The Victorian Branch of the Australian College of Midwives is pleased to offer a range of scholarships for the preparation for practice of both undergraduate and postgraduate entry levels, supporting midwives to reach their full potential by undertaking higher degrees or activities reflecting advanced skills and knowledge related to their area of practice.
In 2009 the Vic Branch will offer the following scholarships:
· 1 metropolitan student of an undergraduate pre-registration program $1000.00
· 1 regional/rural student of an undergraduate pre-registration program $1000.00
· 1 metropolitan student of an postgraduate pre-registration program $1000.00
· 1 regional/rural student of an postgraduate pre-registration program $1000.00
· 1 higher degree or advanced practice scholarship $2000.00
· 1 scholarship for midwife to attend a short course, conference or other professional development activity $2000.00
For more information on the application process please contact
Louise Allen, Membership officer
Ph: 1300 360 480
(02) 6230 7333
F: (02) 6230 6033
website: www.midwives.org.au
POSTSCRIPT
International Midwives Day is on the 5th of May.
This year the Australian College of Midwives has some great Merchandise for you to purchase. Just go to the College website www.midwives.org.au and follow the link the IMD web page.
Lets make this International Midwives day one to remember!
Tuesday, March 31, 2009
Tuesday, March 24, 2009
Save Private Midwifery and homebirth choices
Please support homebirth and private midwifery by signing the the Homebirth Australia petition
Jo Hunter's SAVE PRIVATE MIDWIFERY homebirth Video
SAVE PRIVATE MIDWIFERY
Jo Hunter's SAVE PRIVATE MIDWIFERY homebirth Video
SAVE PRIVATE MIDWIFERY
Monday, March 23, 2009
New policy on continuous monitoring
We have been informed that the Mercy Hospital for Women (MHW) has introduced a new policy requiring continuous electronic fetal monitoring (EFM) in labour, once their pregnancies have gone past 41 weeks gestation.
A midwife phoned the birth centre to find out the how birth centre women would be affected. She was told that they hadn't yet decided whether all women who went past 41 weeks would be transferred to the labour ward or not. A decision is to be made in two weeks.
Women who are booked at MHW, either through the birth centre or a standard booking, are advised to consider how this new policy may impact on their birthing experience. Note that any hospital policy, including this one can not be enforced if a woman declines the intervention. The staff member - midwife or doctor - may attempt to demand compliance, and may use words such as "We can't be sure that your baby is OK (or safe, or alive) without continuous monitoring."
There is no reliable evidence supporting a policy requiring continuous EFM for healthy women who are in normal labour, which has spontaneous onset at Term (37-42 weeks). Policies such as this one are risk management strategies that are based on fear, not on evidence. The hospital has no commitment to promoting normal birth.
Midwives who take their definition seriously, with a duty of care to promote normal birth, are placed in a compromised position by such policies.
Women who have a trusted midwife working with them privately are advised to work with their midwife to develop their personal decision making plan for this and other chalenges that may arise in their maternity care.
A midwife phoned the birth centre to find out the how birth centre women would be affected. She was told that they hadn't yet decided whether all women who went past 41 weeks would be transferred to the labour ward or not. A decision is to be made in two weeks.
Women who are booked at MHW, either through the birth centre or a standard booking, are advised to consider how this new policy may impact on their birthing experience. Note that any hospital policy, including this one can not be enforced if a woman declines the intervention. The staff member - midwife or doctor - may attempt to demand compliance, and may use words such as "We can't be sure that your baby is OK (or safe, or alive) without continuous monitoring."
There is no reliable evidence supporting a policy requiring continuous EFM for healthy women who are in normal labour, which has spontaneous onset at Term (37-42 weeks). Policies such as this one are risk management strategies that are based on fear, not on evidence. The hospital has no commitment to promoting normal birth.
Midwives who take their definition seriously, with a duty of care to promote normal birth, are placed in a compromised position by such policies.
Women who have a trusted midwife working with them privately are advised to work with their midwife to develop their personal decision making plan for this and other chalenges that may arise in their maternity care.
Tuesday, March 10, 2009
A BIG PUSH FROM WOMEN
Contact: Janie Nottingham 03 5974 8364 janie.nottingham@gmail.com
Joy Johnston 04111 90448 joy@aitex.com.au
Calling all midwives, mothers, and others who care about birth
In response to the Report of the Federal Government’s Maternity Services Review http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview-report
Background
The Review Report has been prepared by Department of Health staff, to advise the Minister for Health, Nicola Roxon. Despite hundreds of submissions from women and professionals supporting homebirth, and evidence that homebirth is a reasonable option for many women, the writers of the report have conceded to powerful lobby groups opposing homebirth, over the interests of women. The Minister will decide which of the Department’s advice she will take.
Maternity Coalition believes that with strong community outcry about the proposed loss of homebirth, the Minister may decide to go against the recommendations of her staff, and protect the options of homebirth and independent midwifery practice.
Speak out now!
Every Australian has a Federal Member of Parliament (MP), whose job is to represent their interests. Every person who cares about maintaining homebirth choice should contact their Federal MP, preferably by both letter and with a personal visit.
To find contact info for your MP:
• Go to http://apps.aec.gov.au/esearch/ and enter your locality in the “Search Federal Electorates” window.
