MIDIRS Essence Issue 28

MIDIRS Essence - the FREE monthly online newsletter for maternity healthcare practitioners

Issue 28 is available to view FREE online by clicking the link below

MIDIRS Essence - Issue 28

'Essence' is designed to provide access to the latest news, features and reports on research and education, midwifery, pregnancy, labour and birth in a contemporary style and format that is easy to use. With regular updates and articles from MIDIRS Midwifery Digest, plus the latest news on the Informed Choice resource forming a regular slot in each issue, healthcare professionals can be assured of receiving the best evidence based information on a regular basis.


This Issue includes:

Newly launched - an information portal that provides free online educational resources for maternity health care professionals

The use of anti-D in women who are Rhesus negative

Link to MIDIRS Informed Choice leaflets.

15 million units of maternity information delivered to health care professionals in 2008

Core Competencies and Educational Framework for Maternity Services in Australia

The Core Competencies and Educational Framework for Maternity Services in Australia Project has developed a Draft Maternity Service Competency Model document (Version 4), and is seeking feedback from interested persons.

The aim is to determine core competencies and an educational framework required to provide safe, effective and appropriate maternity services in Australia. This project will take into account the range and complexity of knowledge, skills and attitudes (core competencies) required, and full range of professions involved, to deliver evidence based maternity care across Australia.
The feedback form is available by following the link above, and is due by the end of June 2009.

Delayed cord clamping video

Recommended watching!

HOMEBIRTHS IN VICTORIA 2007

The Victorian Government's Perinatal Data Collection Unit's report of Homebirths 2007 has now been published, and distributed to midwives who provided the data used in the report. A version of this report is also provided to every hospital providing maternity services, as well as to homebirth midwives. The profile for each hospital is presented in the first two columns for each item, and compared with composite data from the rest of the State. Homebirths are treated as a unit for this report. Two of the pages of the Homebirth Profile have been included here, for your information. (You may click on the image to enlarge it).

The following statement is from the Profile (page 28)

Births at home in 2007
253 women had births that were coded as planned home births in 2007. The data relating to these 253 women is reported in this Profile.

Three of these planned to give birth in a hospital or birth centre but actively changed their plan during labour and decided to give birth at home. The other 250 planned to give birth at home and achieved this.

66 (26.1%) of these births were recorded as water births.

Transfer to hospital care

Sixteen women planned to give birth at home, but changed their plan to a hospital birth before the onset of labour. The change in plans could have occurred any time between many weeks before the birth and the day of birth. The reasons were not recorded. Four of these women had a caesarean in labour. One woman had a ventouse delivery and another woman had a vaginal breech. The other six women had unassisted vaginal births.

Another 33 women planned to give birth at home but changed their plan after the onset of labour and transferred to hospital for the birth. Eight of these women gave birth by caesarean section, three had forceps assisted births and ten ventouse. Twelve women had unassisted vaginal births.

The data related to these births is reported for the hospital in which they gave birth.

Babies born before arrival at hospital
306 women planned to give birth in hospital, and 28 planned to give birth in a birth centre, but in fact gave birth at home or in transit. The intended place of birth was not known for another 9 women who gave birth at home. These have been recorded as 'Born Before Arrival' or BBA.

The data for these women is reported for the hospital they attended immediately after the birth of the baby.

KEEPING YOURSELF WELL INFORMED

With the changes announced in the federal budget this week, (provided they pass the Senate), midwives will need to stay well informed. Keep an eye on this blog and others - see links. Anyone who has come into the maternity scene recently may not know about the midwifery email lists that are currently operating. You may consider joining one or more of the lists.

Australian College of Midwives has an email list to send messages to members, but at present does not have discussion groups or online forums or blogs. Any midwives who are not members are encouraged and 'advised' to join your professional body. The membership fees are tax deductible, and you will find the journal and newsletter, as well as email and other services, invaluable.

Maternity Coalition has the OZBIRTHING list and the Maternitycoalitionmidwives list. These are Yahoo! groups. If you wish to join the midwives list, please contact joy@aitex.com.au, and state who you are, and why you wish to join. [we ask for this step, as membership in the group is by invitation only] Maternity Coalition also has state branch Yahoo! groups for members. Membership in Maternity Coalition supports advocacy on behalf of women and midwives, particularly in protecting and promoting normal birth.

A popular and long standing list is Birth International's OZMIDWIFERY Follow the link to join, or to check out the archives.

Then, when you have a spare moment, (!), keep an eye on blogs related to the major newspapers, and the Crikey Health blog, Croakey. Offer your own perspective through the comments sections. Pass on the information you find to your own network, through email lists, blogs, and even (!) word of mouth.

Australian College of Midwives MEDIA RELEASE

“Mothers and Midwives Budget winners”




“Today is an historic day for childbearing women and their families in Australia,” said Associate Professor Hannah Dahlen, National Media Spokespersons for the Australian College of Midwives.

“Not only has the Rudd Government made the welcome commitment to parental leave to better support families with newborn babies, but they have also provided for:
mothers to receive Medicare rebates for midwifery care,
access to PBS for midwives,
national collaborative maternity care guidelines,
increased access at state level to birth centres,
indemnity for midwives
measures to enhance the access of rural and remote women to maternity care as close as possible to their home community.
A national telephone support service for pregnant women and mothers of newborns

“These reforms will together make it much easier for women living anywhere in Australia – from the middle of our largest cities to remote communities - to access continuity of care by a known midwife” Assoc Prof Dahlen said. “They will also be vital in helping to close the gap on disadvantage for Aboriginal and Torres Strait Islander mothers and babies in partnership with Indigenous people themselves.”

Continuity of midwifery care involves a pregnant woman being cared for by a known midwife throughout her pregnancy, labour and birth. It also involves follow up care in the home for up to 6 weeks after the birth of the baby to provide professional support with the all important transition to parenting.

“This is not about substituting doctors with midwives” Assoc. Prof Dahlen said. “Obstetricians will, of course, continue to have a vital role in maternity care. Midwives providing continuity of care collaborate with obstetricians and allied health professionals throughout the episode of care, in response to the individual needs of each woman and her baby.”

Research evidence shows a range of benefits when women are cared for by known midwives from early in pregnancy till well after the birth. These include fewer admissions to hospital antenatally, less need for epidurals or for any pain relief, fewer episiotomies, more normal births, reduced need for their baby to be admitted to a special care nursery, more success with breastfeeding, and less vulnerability to postnatal depression or anxiety.

“Health Minister Nicola Roxon is to be commended for listening to Australian women during the recent national review of maternity services and for acting on the evidence that their needs could be better met with greater access to continuity of care by midwives, said Assoc Prof Dahlen

“These reforms pave the way for tens of thousands of women and their families to benefit from continuity of midwifery care while maintaining Australia’s solid record of safety for mothers and babies,” said Assoc. Professor Dahlen. “The confidence the government has expressed in midwives through these major reforms will be embraced by the profession around Australia.”

“Today the government has honoured women and motherhood in this country and recognised that ‘the hand that rocks the cradle’ does indeed ‘rule the world,’ and that we as a society need to support women and invest in the future– our children,” said Associate Professor Dahlen.

NEWS RELEASE from Homebirth Australia

Contact: Justine Caines 0408210273

Budget Does not treat all Mothers Equally

Tonight Health Minister Nicola Roxon has made a landmark decision to enable midwives to work in their own right, providing women with care during pregnancy, labour and birth and the very important post-natal period funded under Medicare.

“The ability for women to choose a midwife has long been denied them. We applaud Minister Roxon for listening to women” said Justine Caines, mother of seven and secretary of Homebirth Australia.

“In the past successive Governments have put the needs of the powerful medical lobby ahead of Australian mothers. This pandering has resulted in rural maternity units closing, women accessing private health insurance paying huge gap payments and sadly too many women recounting their care during childbirth as traumatic, sometimes violent.” said Ms Caines

“Women and their families have been crying out for support. We believe that a fundamental step has been taken to bring maternity care back to women and local communities. We understand the reform process will take some time but can see major benefits ahead.” said Ms Caines

"Sadly, Minister Roxon has left some women out in the cold. Women who plan to give birth at home will not be able to access funding.” said Ms Caines

Mothers will make thousands of decisions for themselves and their babies. Such a pivotal decision about where and with whom they share the intimacy of birth should not be being dictated by others.” said Ms Caines

"Recent media reports reported on tragic events after births at home without a registered midwife. Conversely a landmark study from the Netherlands released recently of over 500,000 births proved homebirths to be as safe as hospital birth.” said Ms Caines

We have a long way to go to meet the Netherlands where their culture respects and supports natural birth and understands that in many instances birth is a normal life event, not a medical emergency. Over 50% of consumer submissions received by the recent federal review of maternity services were from women seeking the choice of homebirth. said Ms Caines.

"More and more women who give birth in hospitals are experiencing trauma. Some even suffering post traumatic stress disorder, something experienced by soldiers in war. It is these women, when unable to find a homebirth midwife that sometimes choose to give birth alone rather than face the trauma again." This is unacceptable. Said Ms Caines.

For interviews/photos with Homebirth mothers and babies please contact
Justine Caines on 0408210273

BUDGET NIGHT NEWS!

From Justine Caines

Health Minister, Nicola Roxon has announced Medicare funding (access to the PBS) and indemnity insurance for midwives.

http://www.health.gov.au/internet/budget/publishing.nsf/Content/budget2009-hmedia05.htm

By Nov 1 2010, midwives will be able to practice in their own right, providing continuity to women Australia wide (with recurrent funding)

THIS IS A LANDMARK DAY for women and midwives.

Sadly at this stage homebirth is not covered.

Whilst I feel like we have achieved an amazing achievement the icing is not on the cake.

Women must be able to choose where and with whom they share the intimate act of birth.

The work of Homebirth Australia and Maternity Coalition will continue.

I believe homebirth will be funded, we just need to keep it out there.

To the women and midwives who have worked so hard for so long, Thank you.

We have achieved an amazing feat.

I hope to work alongside you into the future.

In solidarity

Justine

Budget statement
“The Government will provide $120.5 million over four years for the introduction of Medicare‑supported midwifery services to provide greater choice for women during pregnancy, birthing and postnatal maternity care. This measure includes $3.1 million in capital funding in 2009‑10 for Medicare Australia.

The new arrangements will allow midwives to work as private practitioners, provide services subsidised by the Medical Benefits Schedule and prescribe medications subsidised under the Pharmaceutical Benefits Schedule. The Government will also provide subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings. To ensure that Australia maintains its strong record of safety and quality in maternity care, a safety and quality framework, including professional guidance and an advanced midwifery credentialing framework, will be developed. A new 24‑hour, seven‑days‑a‑week helpline will also be established to provide antenatal, birthing and postnatal maternity advice and information to women, partners and families during the ante‑natal period and up to 12 months following the birth of a child.

The measure will also assist women in rural and remote areas by expanding the Medical Specialist Outreach Assistance Program to provide integrated outreach maternity service teams for women in under serviced areas. The expanded teams will include midwives, obstetricians, general practitioners and other health professionals, such as paediatricians and Aboriginal health workers. Additionally, funding will be provided for the professional development of midwives and for general practitioners to undertake additional training to become GP obstetricians or GP anaesthetists. The package will be implemented progressively from 1 July 2009. “

NEW Activist group in N/W Sydney

It is with great pleasure that we would like to announce the launch of a new website, SAVE BIRTH CHOICES (www.savebirthchoices.com.au).


Save Birth Choices has been the initiative of a group of women; mothers and midwives in North/West Sydney, passionate about birth and keeping all birth choices available to Australian mothers. We have seen the wonderful efforts of organisations and individuals in response to the Maternity Services Review and felt it necessary to create a central spot that is aimed at educating the greater public and communicating the collaborative efforts of organisations around Australia.


This website was launched two weeks ago with very little publicity other than a facebook causes group which now has well over 1,000 members joined in the past week. We are excited and encouraged by the response to our admin email address and requests for information about the Maternity Coalition’s postcard campaign in particular.


What we are aiming to achieve with this website is support from the greater public for all birth choices rather than targeting only women and families directly affected. We would also like to communicate community events and be a point of referral for all campaigns for birth reform that are being run around the country but not making it to the attention of the greater public. We are not a birthing organisation. We have simply created a website to appeal to the greater public as a tool to help birthing organisations like yours and as such, we would like to invite you to utilise this tool.


What we are looking to advertise is

Birth education classes
Campaigns and events and
Relevant news


We would also like to add you as a supporter to our site and would greatly appreciate a reciprocal link.


If you have any questions about Save Birth Choices please feel free to send an email to admin@savehomebirth.com.au. This email address can also be used to forward information you would like posted on this site.



With warm wishes,
Anna Russell
On behalf of Save Birth Choices
www.savebirthchoices.com.au

Health Minister's Council

This report has been distributed to members of the Australian College of Midwives.

Last Friday, 8 May 2009, the Health Minister’s Council met to discuss some details of the National Registration Scheme for Health Professionals. A copy of the Communiqué is available at the website.

This Ministerial meeting was the latest in a project that has so far stretched over more than two years, with at least five such communiqués following Ministerial meetings.


Separate Registers for Nurses and Midwives

One positive decision of the Ministerial meeting was confirmation that there will be two separate registers managed by the Nursing and Midwifery Board of Australia – one for nurses and one for midwives. Previously it had been proposed that midwives would be members of a single register with nurses and enrolled nurses.

Midwives will be able to remain on both registers if they wish to, or elect to confirm their registration on the midwifery register but not the nursing one or vice versa. Separate registers will make possible distinct regulation of midwifery, as well as enhancing the ability for robust workforce data to be collected about midwives.



Continuing Professional Development

The Ministers also decided that all registrants in the new scheme will be required to demonstrate that they have participated in an approved professional development program during the preceding year. The Board for each profession will be responsible for determining which programs will be recognised.

The Nursing and Midwifery Board of Australia does not yet exist, but once it does ACM will apply for the MidPLUS program to become recognised programs that will assist midwives to meet this requirement. MidPLUS has already been endorsed by many of the existing state/territory Nursing and Midwifery Boards which is expected to assist with the application.



Professional Indemnity Insurance

In reviewing the Minister’s Communiqué, some people have concluded that it’s lack of reference to professional indemnity insurance means that this will not be required for registration. Unfortunately, this is not an accurate interpretation.

There was no discussion about professional indemnity -- for midwives or for any other health professional -- at this meeting because the meeting only addressed aspects of the scheme on which ministers and officials judged that changes were needed in light of consultations that have take place over the preceding six months.

We have not yet succeeded in persuading ministers to change the requirement that midwives, like all other registrants, be required to hold professional indemnity insurance, vicariously through an employer, or directly if self employed, even though such insurance is not currently available in Australia for private midwives.

ACM is continuing to lobby actively for federal government support to address the market failure in indemnity insurance for midwives, with a view to ensuring that all self employed midwives can access a policy before the new national register commences on 1 July 2010. We are also liaising with insurance industry representatives.



Mandatory Reporting

One of the areas of the Communiqué that raises some difficult questions is that of a decision by the Ministers that



“there will be a requirement that practitioners and employers (such as hospitals) report a registrant who is placing the public at risk of harm. Ministers agreed that reportable conduct will include conduct that places the public at substantial risk of harm either through a physical or mental impairment affecting practice or a departure from accepted professional standards. Practitioners who are practising while under the influence of drugs or alcohol, or have engaged in sexual misconduct during practice must also be reported. This requirement will deliver a greater level of protection to the Australian public”.

While ACM supports increased provisions to protect the public, we are at the same time concerned about how ‘a departure from accepted professional standards’ might be measured and applied. We will be seeking clarification on this point from the relevant officials at the earliest opportunity.



Handling of Complaints

Another potentially challenging aspect of the proposed new scheme is that there is not yet a clear and consistent process proposed for handling complaints of professional misconduct. The Health Ministers have essentially compromised differing interests and legislative requirements by agreeing that the details of how any such complaints will be handled will remain the responsibility of each State or Territory, which may choose to opt in to the national scheme processes, opt in for some aspects but not others, or continue to handle these things outside of the national scheme. This creates considerable uncertainty, and will impose an additional burden on midwives who may work in more than one jurisdiction as they will continue to need to be mindful of differing laws relating to their practice, as happens now. ACM will be actively seeking to ensure that the processes established by the Nursing and Midwifery Board of Australia follow appropriate processes of natural justice, and that appropriately experienced midwives are involved in all cases where the conduct of a midwife is being reviewed.


Student Register

Under the scheme, all students, including midwifery students, will be registered. The details of how and when are yet to be determined.

For more information about the proposed national registration scheme, visit the National Health Workforce Taskforce website link posted at the top of this email.


regards Barb
Dr Barbara Vernon
Executive Officer
Australian College of Midwives

Risk and homebirth: what’s at stake?

Published in ON LINE Opinion: Australia's e-journal of social and political debate
By Karen Lane and Kerreen Reiger - posted Wednesday, 6 May 2009

In the aftermath of the recent federal Review of Maternity Services, public debate on the relative merits of home versus hospital birth has been raging with more heat than light. Current affairs coverage of the topic has at times attracted the worst practices of the tabloid press. Alarmist headings such as “Why hospital horrors bring birth risks home” (Daily Telegraph, April 6, 2009) are not helpful to anyone engaged in this debate - not women, not midwives, not obstetricians and not policymakers.

As maternity service researchers and as mothers we make three arguments here. The first relates to media coverage of the topic. The second relates to the international evidence surrounding the safety of homebirth. The third relates to the future provision of optimal maternity services for Australian women. [continued]

Senate Inquiry into the National Registration and Accreditation Scheme for Doctors and other Health Workers

The Senate Inquiry into the National Registration and Accreditation Scheme for Doctors and other Health Workers is underway. The Committee is due to report by 18 June 2009.

The first 90 submissions have been published electronically at the inquiry site, and others will be added as they are processed. The Report will also be available at this site.


As readers of this blog know, independent midwives had hoped that, as an outcome of the Maternity Services Review late last year, our government would provide indemnity insurance for midwives, to enable us to continue private practice after 1 July next year. [Check the blog archive for this past January and February]
The Report of the Maternity Services Review failed to recommend insurance for midwives, which probably means that independent midwifery will cease to exist after 1 July 2010. The Report recommends passing the buck to a process that "could support an expanded role for appropriately qualified and skilled midwives, within collaborative team-based models" - ignoring the fact that appropriately qualified and skilled midwives simply want to do midwifery. We don't need to expand our roles to induction of labour, or to being some sort of mini-doctors.

The Report also made pronouncements that could remove what little access women currently have to homebirth:
"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 potential losers in this sad saga are not only midwives, and the midwifery profession, but also the women who hope to have a midwife who will accompany them through their most basic and primal journeys, in giving birth to their children.

GLOBAL: Shortage of midwives "deadly"

Reuters AlertNet

DAKAR, 5 May 2009 (IRIN) - The number of midwives worldwide would have to more than double to meet Millennium Development Goals of reducing maternal and infant deaths by 2015, according to the International Confederation of Midwives (ICM) and World Health Organization on International Midwife Day.

Maternal mortality is the "highest health inequity in the world with more than 99 percent of deaths [in pregnancy and childbirth] occurring in the developing world," World Health Organization (WHO), World Bank, UN Children's Fund (UNICEF) and UN Population Fund (UNFPA) said in a joint statement. In 2008 the agencies pledged to work with governments to fill the "urgent need for skilled health workers, particularly midwives", the statement says.
[continued]

the world needs midwives now more than ever

[Print: thanks to artist and mother Emma Flaim]

HAPPY INTERNATIONAL DAY OF THE MIDWIFE!




The Australian College of Midwives has elected to dedicate International Day of the Midwife for 2009 to the challenges faced not by our own profession but by a very important group of women and their families - those of Aboriginal or Torres Strait Islander background.

The maternity outcomes for Aboriginal and Torres Strait Islander mothers and their babies continue to be appallingly worse than those for non-indigenous mothers and babies. Babies born to Aboriginal or Torres Strait Islander mothers are more than 2.5 time more likely to die than non-indigenous babies. In a nation as comparatively wealthy as Australia this is a national disgrace. The federal government is working with the state and territory government to try and close the gap in life expectancy for Aboriginal and Torres Strait Islander people, with a multi million funding package over the next few years targeting a range of health and other issues.

While such a high level political commitment is vital and important, it's not the whole answer to resolving the problems faced by Aboriginal women who become pregnant.

Experience overseas indicates that it is also vital for Aboriginal women have increased access to continuity of midwifery care and ideally from midwives who are themselves Aboriginal. Inuit midwives in Canada, and Maori midwives in New Zealand have contributed to major reductions in maternal and infant mortality in their respective homelands. Participation in antenatal care has increased, rates of smoking and drinking during pregnancy have lessened, and rates of pre-term birth and low birthweight have reduced, to the point where in New Zealand, Maori women now benefit from the same rate of maternal and infant mortality as for non-Maori New Zealanders.

The compassion of most Australians towards their Aboriginal and Torres Strait Islander fellow Australians we perhaps no where more evident than when tens of thousands of Australian took to the streets in support of Reconciliation in the late 1990s in the face of refusal by the then federal government to acknowledge the pain and suffering of the 'stolen generations'.

In a spirit of reconciliation, the Australian College of Midwives has decided to do something practical. We are establishing a trust from which we propose to pay annual grants to Aboriginal women studying to become a midwife. Aboriginal midwifery students receive some funding assistance through the federal government. However this is often not sufficient to defray the incidental costs of studying, such as travel to and from clinical placements, purchasing textbooks, or paying for childcare to provide some time and space for study.

We hope to build up a sufficient capital pool to make it possible to provide one-off grants to Aboriginal midwifery students in an effort to support more Aboriginal women to become midwives.

Fundraising for this trust begins today!

You can help to make a difference to Aboriginal and Torres Strait Islander women and babies by making a donation, however large or small, via the College website.

Just go to www.midwives.org.au and click on the Aboriginal Midwives' Trust Donate Now Button on the home page.

100% of all donations received will go to the Aboriginal midwives' trust fund.

ACM and national registration - an update from Barb Vernon

I am writing to provide you with an update for ACM members on the vexed issue of national registration for midwives in private practise in 2010.

Firstly I'd like to reiterate that the ACM takes very seriously the potential for private midwives to be unable to re-register once national registration commences in 2010, due to the lack of affordable professional indemnity insurance and the insistence of the Council of Australian Governments that this requirement be linked to registration.

We have been active in pointing out to the Minister for Health and others the dire consequences if the insistence on evidence of professional indemnity is retained when private midwives are unable to comply with this requirement. The recent tragic death of a baby born to a mother who was unattended by a midwife reported in the media has given additional gravitas to the arguments put to government: that by effectively depriving women of registered midwives to provide care for birth at home, the risks to mothers and babies would become unacceptably high. Not to mention the totally preventable impact on members of the midwifery profession who are among the most experienced clinicians.

There is understandably much discussion on this issue among midwives providing care for homebirth, or interested in doing so, across Australia. It is important that such discussion is well informed To assist with informed discussion of the issues you may find it useful to be aware of the following points (not in any particular order of priority)

1. ACM has been advocating to the officials and ministers responsible for national registration of health professionals on the issue of access to indemnity for private midwives since the project commenced in 2006. This issue well and truly pre-dates the Rudd government, and the Maternity Services Review.

2. The national registration process seems to be proceeding apace but, frustratingly, there is no information about progress being shared by the officials leading the process at present. There was due to be a consultation form in April that was postponed indefinitely due to the creation of the Senate Inquiry into the National Registration Scheme Project, which may affect the timelines for implementation of the scheme

3. ACM has consistently opposed evidence of professional indemnity being a requirement of the scheme while private midwives are unable to access such indemnity. While we support the principle that consumers should have recourse to compensatory funding if they prove negligence (in the absence of any other funding support for parents or children with catastrophic injury related to childbirth, this is an ethical stance), but we have been advocating strongly to the federal health Minister, the department of Health and Ageing, the COAG officials and others since 2007 when the details of the scheme were first made public, that midwives are unable to meet this requirement and it must only be applied if midwives are again able to access affordable insurance as they were up to July 2001.

4. ACM has been actively collaborating with the member bodies of the Australian Peak Nursing and Midwifery Forum - which includes the Australian Nursing Federation, the Australian Nursing and Midwifery Council, the Royal College of Nursing Australia, the Congress of Aboriginal and Torres Strait Islander Nurses, and the Council of Deans of Nursing and Midwifery - in lobbying the Council of Australian Governments to respond to 2 key issues affecting midwives under the proposed national registration scheme. These include the establishment of a separate register for midwives from nursing (it was proposed midwifery would return to being a specialty of nursing) and the necessity of either exempting private midwives form the requirement to prove they hold professional indemnity, or resolving the market failure in indemnity to ensure they do have access to this before the national scheme begins. All APNF members have supported midwives in making these arguments to the ministers and officials. To date it looks as though there has been progress on gaining a separate register, but the indemnity issue remains unresolved....as yet.

5. APNMF has also submitted a submission to the Senate Inquiry into the National Registration scheme in the past week. APNMF members all endorsed additions by ACM to the submission which highlight the negative impact of the scheme on the safety and quality of maternity care if private midwives are unable to secure re-registration because of the lack of indemnity insurance.

6. The College has also prepared formal letters to all Australian health ministers, which will be sent out next week, on the issue of national registration and indemnity for midwives. I'll send you a copy of the letter once it is finalised. If any member who has not already done so wishes to write to their state health minister about these issues that would be useful. The health ministers have collective carriage of the national registration scheme implementation.

7. ACM has also met in recent weeks at 2 separate meetings with the CEO and Board of Directors of a major professional indemnity insurer. There is nothing concrete from these discussions as yet - but some promising lines of discussion. The insurer is targeting all health professions - not just medical practitioners and did not seem to have pre-conceived views of either midwifery or of homebirth. But there is much more discussion needed before we can be optimistic this might become a solution. Nevertheless it's an encouraging first step, more so than anything else over the past 8 years since indemnity became unavailable.

8. Lastly, and it probably goes without saying, the College has sought to advocate for midwives actively in the media. This has included mainstream television programs like the 7.30 Report, the Sunrise program and the Today Show, as well as in newsprint and radio media. A range of spokespeople have attempted to convey the importance of women being able to continue to choose the care of a midwife for birth at home after the advent of national registration. It is not always easy to get your message across. The appetite of the media for conflict as the basis for any story works against sensible and informed coverage of the issues sometimes. Nevertheless we are persisting.



Thank you to all members who are actively working to raise awareness of these issues with local, state and federal politicians, in your local media. It all helps. We will endeavour to keep you informed of any progress on this important issue.

regards Barb

Dr Barbara Vernon
Executive Officer
Australian College of Midwives

Email: executiveofficer@midwives.org.au

Tel: 02 6230 7333

Mob: 0438 855 529

Website: www.midwives.org.au