To update readers about the new maternity service regulations in Australia, I give you the words of those much better informed than I:
"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.
The Determination 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 don't expect midwives in private midwifery practice (working for themselves, not a doctor) to 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."
- Control of care is taken out of the hands of women, and given to doctors.
- Defacto “parallel regulation” of the midwifery profession, with doctors setting conditions for Medicare-funded midwifery practice.
- Anti-competitive influence on the health care market, giving one group of providers control over consumer access to another group of providers of the same health care service.
- "Collaborative arrangements” cannot be made with hospitals, even though most private midwives consult and refer to hospitals rather than individual doctors.
- The requirements do not improve “safety”, “access” or “continuity” for Australian mothers."
She went on to urge the health minister to demonstrate real commitment to maternity reform by addressing:
- that the requirements for permission from a doctor be removed from the Medicare for midwives legislation (Collaborative arrangements for midwives), thus ensuring that women’s choices are protected;
- that women's rights to informed consent (including right of refusal) are expressly recognised in all codes, guidelines and frameworks relating to midwifery practice;
- that a long-term solution be sought for women to continue to have access to midwife-attended homebirth;
- that the Federal Government provide strong leadership to ensure jurisdictions provide mechanisms for visiting rights for midwives in public hospitals.
Maternity Coalition appeals for urgent action to be taken so that there is some chance of the reforms meeting the stated aim “to increase access and affordability of midwifery services” for Australian women. It is simply not possible for the reforms to deliver for women while a medical veto over access to midwifery care remains in place. The definition of collaborative arrangements must recognise women’s right to reproductive self-determination."
Midwives Victoria blogged about the safety and qualitify framework outlined in the maternity reforms, revealing that:
"Women with a singleton pregnancy, cephalic presentation, at term and free from any significant pre existing medical or pregnancy complications are those identified in the ACM guidelines as clearly meeting criteria for midwifery led care.
When PPMs are the primary carers for women who fall outside of these criteria, the consultation and referral pathways must be documented and followed. Clearly articulated and documented plans of escalation and collaboration are integral to provision of safe high quality care leading to positive outcomes for mothers and babies."
No surprises there. Multiples are explicitly excluded from eligibility for midwifery led care, and most other variations of pregnancy and birth could fall under: "any significant pre existing medical or pregnancy complication" depending on who the care-provider and her callaborators are (
see this previous post).
At no point in the last two years of this maternity reform battle has the health minister or Australian government bothered to listen to stakeholders like: homebirthing women, midwives in private practice and groups like Maternity Coalition. We've heard a lot of "choice" rhetoric and been fed false promises from the minister that no woman's self-determination will be taken away. But at the end of the day actions speak louder than bullshit and the government's actions have made midwife attended homebirth near impossible for many, many families.
Fuck the government. Fuck the rich obstetric lobby who have had their ears this whole time. Fuck "collaboration". VOTE GREEN and be done with these bastards!
One of the many treasured memories I have from my daughter's birth was easing into a warm herbal bath, lovingly prepared for me by my doula, Julie Bell. While I enjoyed the relaxing warmth and the beautiful scents, little did I know Julie's herbal blend were busy helping my very sore vagina heal.