• In the next window, click on the name of your electorate for more information.
• On the electorate page, click on “profile and map”.
• For contact info for your MP (“Current Member Details”), click on the “Parliament of Australia Website” link.
Write to your MP and tell them how important it is to you that women can choose homebirth. Ask them to contact the Minister for Health on your behalf. Recognise the good sides of the Review, and expect them to help you.
Meet with your MP. Phone their electorate office and ask for an appointment, to talk about the Federal Maternity Services Review. Take some friends from the same electorate. Tell them why women should have choice.
Your MP is expecting a letter or visit from a mother or a midwife, not a professor. Tell them why birth and choice are so important to you. Talk about scientific evidence or policy processes if you want, but you are the expert about your own story.
For more information contact Maternity Coalition
Joy Johnston 04111 90448 joy@aitex.com.au
Calling all midwives, mothers, and others who care about birth
In response to the Report of the Federal Government’s Maternity Services Review http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesreview-report
Background
The Review Report has been prepared by Department of Health staff, to advise the Minister for Health, Nicola Roxon. Despite hundreds of submissions from women and professionals supporting homebirth, and evidence that homebirth is a reasonable option for many women, the writers of the report have conceded to powerful lobby groups opposing homebirth, over the interests of women. The Minister will decide which of the Department’s advice she will take.
Maternity Coalition believes that with strong community outcry about the proposed loss of homebirth, the Minister may decide to go against the recommendations of her staff, and protect the options of homebirth and independent midwifery practice.
Speak out now!
Every Australian has a Federal Member of Parliament (MP), whose job is to represent their interests. Every person who cares about maintaining homebirth choice should contact their Federal MP, preferably by both letter and with a personal visit.
To find contact info for your MP:
• Go to http://apps.aec.gov.au/esearch/ and enter your locality in the “Search Federal Electorates” window.
• In the next window, click on the name of your electorate for more information.
• On the electorate page, click on “profile and map”.
• For contact info for your MP (“Current Member Details”), click on the “Parliament of Australia Website” link.
Write to your MP and tell them how important it is to you that women can choose homebirth. Ask them to contact the Minister for Health on your behalf. Recognise the good sides of the Review, and expect them to help you.
Meet with your MP. Phone their electorate office and ask for an appointment, to talk about the Federal Maternity Services Review. Take some friends from the same electorate. Tell them why women should have choice.
Your MP is expecting a letter or visit from a mother or a midwife, not a professor. Tell them why birth and choice are so important to you. Talk about scientific evidence or policy processes if you want, but you are the expert about your own story.
For more information contact Maternity Coalition
No more homebirth?
The Maternity Services Review Report: no more homebirth?
Bruce Teakle 8 March 2008
[Bruce is a leader in Maternity Coalition Queensland Branch, and has given permission for this article to be displayed]
The recently released report of the Federal Maternity Services Review proposes some promising reforms. It could, if implemented in the most positive spirit, bring huge breakthroughs in many areas of maternity care.
The Report recommends improving women’s access to midwifery care and information about pregnancy and birth. It proposes culturally appropriate care for indigenous women, better support for women in pregnancy and postnatally, and more collaborative relationships between caregivers.
Its ultimate goal for Australian mothers is “safe, high-quality and accessible care based on informed choice” (page iii).
Australia has waited a long time for the reforms proposed in the Review. However, there is a dark side to the Report.
The Report proposes an end to women’s access to midwifery care for homebirth, except possibly within state-run services. If the Report’s recommendations are followed, homebirth midwifery could become illegal in 2010 with the introduction of National Registration of health caregivers.
Below are some key points, with quotes from the Report, to help women who want to lobby for their right to access safe, legal homebirth in Australia:
1. Women choosing homebirth are a trivial minority:
A strong point is made of the small number of homebirths which occur in Australia:
P16: shows a graph of declining numbers of homebirths in Australia from 1991 to 2006.
P16: “Homebirths account for a very small number of births in Australia. In 2005, homebirth accounted for 0.22 per cent of all births in Australia, compared with 2.7 per cent in England and Wales, 2.5 per cent in New Zealand, and 0.6 per cent in the United States.”
P20: “New Zealand maternity data for 2004 found that, while 4.5 per cent of mothers had planned a homebirth, only 2.5 per cent actually experienced a homebirth.”
The reasons for the small Australian numbers are not explored, in particular the great difficulty most Australian women have accessing information or care for homebirth.
No comparison is made with other minority choices, such as caesarean section on request, and there is certainly no consideration of banning these choices.
The Reviewers acknowledge the high number of individual submissions from women who desired greater access and funding for homebirth. Despite this, it appears the Reviewers have been more responsive to the input of those who want to control women’s choices.
2. Homebirth will not be retained as a choice for women:
The Report is very clear that it does not support reforms which increase or fund women’s access to homebirth:
Pp20-21: “In recognising that, at the current time in Australia, homebirthing is a sensitive and controversial issue, the Review Team has formed the view that the relationship between maternity health care professionals is not such as to support homebirth as a mainstream Commonwealth-funded option (at least in the short term). The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
P21: “While acknowledging it is a preference for some women, the Review Team does not propose Commonwealth funding of homebirths as a mainstream option for maternity care at this time. It is also likely that professional indemnity cover support for a Commonwealth- funded model that includes a homebirth setting would be limited, at least in the short term. It is likely that insurers will be less inclined to provide indemnity cover for private homebirths and, if they did provide cover, the premium costs would be very high. Indemnity issues for midwife care more broadly are considered in Chapter 6.2.”
