It's a confusing issue which involves a few pieces of legislation at both the federal and state level.

Here's my understanding:

  1. At a state level: a new National Registration Scheme for health professionals (not just midwives) will come into effect in July 2010. Where previously midwives have registered in their state, they will now be registered nationally. BUT, in order to register they must have Professional Indemnity Insurance(PII). Of the health professionals covered by these changes, only midwives are unable to get this insurance in private practice. No commercial insurance product exists as the pool of midwives who would pay premiums is too small. The new registration scheme will be enacted by all the state governments.
  2. At a Federal level, the government has introduced legislative changes which will give Midwives Medicare Provider numbers, which they have never had before, as well as Professional Indemnity Insurance (which the goverment is subsidising). Meaning a midwife can set up a private clinic and her clients can claim a rebate for her services via Medicare.

BUT:

  • Only "eligible" midwives will be able to get Medicare numbers and the criteria for who is "eligible" is yet to be defined.
  • Midwives will have to have "collaborative arrangements" with a doctor or hospital in place to access Medicare, and again this has yet to be defined. How hard this will be to get is unknown.
  • Homebirth will not be covered by the subsidised insurance or Medicare. So a midwife who attends homebirth will be doing so without insurance cover and potentially face being de-registered.


Last Sept, the state govts agreed to granting a 2 year exemption on insurance for attending homebirths. So midwives can attend homebirths without compromising their registration. BUT AGAIN, there is a framework being drafted which will detail what conditions this exemption requires which is yet to be made public.

The status quo is that any registered midwife can attend a birth at home. Her services are not covered by Medicare and she has no PII, but in most states this is not illegal. The law in a few states is unclear but so far most states have chosen not to police it. (with the notable exception of the NT where there are no independent midwives).

After July 2010, the best case scenario is that independent midwives will have to find a doctor or hospital to enter into a collaborative arrangement with in order to get PII and be able to register.

The worst case scenario is that in order to get these collaborative agreements, midwives will have to agree to stop supporting women with 'high risk' pregnancies like VBAC/twins/breech and also be subject to strict guidelines on things like ante-natal testing, post-dates management, transfer protocols etc.

Where are the women in these scenarios, you may ask?

Well, that's a very good point.