Well, yes, it is an insurance problem.

You see, in the most recent budget, the government announced several reforms in the maternity health care system, principal being that midwives would be given limited access to medicare funding, and that public health indemnity insurance would be extended to midwives working as practicioners within the public system.

They have never clarified their reasoning for this, but as I understand the system, the two go hand in hand; allowing midwives to order antenatal screening or pathology, for example, is not a traditional role for midwives and I suspect this means that those midwives who are doing so will not be covered under the government's existing indemnity insurance schemes; thus the need for this new publically-funded indemnity insurance.

Is this something of a white elephant on behalf of the government - extending indemnity insurance to the group least likely to need it, while refusing to assist those midwives who are crying out for it? Absolutely. But it is economically sound, in that what I think we will begin to see are antenatal services that are coordinated and operated by midwives, because in the current hospital maternity care system, this is really the only place where this new limited autonomy is of any use. And allowing midwives to operate autonomously and coordinate antenatal care for appropriately screened clients will be a major cost saver for the government, because routine antenatal care for low-risk clients has traditionally been overseen by medical officers, for really no reason other than without them, it has not been possible for antenatal screening to be ordered.

The optimist in me sees a future where low-risk women are able to have their antenatal care appropriately well managed by a team of midwives, and bedause of that support go on to have an empowered and supported natural birth; the cynic in me sees little more than an excuse to save money and strip doctors out of the maternity care system. Time will tell, I guess.