Thursday, October 6, 2011

mipps and public hospitals in Victoria

Independent midwives in Victoria have for many years encouraged and guided women planning homebirth to make backup bookings with public hospitals. Those women who experience complications are referred to the back-up hospital. The midwife usually continues with the woman in labour, visits her in hospital postnatally, and picks up postnatal care after the woman and baby have been discharged. This process does not usually receive any special attention; it's just the way midwives work. Recent posts have discussed the midwife's role in hospital based intrapartum care.

A multi-disciplinary reference group has been brought together by the Health Department, to inform and support a process under which eligible midwives (ie midwives who have a notation on their registration that they are eligible for Medicare*) will be able to attend women privately in public hospitals.

This action by the State Health Department is an outcome of the [Federal government's] National Maternity Services Plan, which requires “... jurisdictions (to) develop consistent approaches to the provision of clinical privileges within public maternity services, to enable admitting and practice rights for eligible midwives and medical practitioners ...”

There are many details to be worked through, and of course the issues for rural/regional hospitals are often different from the big metro hospitals. Of particular interest to all concerned is the development of a process whereby a midwife has is able to book and admit a woman privately to hospital, attend her for antenatal care, and for birth in the hospital, and postnatal care in the hospital and the woman's home. The process would require the midwife to have a clear arrangement for referral to an obstetrician if indicated. Since most public maternity services have obstetricians and GP-obs covering the service on a roster system, the midwife and her client need to tap into that process of cover.

Hospitals have processes in place for 'credentialling' visiting medical officers.  Processes that are set up for midwives will be consistent with those for other health professionals.   When a woman is admitted as a patient of a private obstetrician, the hospital provides midwives and other staff and services that are considered necessary to enable appropriate care.  This is also the expectation of midwives.  We anticipate having access to the full range of services and personnel within the hospital's operating systems.

Midwives have been asked if they are also pursuing visiting access in private maternity hospitals. This option would fit quite well with the legislation, National Health (Collaborative arrangements for midwives) Determination 2010. However, anecdotal reports from midwives who have considered this option lead us to doubt that private hospitals or the obstetricians who work in them will welcome collaborative arrangements with midwives for midwife-attended births. One concern is that Dr A might be very happy to work with Midwife B, but Dr A works only 1 weekend in 3, and Dr A's colleagues, Drs C and D, do not agree to a collaborative arrangement with Midwife B.

Midwives, hospitals, and government face a complex and multi-faceted area of endeavour as we proceed along the road to visiting access to public hospitals.  We know that it can be done.  Midwives in New Zealand, Canada, the UK, and many European countries have access to hospitals as well as homes.  The goal is that the woman and her baby have the opportunity to receive consistent expert care from a known and trusted midwife, who is able to provide primary maternity care in any setting.

* eligibility includes access to PBS, the Pharmaceutical Benefits Scheme, by which midwives will be able to prescribe certain medicines.  Before this reform can be realised in Victoria, legislative reform is required to the Drugs, Poisons and Controlled Substances Act.  Eligible midwives are required to sign an undertaking that they will complete a course of study in prescribing/medication management for midwives within 18 months of having the notation on the register.  To date there is no course approved by the regulatory body for this purpose.

No comments: