Monday, January 31, 2011

Private midwifery in Victoria at the end of January 2011

This post is a brief round-up, especially aimed at midwives considering private practice as a career option, and women considering employing midwives to attend and work professionally with them throughout the birthing continuum, including when they give birth.

Eligible midwives
Midwives are now able to apply for eligibility for Medicare provider numbers, thereby enabling clients to claim certain rebate on the midwife's fees. For more information on eligible midwives, go to the APMA blog. If you would like further detail on the $ amount that is rebatable, and the items under Medicare, please send an email request to the blogger, joy[at] [email address not hyperlinked, as this can encourage spam] The amount of rebate that a woman with an uncomplicated pregnancy and birth could expect to obtain via Medicare, for private midwifery services, is about $700 for the antenatal and postnatal care segment, and $724 for attending birth in hospital, working as the private midwife with clinical privileges/visiting access in that hospital [an option that does not yet exist in this State]. Note that there is no indemnity insurance for home birth, and no Medicare item number for home birth.

Collaborative arrangements
Midwives who have Medicare provider numbers are required to comply with laws that describe suitable collaborative arrangements, in order to avail their clients of rebates. This requirement is discussed in greater detail at the APMA blog.

Hospital visiting access
Midwives who have Medicare provider numbers and are insured with the inndemnity insurance product that has Government underwriting are theoretically able to apply for visiting access/clinical privileges at a public maternity hospital. Meetings and correspondence between Victorian hospitals and midwives have, to date, failed to provide any pathway by which this option is actually possible.

Homebirth can now be accessed either privately, with independent midwives, or in a couple of public hospital pilot projects. These are through Sunshine hospital (in the Western suburbs) and Casey hospital (in the outer South-Eastern suburbs). The announcement of these homebirth programs is available in an earlier post on this blog.

A message left by 'Shane' stated
I have recently met two of the midwives and one obstetrician working in this program and it seems wonderful. I am keen to read the evaluation and to hear of the outcomes, in terms of women's satisfaction, neonatal and post-natal morbidity and mortality,caesarean rates and maternal morbidity and mortality.

We do not have outcome statistics from these programs yet. There is usually a lag of a couple of years before statistics are published. Many interested parties will be keen to see those statistics, and any other research that is done. I expect there will be a few academics lining up to write Masters and Doctorate theses.

MidwivesVictoria keep our ears to the ground for news, and share it with our readers when ever possible. We have heard that Southern Health is planning a new homebirth program from its Clayton campus, providing homebirth services for 50-60 women per year.

We have also been informed by women who have made inquiry about homebirth through these publicly funded services that:
  • Women must agree to all the tests and investigations that are offered
  • Women who intend to avoid the injection of oxytocic drugs for Third Stage are excluded from planning homebirth
  • Women who are having their first baby (primipara) may be discouraged from planning homebirth.

No comments: