Wednesday, August 4, 2010

New information on professional indemnity insurance for midwives

The scanned page here is from a Draft Summary of Professional Indemnity Insurance for Midwives, developed by the  NMBA.  This flow chart outlines the process for midwives to comply with the professional indemnity insurance (PII) requirements of the National Registration and Accreditation Scheme which has been in effect since 1 July this year.

When I have found a link to the document at the NMBA website I will add that to this post.

As has been clearly stated for all to read, in this and other blogs and professional websites, midwives have sought to protect our right to practise midwifery as it has been defined internationally by the ICM - see Definition of a midwife. This ICM Definition is foundational to all Australian midwifery codes and courses of study. It is not something that can be ignored by legislators or regulators.

According to this flow chart, there are three options for private midwifery practice.

1. ONLY PROVIDING HOMEBIRTH intrapartum midwifery services with no antenatal or postnatal care. --- Midwife does not require PII.

2. and 3. Midwife intends to provide private antenatal, intrapatum care in hospital setting &/or postnatal care. --- Midwife must purchase PII.

#2 Midwife provides private midwifery services for pre and postnatal care without any access to Medicare, and purchases appropriate PII.

#3 Midwife provides private midwifery services for pre, intra, and postnatal care, and has the notation by the NMBA as a midwife who is eligible for Medicare. The midwife purchases PII from the Australian Government-supported authorised insurance provider.

Option #1 is unreasonable - UNPROFESSIONAL!
There is no point in calling ourselves midwives if we cannot practise midwifery. It's outrageous to be forced into being in the position, as this flow chart indicates, of "Only providing homebirth intrapartum midwifery services with no antenatal or postnatal care." What sort of midwife would take professional responsibility for homebirth without also providing prenatal and postnatal services? How is it that a body charged with regulation of midwifery in this country should consider a statement like that reasonable, that it should appear in a draft flow chart under the NMBA letterhead?

This is madness, as the regulators try to squeeze a square peg (NRAS) into a round hole (midwifery). The requirement for PII, with the 2-year exemption for homebirth, was never a workable arrangement.

The midwife is 'with woman' - not 'with homebirth'! In normal, physiological labour the woman and her midwife agree on the best place for birth as progress and other events at the time are taken into account.

1 comment:

Joy Johnston said...

A colleague has suggested that I am being excessively critical of the NMBA in this post, in that the Board has been handed the mess
that politicians and bureaucrats have caused.

That may be the case.

But, the NMBA have put out this draft flow chart of professional indemnity insurance for midwives, acknowledging the exemption for homebirth, and posing a totally unprofessional solution for women in the care of midwives who attend homebirths without any insurance.

The regulatory boards are there to "Protect the public". They have to make regulatory standards that are in the public interest - which this one clearly is not.

This standard puts the lives of mothers and babies at risk.

Let's not look at the midwife - look at the woman. Midwives are supposed to provide woman centred care. Look at the woman at the centre of that option of care where the midwife only provides intrapartum care. Perhaps this woman will have a visit with the GP and may even have some antenatal care with the local public hospital. Perhaps she is well nourished and fit and all's perfect. What happens when postnatally the midwife drops in for a cuppa and recognises jaundice? Will that midwife facilitate the urgent review of the baby at a hospital with the capacity for treatment, or set up an inadequate level of phototherapy in the sunlight (if there is any)? Will the midwife play this absurd and pointless game that she/he cannot give postnatal care. Will the midwife coach the parents as to what they can and can't say about her/his involvement in their care, that she/he just happened to drop in for a cuppa and to bring over some fresh scones and noticed that this baby who is not yet 2 days old is a bit orange?

What about Rh Negative women in this group?

What about early breastfeeding problems in this group?

We need to call a spade a spade. The NMBA will act with all its considerable authority and power if a complaint is made against a midwife. Their duty to the public, in whose interest they are bound to act, is to refuse to publish a Registration Standard that is so clearly compromising the care of individual women and babies.