The Report proposes Commonwealth support for Medicare and indemnity insurance for midwives, but only working in non-homebirth practice. Midwives working outside these restrictions would not be able to legally practice, due to impending reforms:
P53: “For privately practising midwives, it is not currently a requirement in most jurisdictions to have professional indemnity cover in place before registration is granted. However, this situation is expected to change under the proposed new National Registration and Accreditation Scheme.”
The consequence of all this is that homebirth practice by private midwives (most homebirth care) would not be insured, and would be illegal under national registration laws, scheduled to take effect in July 2010.
State-run homebirth services (currently operating in NT, NSW, SA, and WA) might also be forced to close, if non-homebirth maternity services attract Commonwealth funding (through Medicare for midwives) but homebirth services do not.
3. Scientific evidence does not inform the recommendations regarding homebirth:
Although some reference is made to scientific evidence on some issues in the report, no reference is made to evidence regarding the outcomes of homebirth. It appears that medical opposition alone informs the Review’s position:
P21: “The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
4. The safety of women birthing without a caregiver can be overlooked
P21: “Of concern to the Review Team is the number of submissions and other evidence that suggests a small number of Australian women are choosing homebirths without the support of an appropriately trained health professional. Accordingly, as with any other maternity care model, the Review Team considers that appropriate standards, monitoring and evaluation should be integral components of any service involving homebirth.”
Women choosing to birth at home without a trained caregiver will not be helped by “standards, monitoring and evaluation”, because they are outside the system. The Review Team appear not to understand that these women are within neither a “maternity care model”, nor a “service involving homebirth”.
Maternity Coalition’s experience is that most women birthing at home without a trained caregiver do so because they are unable to access midwifery care at home, and unwilling to use hospital-based services. It is frequently a choice made in desperation. The way to help these women is to provide them access to a high standard of midwifery care in their preferred venue.
The Reviewers overlook the likelihood that the loss of homebirth midwifery care will push more women into unattended homebirth. This would ensure an absence of standards, monitoring or evaluation of any homebirth outcomes.
5. Medical extremists will become more cooperative if they are given a veto on women’s choices
The proposed reason for preventing homebirth midwifery is that it “risks polarising the professions”. The implied strategy seems to be for Government to restrict midwifery practice, against scientific evidence, against the principle of women’s informed choice and against the safety of determined homebirthing women. The presumed intention – for less collaborative doctors to become more respectful of the evidence, principles of informed choice, and women’s perspectives on safety; seems a highly unlikely outcome. The Reviewers reinforce a subordinate position for midwives relative to doctors by proposing to restrict midwifery practice in line with the prejudices of less collaborative doctors. This undermines the relationships they hope to enhance.
The Government must make it clear that the needs, interests and autonomy of women come first. Healthcare policy and services should not be corrupted by the prejudices of health care professions, which prosper on taxpayer funds.
Fear or leadership?
The Minister, Nicola Roxon, is aware that significant modernisations of the healthcare system have historically been met with protest, threats, and predictions of disaster by extreme medical voices. Reforms of Australia’s maternity care system will always provoke this sort of reaction. Those reforms include normalising midwives’ access to public funding and insurance, and women’s access to options including homebirth.
It appears that the Reviewers have conceded to fear of extreme medical voices, over the interests of women. Hopefully the Minister, who is directly accountable to women, will be braver.
Speak out now!
The Review Report has been prepared by Department of Health staff, to advise the Minister for Health, Nicola Roxon. The Minister will decide which of the Department’s advice she will take. If there is enough community outcry about the proposed loss of homebirth, the Minister may decide to act in the interests of choice.
Every Australian has a Federal Member of Parliament (MP), whose job is to represent their interests. Every person who cares about maintaining homebirth choice should contact their Federal MP, preferrably by both letter and with a personal visit.
To find contact info for your MP:
Go to http://apps.aec.gov.au/esearch/ and enter your locality in the “Search Federal Electorates” window.
In the next window, click on the name of your electorate for more information.
On the electorate page, click on “profile and map”.
For contact info for your MP (“Current Member Details”), click on the “Parliament of Australia Website” link.
Write to your MP and tell them how important it is to you that women can choose homebirth. Ask them to contact the Minister for Health on your behalf. Recognise the good sides of the Review, and expect them to help you.
Meet with your MP. Phone their electorate office and ask for an appointment, to talk about the Federal Maternity Review. Take some friends from the same electorate. Tell them why women should have choice.
Your MP is expecting a letter or visit from a mother, not a professor. Tell them why birth and choice are so important to you. Talk about scientific evidence or policy processes if you want, but you are the expert about your own story.
Bruce Teakle 8 March 2008
[Bruce is a leader in Maternity Coalition Queensland Branch, and has given permission for this article to be displayed]
The recently released report of the Federal Maternity Services Review proposes some promising reforms. It could, if implemented in the most positive spirit, bring huge breakthroughs in many areas of maternity care.
The Report recommends improving women’s access to midwifery care and information about pregnancy and birth. It proposes culturally appropriate care for indigenous women, better support for women in pregnancy and postnatally, and more collaborative relationships between caregivers.
Its ultimate goal for Australian mothers is “safe, high-quality and accessible care based on informed choice” (page iii).
Australia has waited a long time for the reforms proposed in the Review. However, there is a dark side to the Report.
The Report proposes an end to women’s access to midwifery care for homebirth, except possibly within state-run services. If the Report’s recommendations are followed, homebirth midwifery could become illegal in 2010 with the introduction of National Registration of health caregivers.
Below are some key points, with quotes from the Report, to help women who want to lobby for their right to access safe, legal homebirth in Australia:
1. Women choosing homebirth are a trivial minority:
A strong point is made of the small number of homebirths which occur in Australia:
P16: shows a graph of declining numbers of homebirths in Australia from 1991 to 2006.
P16: “Homebirths account for a very small number of births in Australia. In 2005, homebirth accounted for 0.22 per cent of all births in Australia, compared with 2.7 per cent in England and Wales, 2.5 per cent in New Zealand, and 0.6 per cent in the United States.”
P20: “New Zealand maternity data for 2004 found that, while 4.5 per cent of mothers had planned a homebirth, only 2.5 per cent actually experienced a homebirth.”
The reasons for the small Australian numbers are not explored, in particular the great difficulty most Australian women have accessing information or care for homebirth.
No comparison is made with other minority choices, such as caesarean section on request, and there is certainly no consideration of banning these choices.
The Reviewers acknowledge the high number of individual submissions from women who desired greater access and funding for homebirth. Despite this, it appears the Reviewers have been more responsive to the input of those who want to control women’s choices.
2. Homebirth will not be retained as a choice for women:
The Report is very clear that it does not support reforms which increase or fund women’s access to homebirth:
Pp20-21: “In recognising that, at the current time in Australia, homebirthing is a sensitive and controversial issue, the Review Team has formed the view that the relationship between maternity health care professionals is not such as to support homebirth as a mainstream Commonwealth-funded option (at least in the short term). The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
P21: “While acknowledging it is a preference for some women, the Review Team does not propose Commonwealth funding of homebirths as a mainstream option for maternity care at this time. It is also likely that professional indemnity cover support for a Commonwealth- funded model that includes a homebirth setting would be limited, at least in the short term. It is likely that insurers will be less inclined to provide indemnity cover for private homebirths and, if they did provide cover, the premium costs would be very high. Indemnity issues for midwife care more broadly are considered in Chapter 6.2.”
The Report proposes Commonwealth support for Medicare and indemnity insurance for midwives, but only working in non-homebirth practice. Midwives working outside these restrictions would not be able to legally practice, due to impending reforms:
P53: “For privately practising midwives, it is not currently a requirement in most jurisdictions to have professional indemnity cover in place before registration is granted. However, this situation is expected to change under the proposed new National Registration and Accreditation Scheme.”
The consequence of all this is that homebirth practice by private midwives (most homebirth care) would not be insured, and would be illegal under national registration laws, scheduled to take effect in July 2010.
State-run homebirth services (currently operating in NT, NSW, SA, and WA) might also be forced to close, if non-homebirth maternity services attract Commonwealth funding (through Medicare for midwives) but homebirth services do not.
3. Scientific evidence does not inform the recommendations regarding homebirth:
Although some reference is made to scientific evidence on some issues in the report, no reference is made to evidence regarding the outcomes of homebirth. It appears that medical opposition alone informs the Review’s position:
P21: “The Review also considers that moving prematurely to a mainstream private model of care incorporating homebirthing risks polarising the professions rather than allowing the expansion of collaborative approaches to improving choice and services for Australian women and their babies.”
4. The safety of women birthing without a caregiver can be overlooked
P21: “Of concern to the Review Team is the number of submissions and other evidence that suggests a small number of Australian women are choosing homebirths without the support of an appropriately trained health professional. Accordingly, as with any other maternity care model, the Review Team considers that appropriate standards, monitoring and evaluation should be integral components of any service involving homebirth.”
Women choosing to birth at home without a trained caregiver will not be helped by “standards, monitoring and evaluation”, because they are outside the system. The Review Team appear not to understand that these women are within neither a “maternity care model”, nor a “service involving homebirth”.
Maternity Coalition’s experience is that most women birthing at home without a trained caregiver do so because they are unable to access midwifery care at home, and unwilling to use hospital-based services. It is frequently a choice made in desperation. The way to help these women is to provide them access to a high standard of midwifery care in their preferred venue.
The Reviewers overlook the likelihood that the loss of homebirth midwifery care will push more women into unattended homebirth. This would ensure an absence of standards, monitoring or evaluation of any homebirth outcomes.
5. Medical extremists will become more cooperative if they are given a veto on women’s choices
The proposed reason for preventing homebirth midwifery is that it “risks polarising the professions”. The implied strategy seems to be for Government to restrict midwifery practice, against scientific evidence, against the principle of women’s informed choice and against the safety of determined homebirthing women. The presumed intention – for less collaborative doctors to become more respectful of the evidence, principles of informed choice, and women’s perspectives on safety; seems a highly unlikely outcome. The Reviewers reinforce a subordinate position for midwives relative to doctors by proposing to restrict midwifery practice in line with the prejudices of less collaborative doctors. This undermines the relationships they hope to enhance.
The Government must make it clear that the needs, interests and autonomy of women come first. Healthcare policy and services should not be corrupted by the prejudices of health care professions, which prosper on taxpayer funds.
Fear or leadership?
The Minister, Nicola Roxon, is aware that significant modernisations of the healthcare system have historically been met with protest, threats, and predictions of disaster by extreme medical voices. Reforms of Australia’s maternity care system will always provoke this sort of reaction. Those reforms include normalising midwives’ access to public funding and insurance, and women’s access to options including homebirth.
It appears that the Reviewers have conceded to fear of extreme medical voices, over the interests of women. Hopefully the Minister, who is directly accountable to women, will be braver.
Speak out now!
The Review Report has been prepared by Department of Health staff, to advise the Minister for Health, Nicola Roxon. The Minister will decide which of the Department’s advice she will take. If there is enough community outcry about the proposed loss of homebirth, the Minister may decide to act in the interests of choice.
Every Australian has a Federal Member of Parliament (MP), whose job is to represent their interests. Every person who cares about maintaining homebirth choice should contact their Federal MP, preferrably by both letter and with a personal visit.
To find contact info for your MP:
Go to http://apps.aec.gov.au/esearch/ and enter your locality in the “Search Federal Electorates” window.
In the next window, click on the name of your electorate for more information.
On the electorate page, click on “profile and map”.
For contact info for your MP (“Current Member Details”), click on the “Parliament of Australia Website” link.
Write to your MP and tell them how important it is to you that women can choose homebirth. Ask them to contact the Minister for Health on your behalf. Recognise the good sides of the Review, and expect them to help you.
Meet with your MP. Phone their electorate office and ask for an appointment, to talk about the Federal Maternity Review. Take some friends from the same electorate. Tell them why women should have choice.
Your MP is expecting a letter or visit from a mother, not a professor. Tell them why birth and choice are so important to you. Talk about scientific evidence or policy processes if you want, but you are the expert about your own story.
Friday, March 6, 2009
Cost of midwife cover an obstacle,to homebirth service
From The Australian
Cost of midwife cover an obstacle,to homebirth service
Adam Cresswell, Health editor | March 05, 2009
Article from: The Australian
"SUBSIDISING indemnity payments for midwives could cost taxpayers an estimated $12 million to $24 million annually if the federal Government were to treat them as favourably as specialist obstetricians.
"Insurance experts warned yesterday that despite public perceptions that mothers who delivered their babies with a midwife faced fewer risks, premiums to insure midwives against bad outcomes were likely to be similar to those faced by obstetricians -- who can pay from $60,000 to $100,000 a year for their policies.
... continued
A calculation in this article that:
"... if a midwife performed 100 deliveries a year and charged $2000 each, earning $200,000, a $45,000 premium would exceed the 7.5 per cent threshold by $30,000.
"Existing federal subsidies for obstetricians cut in when the premium cost exceeds 7.5 per cent of the doctor's gross income. Above that threshold, the taxpayer picks up 80 per cent of the insurance cost."
The usual annual caseload that midwives who provide primary care through the pregnancy, birth and postnatal period, is approximately 40 women per year. If a midwife was not travelling much and had a partner who shared oncall times, she might be able to book 50 per year. I can't imagine 100! Upon my word, you would have to work like an obstetrician, do quick consultations, have *someone* (at present this role is filled by a midwife employed by the hospital) call you just in time so that you could show up for the birth, and not have much involvement in postnatal care. Oh, and btw, there are only approximately 200 homebirths per year in Victoria, and those are attended by 10 or more primary care midwives and a group of up to 20 'second' midwives.
As for the calculation being based on $2000 each, midwives around Melbourne are each charging between $2000 to $3000 for the whole package of care, from the initial consultation, through the postnatal home visits. We don't do 'deliveries' - the mother gives birth.
So here's the revised equation:
Each midwife attends 40 births per year, earning $2,500 each = $100,000
7.5% of $100,000 is $7,500.
A $45,000 insurance premium would require the government to subsidise 80% of $37,500 = $30,000.
["Dr Nisselle said that If midwives were granted the same deal as obstetricians, the subsidy would amount to $24,000 per midwife."]
"Official estimates have suggested between 500 and 1000 midwives would be needed to take pressure off existing birthing services, creating a potential subsidy cost of up to $24 million."
I hate to disagree with official estimates, but ONE midwife providing primary care on takes pressure off existing birthing services. That's pretty obvious. The Report of the Maternity Services Review estimates that there are 150 midwives currently self employed. Most are not fully employed - there simply aren't enough women willing to pay $2000-$5000 for the homebirth package (one or two midwives). But let's imagine for the sake of easy arithmetic that they were all fully employed, each earning $100,000 (which we are not), and the government subsidised each one by $30,000. That alters the amount the government would shell out to $30,000 X 150 = $4,500,000. Only a fraction of $24 Million.
Figures can be used in all sorts of ways, and I would not like to hold this calculation up as having any more meaning in the current debate than the published calculation I have quoted above. The total inequity of the monopoly of funds that medical professionals hold in maternity care defies belief. Why would the number crunchers and bean counters allow such an unwarranted haemorrhage of public money to continue? Noone is asking for extra government funding - just a more equitable use of the money, in allowing women to choose a midwife rather than a doctor. The number of pregnancy/birth episodes is not dependent on who provides the care.
Those who are interested in government support of midwifery need to understand that midwives and doctors do not do the same work. Doctors routinely require midwives to assist them in births; midwives don't require doctors unless complications arise. Doctors are surgeons and physicians; midwives are experts in working in harmony with each woman's own ability to give birth to her baby, promoting physiologically normal processes. A few women need doctors to get them pregnant; most don't. A few women need doctors to *deliver* their babies; most don't.
Joy Johnston
Cost of midwife cover an obstacle,to homebirth service
Adam Cresswell, Health editor | March 05, 2009
Article from: The Australian
"SUBSIDISING indemnity payments for midwives could cost taxpayers an estimated $12 million to $24 million annually if the federal Government were to treat them as favourably as specialist obstetricians.
"Insurance experts warned yesterday that despite public perceptions that mothers who delivered their babies with a midwife faced fewer risks, premiums to insure midwives against bad outcomes were likely to be similar to those faced by obstetricians -- who can pay from $60,000 to $100,000 a year for their policies.
... continued
A calculation in this article that:
"... if a midwife performed 100 deliveries a year and charged $2000 each, earning $200,000, a $45,000 premium would exceed the 7.5 per cent threshold by $30,000.
"Existing federal subsidies for obstetricians cut in when the premium cost exceeds 7.5 per cent of the doctor's gross income. Above that threshold, the taxpayer picks up 80 per cent of the insurance cost."
The usual annual caseload that midwives who provide primary care through the pregnancy, birth and postnatal period, is approximately 40 women per year. If a midwife was not travelling much and had a partner who shared oncall times, she might be able to book 50 per year. I can't imagine 100! Upon my word, you would have to work like an obstetrician, do quick consultations, have *someone* (at present this role is filled by a midwife employed by the hospital) call you just in time so that you could show up for the birth, and not have much involvement in postnatal care. Oh, and btw, there are only approximately 200 homebirths per year in Victoria, and those are attended by 10 or more primary care midwives and a group of up to 20 'second' midwives.
As for the calculation being based on $2000 each, midwives around Melbourne are each charging between $2000 to $3000 for the whole package of care, from the initial consultation, through the postnatal home visits. We don't do 'deliveries' - the mother gives birth.
So here's the revised equation:
Each midwife attends 40 births per year, earning $2,500 each = $100,000
7.5% of $100,000 is $7,500.
A $45,000 insurance premium would require the government to subsidise 80% of $37,500 = $30,000.
["Dr Nisselle said that If midwives were granted the same deal as obstetricians, the subsidy would amount to $24,000 per midwife."]
"Official estimates have suggested between 500 and 1000 midwives would be needed to take pressure off existing birthing services, creating a potential subsidy cost of up to $24 million."
I hate to disagree with official estimates, but ONE midwife providing primary care on takes pressure off existing birthing services. That's pretty obvious. The Report of the Maternity Services Review estimates that there are 150 midwives currently self employed. Most are not fully employed - there simply aren't enough women willing to pay $2000-$5000 for the homebirth package (one or two midwives). But let's imagine for the sake of easy arithmetic that they were all fully employed, each earning $100,000 (which we are not), and the government subsidised each one by $30,000. That alters the amount the government would shell out to $30,000 X 150 = $4,500,000. Only a fraction of $24 Million.
Figures can be used in all sorts of ways, and I would not like to hold this calculation up as having any more meaning in the current debate than the published calculation I have quoted above. The total inequity of the monopoly of funds that medical professionals hold in maternity care defies belief. Why would the number crunchers and bean counters allow such an unwarranted haemorrhage of public money to continue? Noone is asking for extra government funding - just a more equitable use of the money, in allowing women to choose a midwife rather than a doctor. The number of pregnancy/birth episodes is not dependent on who provides the care.
Those who are interested in government support of midwifery need to understand that midwives and doctors do not do the same work. Doctors routinely require midwives to assist them in births; midwives don't require doctors unless complications arise. Doctors are surgeons and physicians; midwives are experts in working in harmony with each woman's own ability to give birth to her baby, promoting physiologically normal processes. A few women need doctors to get them pregnant; most don't. A few women need doctors to *deliver* their babies; most don't.
Joy Johnston
LETTERS TO POLITICIANS
The following advice is from Justine Caines, President of Maternity Coalition, and leader in Homebirth Australia australianhomebirth@yahoo.com.au
To find your local Federal Politician, search the AEC website http://apps.aec.gov.au/esearch/
I suggest you send 2 separate letters. One to
Nicola Roxon
Minister for Health and Ageing
Parliament House
CANBERRA ACT 2600
In the letter to your local FEDERAL member you can cut and paste the contents but add in this to your local members letter.
Dear [NAME]
I ask you to represent my concerns to Health Minister, Nicola Roxon and please inform me of the outcome.
[Some suggested paragraphs, particularly for the local members:]
The Maternity Services Review handed down its report on February 21. This report made the 38th inquiry into maternity services since 1985.
I believe the only issue more investigated into is petrol prices. The needs of women and their babies should come before that of vested interest groups.
