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Thread: can someone explain the homebirth debate to me?

  1. #1

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    Default can someone explain the homebirth debate to me?

    I'm a little confused as to what's going on at the moment. I know the government wanted to stop them from June 2010 and then backed off a bit is that right? So where do they stand now? I could go google it, but I just thought it'd be easier to get one of you lovely ladies to explain it to me.
    Ta

  2. #2

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    As far as I know it is still going to be banned, because the govt bows to the men in white coats with money. Stupid thing is they would save themselves money by ignoring the men in white coats.

  3. #3

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    as far as the june 2010 cut off date is concerned they were referring to the fact that registered midwives practising outside of a clinical setting (ie at home!) would face de-registration. so they can still work, but not be registered. which is not a happy precedent or state of affairs for the midwifery community as a whole. it takes away the acknowlegement that these midwives have trained to do their job and undermines their specialisation and expertise by the likes of the AMA.

  4. #4

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    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.

  5. #5

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    :yeahthat:

    though my understanding is the collaborative agreement has to be with an individual doctor, not a hospital (the AMA were very heavy about this). My midwife has an arrangement with the RWH anyway, but the government will want her answering to a specific doctor. So midwives will have to search for a doctor who will back their decisions. Apart from the insult to experienced midwives, it will make it harder for midwives who cannot find an appropriate doctor. The doctor's will have to take into account their own Indemnity Insurance expense before they make such an agreement (so may not actually be able to anyway). I expect rural midwives will have the worst time.

    I get the impression the government just want the whole homebirth thing to go away. It's a small part of the whole health care system, but one of the most vocal. It seems that they just forgot about private midwives when drafting the legislation, and don't know what to do about it. I get the impression they're burying their heads in the sand until the next election. They only have 15 weeks to sort it out.

  6. #6

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    Thanks doulacara for that great summary. I too had no idea... its a bit clearer now.

    As for this...

    Quote Originally Posted by tashybabe View Post
    ... So midwives will have to search for a doctor who will back their decisions. Apart from the insult to experienced midwives, it will make it harder for midwives who cannot find an appropriate doctor...
    That is so harsh for MWs. It would absolutely be an insult to them.

    Sigh

  7. #7

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    Doulacara posts an excellent summary of the current controversy around independently practicing midwives.

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    Well said Doulacara. A very good explanation.

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    Thanks so much doulacara

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    Thanks everyone.

    I haven't been around here in a while, thought it might be time to check in again.

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    So now the bill has been passed but i'm still a little confuzzled about one aspect. So midwives that get insurance and a medicare provider number can attend homebirths for the time being but what about midwives who choose not to get insurance, can they still practice?

    Will they get deregistered if they provide antenatal/postnatal care or just if they attend a homebirth? Or can they still practice all aspects but their clients won't be able to claim any from medicare?

  12. #12

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    As I understand it, after the 2 year extension has passed, midwives who practice uninsured will be liable to be deregistered; if they become deregistered, and then continue to practice, they can be found liable for impersonating a midwife, and face jail time and a hefty fine, as can the woman or partner who asked them to midwife for them.

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    SO are you saying. that in two years time every midwife has to have insurance?

    Or does this only apply for IM?

    What about the midwifes that work in hospitals

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    midwives who work in hospitals are already covered by their employers insurance


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    Is anyone aware if there have been any more recent developments on this? Talking to an IM locally last week, she seemed to think things would become clearer over the coming weeks?? I'm assuming the finer points of legislation are being worked on? If anyone is following things closely or has more detailed info that would be really helpful.

    We're considering homebirth and the moment (VBAC) so these changes are likely to compromise my chances.

    Thanks

  16. #16

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    I know this is an old thread but I have only just seen it so thought I'd clear a few things up.

    Due to National Registration, as of the 1st of July, ALL health care professionals must have professional indemnity insurance (PII) in order to practice. There is no PII available for births occuring at home and there is an exemption from the insurance requirement for this, and for this only. So midwives still need PII for antenatal and postnatal care. If a midwife is found to be practising without insurance (except for attending a homebirth) she is outside the conditions of her registration and can be disciplined; i have been advised that the likely action would be deregistration.

    So, at the moment, midwives can attend homebirths without insurance, but do need PII in order to provide antenatal and postnatal care.

    Now, to complicate things a bit, there are two PII policies available for midwives to provide antenatal and postnatal care. One policy has no restrictions on practice, while the other policy has several hoops the midwife must jump through. These "hoops" include things like booking all clients into hospital, following guidelines or specific documentation when women choose not to follow the guidelines, providing the hospital with copies of all pathology and other diagnostic testing and providing the hospital with a care plan.

    This issue has been quite divisive and controversial as some women don't want their details passed on to the hosptial and some midwives don't want to require this of women.

    The other issue that is still "up in the air" is that in order to access the exemption from PII for a birth at home, the midwife is required to adhere to a quality and safety framework. This framework has not been finalised or adopted yet, so at this stage midwives don't need to worry about it. However it will be finalised and adopted at some stage and it has the potential to restrict women's choices and restrict midwives' practice.

    Hope that clarifies things a bit!

  17. #17

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    Quote Originally Posted by r8chele View Post
    Now, to complicate things a bit, there are two PII policies available for midwives to provide antenatal and postnatal care. One policy has no restrictions on practice, while the other policy has several hoops the midwife must jump through.
    Excellent info thanks! The fact that insurance is mandatory and includes loop-holes really concerns me! I want to chat to my midwife next week about what insurance she has gone for... do you have the names of the companies offering these two policies, so that I am clear on which is which? Thanks

  18. #18

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    Is there anyone 'in the know' as to what's happening now? I spoke about it all quite a bit last year with my IM but have now totally forgotten any details! Guess my mine was a little focused only on the birth at the time :-)

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