Controversial Midwife Laws Passed by Parliament

A dramatic but somewhat controversial reform has been passed by parliament last week allowing midwives to provide Medicare funded care in Australia for the first time.

This means that under specific guidelines, women will be eligible to receive Medicare rebates for private midwifery care, and also some Pharmaceutical Benefits Scheme (PBS) rebates for particular tests and medications.

The government is also supporting midwives access to professional indemnity insurance, which has been unavailable to midwives since 2001.

Summary of Reform

• Midwives will be able to provide Medicare-funded care for the first time.
• A national register will be set up, instead of current State bodies.
• Indemnity insurance will be a registration pre-requisite.
• No midwives have been indemnified since 2001.
• New laws fail to provide for midwives offering home births.
• Framework includes a request for midwives to form a collaborative relationship with a doctor.
• Midwives will require doctor to sign-off to access Medicare insurance and pharmaceutical benefits.

- source: The Daily Examiner

These new laws represent a fairly significant step forward for midwives and have the potential to greatly improve women’s access to care by a primary midwife. They have also raised some controversy however, with home birth advocates in particular feeling that they have been left short-changed by the deal.  

Under the new laws, the government will provide support for indemnity insurance for midwives and include a two year buffer for those having trouble finding providers, however the insurance support will not be extended to include home births.

Others have also raised concerns over the specifics of indemnity insurance:

“What worries me the most is that midwives’ being without indemnity insurance is going to drag on and on,” says Gail Baker, Registered Midwife and operator of home birth services. A Grafton-based midwife, who did not wish to be named, said the laws gave doctors ‘veto over midwives’. To be eligible for a Medicare provider number, midwives will need the sign-off of an obstetrician.
 
“This provides an opportunity for doctors to have power over a qualified, experienced midwife,” she said. The midwife called for a ‘publicly-funded home birth service’, which would come under the State hospital umbrella. “It’s a choice that should be available to all women.”

The Australian College of Midwives has also responded by saying the changes signal a significant step forward, but they call on the government to ensure that midwives who offer homebirths can also be insured.

ACT Australian Nursing Federation spokeswoman Jenny Miragaya suggests that it may take some time for the changes to filter through to the community and private sector, but agrees that “ultimately the change should lead to better healthcare.” (ABC News)

** Thanks to Peter McCartney for bringing these new laws to my attention