The Report examines enhancing midwifery practice, which is long overdue. The care of a known midwife from early pregnancy through labour and birth and the early post-natal period has considerable benefits. These benefits can be be measured financially through a reduction in unnecessary surgical birth and other interventions. More subtle but important benefits are increased rates of bonding and breastfeeding, lower rates of post-natal depression and greater satisfaction with the experience of childbirth. This greatly assists a woman entering motherhood.
Unusually the Report does not examine the urgent need to redress obstetric practice in Australia. Many practices currently employed by obstetricians are not based on sound research evidence, but rather custom and practice. This leads to varied outcomes, for example one hospital may have a caesarean section rate of 16% while another of similar size and capacity has a rate of 30%. Maternity outcomes in Australia are based on post-code. There is currently not a ‘bench-mark’ for quality and safety. The cost of maternity care is spiralling out of control. The Medicare Safety-net was established in 2004 to assist Australian families with the cost of health care. In just over 4 years payments made to Obstetricians under the Medicare Benefits Schedule have increased by approximately 300%. Such increases are not sustainable and have the capacity to see the demise of the Medicare Safety-net, something that will impact many Australians.
Private health costs have risen again this week. The cost of maternity care is considerable. Childbirth is the highest volume area of health and accounts for the greatest number of bed stays. Private maternity care is totally anti-competitive. As a taxpayer who funds the Governments 30% rebate on private health insurance premiums I object to a system that is unnecessarily expensive, not based on evidence and gives women no choice but medically dominated services.
The report of the Maternity Services Review states that the Government will not support the costs of private homebirth services under the Medicare Benefits Schedule, nor will they provide indemnity insurance assistance to midwives working in private practice. Midwives in private practice are the only health professionals in Australia currently without indemnity insurance. This is not due to their pracitce, or claims history, it is simply due to the fact that they are small in number. Medical practitioners and their clients currently enjoy indemnity protection at an estimated cost of $500 Million.
There are currently plans to establish a national registration body for health professionals by mid next year. An appropriate requirement for registration is professional indemnity insurance. If midwives in private practice are not assisted, they will be prevented from registering. If they practice will unregistered they face a jail term. If national registration proceeds as planned women choosing homebirth will be unable to access a registered midwife, and essentially the practice will go ‘underground’. It is not acceptable that women are unable to choose the care of a registered midwife to give birth at home. Homebirth is a nationally funded option in the United Kingdom, Canada, New Zealand and The Netherlands. I ask that you support a woman’s right to choose where and with whom she gives birth.
I ask you to investigate my concerns and make representations to Health Minister Roxon as a matter if urgency.
To find your local Federal Politician, search the AEC website http://apps.aec.gov.au/esearch/
I suggest you send 2 separate letters. One to
Nicola Roxon
Minister for Health and Ageing
Parliament House
CANBERRA ACT 2600
In the letter to your local FEDERAL member you can cut and paste the contents but add in this to your local members letter.
Dear [NAME]
I ask you to represent my concerns to Health Minister, Nicola Roxon and please inform me of the outcome.
[Some suggested paragraphs, particularly for the local members:]
The Maternity Services Review handed down its report on February 21. This report made the 38th inquiry into maternity services since 1985.
I believe the only issue more investigated into is petrol prices. The needs of women and their babies should come before that of vested interest groups.
The Report examines enhancing midwifery practice, which is long overdue. The care of a known midwife from early pregnancy through labour and birth and the early post-natal period has considerable benefits. These benefits can be be measured financially through a reduction in unnecessary surgical birth and other interventions. More subtle but important benefits are increased rates of bonding and breastfeeding, lower rates of post-natal depression and greater satisfaction with the experience of childbirth. This greatly assists a woman entering motherhood.
Unusually the Report does not examine the urgent need to redress obstetric practice in Australia. Many practices currently employed by obstetricians are not based on sound research evidence, but rather custom and practice. This leads to varied outcomes, for example one hospital may have a caesarean section rate of 16% while another of similar size and capacity has a rate of 30%. Maternity outcomes in Australia are based on post-code. There is currently not a ‘bench-mark’ for quality and safety. The cost of maternity care is spiralling out of control. The Medicare Safety-net was established in 2004 to assist Australian families with the cost of health care. In just over 4 years payments made to Obstetricians under the Medicare Benefits Schedule have increased by approximately 300%. Such increases are not sustainable and have the capacity to see the demise of the Medicare Safety-net, something that will impact many Australians.
Private health costs have risen again this week. The cost of maternity care is considerable. Childbirth is the highest volume area of health and accounts for the greatest number of bed stays. Private maternity care is totally anti-competitive. As a taxpayer who funds the Governments 30% rebate on private health insurance premiums I object to a system that is unnecessarily expensive, not based on evidence and gives women no choice but medically dominated services.
The report of the Maternity Services Review states that the Government will not support the costs of private homebirth services under the Medicare Benefits Schedule, nor will they provide indemnity insurance assistance to midwives working in private practice. Midwives in private practice are the only health professionals in Australia currently without indemnity insurance. This is not due to their pracitce, or claims history, it is simply due to the fact that they are small in number. Medical practitioners and their clients currently enjoy indemnity protection at an estimated cost of $500 Million.
There are currently plans to establish a national registration body for health professionals by mid next year. An appropriate requirement for registration is professional indemnity insurance. If midwives in private practice are not assisted, they will be prevented from registering. If they practice will unregistered they face a jail term. If national registration proceeds as planned women choosing homebirth will be unable to access a registered midwife, and essentially the practice will go ‘underground’. It is not acceptable that women are unable to choose the care of a registered midwife to give birth at home. Homebirth is a nationally funded option in the United Kingdom, Canada, New Zealand and The Netherlands. I ask that you support a woman’s right to choose where and with whom she gives birth.
I ask you to investigate my concerns and make representations to Health Minister Roxon as a matter if urgency.
Thursday, March 5, 2009
WHAT CAN I DO?
What can I do in response to the Report of the Maternity Services Review?
This is a question that many are asking. Anyone coming to this blog is likely to have some interest in midwives private practices and homebirth. Many of you will have written submissions to the Review. Please:
1. go to the Report and compare what you said in your submission with what is recommended in the Report. Then write to the Health Minister telling her how the Report has ignored consumer preference and informed choice, and sidestepped evidence in support of the opinion of powerful professional lobby groups.
2. contact your maternity groups - Maternity Coalition or professional, and find out what response is being made to the Report and its recommendations.
3. be ready to respond with Letters to Editors of news papers, as well as blogs to opinion pieces, such as The Australian and ABC Radio UNLEASHED Note that there are 133 comments in response to Alison Leemen's piece 'Homebirth Ban' which went to air only a week ago! Homebirth and private midwifery practice are issues that our community cannot afford to ignore. As Leemen says,
"The government can't ban homebirth any more than it can ban sex, but by banning professional, registered midwives from attending homebirths, it greatly increases risk.
"Not funding homebirth is just bad policy: cost-ineffective to Australian taxpayers and unfair to Australian women. But making homebirth illegal is paternalistic, internationally isolated and dangerous."
Now is the time for everyone who cares about homebirth and autonomous midwifery practice to take action. If we don't, we stand to lose what little access we have.
Joy Johnston
This is a question that many are asking. Anyone coming to this blog is likely to have some interest in midwives private practices and homebirth. Many of you will have written submissions to the Review. Please:
1. go to the Report and compare what you said in your submission with what is recommended in the Report. Then write to the Health Minister telling her how the Report has ignored consumer preference and informed choice, and sidestepped evidence in support of the opinion of powerful professional lobby groups.
2. contact your maternity groups - Maternity Coalition or professional, and find out what response is being made to the Report and its recommendations.
3. be ready to respond with Letters to Editors of news papers, as well as blogs to opinion pieces, such as The Australian and ABC Radio UNLEASHED Note that there are 133 comments in response to Alison Leemen's piece 'Homebirth Ban' which went to air only a week ago! Homebirth and private midwifery practice are issues that our community cannot afford to ignore. As Leemen says,
"The government can't ban homebirth any more than it can ban sex, but by banning professional, registered midwives from attending homebirths, it greatly increases risk.
"Not funding homebirth is just bad policy: cost-ineffective to Australian taxpayers and unfair to Australian women. But making homebirth illegal is paternalistic, internationally isolated and dangerous."
Now is the time for everyone who cares about homebirth and autonomous midwifery practice to take action. If we don't, we stand to lose what little access we have.
Joy Johnston
Monday, March 2, 2009
Homebirths may have to be secret
In the Australian today
Adam Cresswell, Health editor | March 02, 2009
Article from: The Australian
"HUNDREDS of women each year who choose to give birth in their homes are likely to face greater medical danger for themselves and their babies with the introduction of regulations that could force the practice underground. [continued]
Thankyou Adam Cresswell for this article.
There are several options open to the government, to avoid criminalisation of independent midwifery practice:
*1. To extend to midwives the same indemnity support that they already provide doctors, as noted by Cresswell
*2. To reform the insurance system, making a 'no fault' scheme similar to the TAC, that is linked to all services provided by health professional. This removes claims from the law courts. New Zealand has such a scheme by which anyone who sustains injury or loss as a result of health care is able to receive compensation, without having to sue the person(s) who they consider responsible (a very complex and difficult process).
*3. To amend the requirements of the new national health registration legislation, so that indemnity insurance is not mandated.
Options 1 and 2 are rational and do-able. Option 3 makes no more sense than does the deregistration of midwives who are offering safe and effective maternity care.
Joy Johnston
Adam Cresswell, Health editor | March 02, 2009
Article from: The Australian
"HUNDREDS of women each year who choose to give birth in their homes are likely to face greater medical danger for themselves and their babies with the introduction of regulations that could force the practice underground. [continued]
Thankyou Adam Cresswell for this article.
There are several options open to the government, to avoid criminalisation of independent midwifery practice:
*1. To extend to midwives the same indemnity support that they already provide doctors, as noted by Cresswell
*2. To reform the insurance system, making a 'no fault' scheme similar to the TAC, that is linked to all services provided by health professional. This removes claims from the law courts. New Zealand has such a scheme by which anyone who sustains injury or loss as a result of health care is able to receive compensation, without having to sue the person(s) who they consider responsible (a very complex and difficult process).
*3. To amend the requirements of the new national health registration legislation, so that indemnity insurance is not mandated.
Options 1 and 2 are rational and do-able. Option 3 makes no more sense than does the deregistration of midwives who are offering safe and effective maternity care.
Joy Johnston
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