did not give doctors control over women’s access to Medicare rebates.

After months of suspense, the Determination defining “collaborative arrangements” was quietly signed into law by the Governor General on 16 July, without notification to stakeholders. The Determination can be downloaded from this link:

Maternity Coalition is dismayed at the introduction of the Determination that provides 4 options for collaborative arrangements. Each option requires the midwife to have some form of permission from a doctor, before a woman can receive Medicare rebates.

The minimum form of permission is an “Arrangement – midwife’s written records” (section 7 in the Determination). This option requires a named doctor of a specific type to acknowledge “that the practitioner will be collaborating in the patient’s care”, and that the named doctor has received copies of a hospital booking letter and a maternity care plan.

These requirements will make it very difficult for women to access Medicare-funded care from midwives in private midwifery practice. We expect midwives in private midwifery practice (working for themselves, not a doctor) will rarely be able to find private doctors who are willing to enter collaborative arrangements with them. In some cases this may be possible under very specific conditions. However it is unrealistic to expect that private doctors will collaborate in the care of women planning homebirths.

Even for women planning births in public hospitals, these requirements for collaborative arrangements will make it extremely unlikely for them to be able to access Medicare-funded midwifery care. There is no reason to expect public hospital doctors to enter the required collaborative arrangements with private midwives. They have no incentive, and there is no sign that state governments are ready to implement to effective collaborative arrangements in State hospitals.

In March 2010 when the Senate was debating this legislation, the Government stated that “There is no intention to provide a right of veto over another health professional’s practice”. However, under intense pressure from the medical lobby, this is exactly what has occurred. Most importantly, it is women’s choices and access to care which are being vetoed, to protect medical control of the maternity marketplace.

If these reforms are to deliver the “choice and access” promised to Australian women by Government, the medical veto must be removed. Midwives must be accountable to the women they care for, and to their regulating body, not to another profession.

4 responses to “Maternity Coalition Update.”

  1. Tangerine Meg
  2. Serena26

    Thank you for the wonderful website! I have been following the events, because, although I am far away from Australia (in Latvia, Europe) the issues surrounding homebirth are the the same all over the world. In Latvia women choosing homebirth receive no funding for their birth from the state. The state ignores the fact that homebith costs less than hospital birth (drugs, interventions, operations) and say that homebirth is an exclusive service that we should pay for ourselves. And we do, as we have no other choice. It is so sad to see, that because of a faulty research (if you can call that piece research with all the selection mistakes etc) people in charge can make such decisions.
    My only suggestion if all else fails – for a couple of midwives to become a practicing obstetricians and then the midwives can have the needed agreements. I know that it would probably take years to go through medical college and residency etc. but if this crazy rule will not be overturned, then you need to find a way around it. Good luck!

  3. Serena26

    A link to your website was posted on a local homebirth forum by one of the moms, so I am not the only one reading :) I agree that for a homebirth midwife it is very hard to go through medical school, as you see all the things that are being done wrong. My doula just finished her official midwife training. When she was doing the practical work in a hospital, she used to call me on a regular basis just to vent. One of our midwives has become an Ob/Gyn. Do not know her reasons and the whole story, but I think that the main reason was to get more influence and have something to answer in case someone says – oh, you don’ t understand the whole complexity and risks of childbirth, you’ re just a midwife. The general public often believes that a midwife is sort of lower in the ranks than Ob. When you get to know more you understand that few doctors know even half of what a midwife knows about normal childbirth, but that undrestanding comes with experience and most of the people, including the ones passing laws rarely have that experience. The news about the Greens coming to defence sounds promising.