can someone explain the homebirth debate to me?

[allycat06]

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

[alioops]

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.

[Cassius2]

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.

[doulacara]

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.

[LionsandBears]

: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.

[OceanPrincess]

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

As for this...

... 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

[Schmickers]

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