Update On The Future Of Australian Homebirth

On March 16 The Senate passed the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009. While the health minister has been keen to highlight that these reforms mean Australian women will supposedly be able to choose their own midwife for pregnancy, birth and postpartum care for a birth centre or hospital birth (thereby fostering continuity of care) and that midwives will have access to medicare, we still lack a clear definition of the terms "collaboration" and "eligible midwife" as used in the Bill.

It is still unclear whether "collaboration" means doctors and independent midwives working on an equal footing or doctors having the power of veto over midwives (and the women who hire them). For those of us familiar with the workings of the current maternity system it is hard not to assume a cynical definition of "collaboration". As stated on the Private Midwifery Services blog:

"Even today, before any of these reforms come into effect, some doctors refuse to provide services, such as ordering blood tests, if they know a woman is planning homebirth attended by a private midwife. Women have been told by their GPs that the GP is not willing to accept the 'risk', from an indemnity point of view, of collaboration with a midwife. Midwives who try to make collaborative arrangements with local hospitals, establishing transparent and seamless processes for referral and transfer to hospital care when appropriate often face barriers and difficulties."

This does not fill homebirthers and independent midwives with much hope.

In Birth Writes (newsletter of the Victorian Branch of Maternity Coalition) Joanne Smethurst notes that "There is nothing in the Bills for homebirth – the Bills neither support nor outlaw homebirth." (April 2010: 2). She goes on to state that the health minister has assured homebirth lobbyists that midwife attended homebirth will remain an option for Australians, but just how easy that access will be remains unclear. Melbourne private practice midwife Joy Johnston said it best when she wrote on her blog:

"It's POSSIBLY a landmark day for SOME midwifery. But for midwives like me, who have chosen to be employed privately by women for homebirth or for other private midwifery services, the legislation gives us little to cheer about. Even the promise of Medicare and prescribing rights, to be implemented by November this year, appears to be so wound up in bureaucratic micro-management that we wonder if we will ever be able to meet the criteria. We are doubtful that the Medicare-funded midwife will be able to provide any service that is acceptable to clients, at the same time as providing a reasonable livelihood for the midwife."

To attempt to have your say (yet again) there is the option of sending your feedback to The draft National Guidance on Collaborative Maternity Care. This remains open to public consultation until April 27th.

You mean we have to write to the government AGAIN?!

For more information:

A Landmark Day For Midwifery in Australia?

Maternity Coalition's 101 on The Passed Bills

Questions About Professional Indemnity Insurance For Midwives

Maternity Coalition's Q&A on Maternity Reform

Maternity Coalition's 10 Steps to Keeping Maternity Reform on Track

Scope of Practice - Questions Raised By One Midwife in Private Practice

What The Government Says About These Maternity Reforms