Tuesday, May 15, 2012


please click on picture to enlarge
Last week I reported on the Senate motion calling for immediate action on the obstacles facing privately practicing midwives in Australia.
"Roadblocks frustrating women's right to choose a range of birthing arrangements needs clearing." ... "It is time governments across Australia joined together to enable midwives to properly do their work." 

The Senate motion focused on the ROADBLOCK of obstruction midwives face in seeking access to hospitals, enabling us to properly do our work, attending women through the labour and birth of their babies, in addition to pre- and postnatal services.

Another ROADBLOCK that midwives face is the veto given to doctors through the requirement that a signed collaborative arrangement be made to enable women to claim Medicare rebate on the fees of midwives who are participating in Medicare.

Here's an actual scenario:
Ms A is pregnant with her first baby, and has been seen by local GP/Obs/Womens Health Dr B.  Ms A then decides she would like to be in the care of a midwife who will attend her privately in labour.  Ms A is undecided as to whether she wants to give birth at hospital or at home.  It's all very new to her!

Ms A visits Midwife C, who agrees to the booking, and advises her about a collaborative arrangement.  Ms A visits Dr B, with a letter from Midwife C explaining the collaborative arrangement requirements of Medicare, and requesting a referral for antenatal and postnatal midwifery services. (and that's where it gets interesting)

Dr B's response, in writing, is:
"Unfortunately we [Dr B and Midwife C] have neither met nor previously worked together professionally and I have no knowledge of your practice, your approach to patient care, and your professional experience. Clearly you will understand that I am unable to participate in a collaborative arrangement unless I am completely confident that Ms A will be provided with the best standard of practice.
"A clear written agreement between patient, nurse practitioner [this is the first mention of a nurse practitioner] and the nominated medical practitioner is essential to ensure that there is clear delineation of roles and responsibility, to avoid misunderstanding and to ensure the best patient outcome.
"In summary in order to collaborate with a midwife on the antenatal/postnatal care of a patient I need a copy of current registration and indemnity insurance, schedule of visits planned and routine investigations to be ordered and protocol for sharing records/results/referrals/transfer, prescribing arrangements, protocols for following up abnormalities and plans for communication/consultation with named medical practitioner including where and how these would occur and remuneration arrangements. ..."
A first reading of this letter might lead one to believe that the doctor is acting with integrity. However, if this doctor’s requests were followed by Midwife C it would set up another tier of regulation, and another tier of responsibility on the part of the doctor.  A midwife who has achieved eligibility for Medicare has undergone a rigorous application process which includes extensive professional monitoring.  The midwife's registration can be checked on the public register, and there would be no point in complying with the collaborative arrangement rules if the midwife did not actually have current participation in Medicare. 

When GPs write referrals to psychologists, or dentists, or other ‘allied health’ funded under Medicare’s extended care arrangements, do they ask for a similar level of disclosure? I doubt it.

The closing phrase in the quote from Dr B "and remuneration arrangements" suggests there might be something else on her mind -- $$.  After all, why would a doctor whose livelihood is partially reliant on women, such as Ms A, want to refer Ms A to a midwife? Conflict of interest? Undoubtedly.

This letter demonstrates the unworkability of the collaborative arrangement ROADBLOCK as it stands.  The legislation attached to the government's maternity reforms is in and of itself preventing midwives from  properly doing their work.

This is the opinion of the writer.  Your comments are welcome.
Joy Johnston

Friday, May 11, 2012

Senate passed motion to support private midwives

From Greens Senator Lee Rhiannon

Senate support private midwives

10 May 2012 | Health, including preventive / Women

The Senate today passed a motion calling for immediate action on the obstacles facing privately practicing midwives in Australia.

"The government set aside $120 million in 2010 for midwives in private practice to access Medicare and the PBS, but hardly any have been able to do so," said Dr Richard Di Natale, the Greens Spokesperson on Health. "Because they can't get visiting access rights, they can't be by their patients if they get admitted to public hospitals."

The Senate motion called upon the government to work with states to resolve visiting access issues and to clear any other roadblocks preventing privately practicing midwives accessing Medicare and the PBS.

"This situation has to change. Mothers want and expect continuity of care, not to have to say goodbye to their chosen midwife at the hospital doors. The Senate has now recognised the issue and it is now up to the states to deliver."

Australian Greens Senator and spokesperson for women Lee Rhiannon said:
"Australia is still well behind when it comes to midwifery compared with other nations such as Norway. "Roadblocks frustrating women's right to choose a range of birthing arrangements needs clearing. "Midwives are known to provide extremely safe and high quality care, facilitating continuity over the pregnancy, birthing and post natal periods.

"It is time governments across Australia joined together to enable midwives to properly do their work."

Motion Notes 

on 1 November 2010 $120.5 million was made available to improve choice and access to maternity services, and for eligible midwives to work in private practice Australia; to provide greater access to maternity care provided by midwives, Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) benefits were made available for services provided by eligible midwives; eligible privately practicing midwives are not currently able to work to their full scope of practice and claim MBS and PBS because access and admitting rights to public hospitals have not been established by state and territory governments.
Calls on the Minister for Health and Ageing to work with COAG and Australian health ministers to urge state and territory action on access and admitting rights to public hospitals for eligible privately practicing midwives; investigate any further support necessary for privately practicing midwives to transition into private practice, to work to their full scope of practice and access MBS and PBS benefits; and consult with stakeholders.

Friday, May 4, 2012

NMBA celebrates International Midwives' Day

Media release
4 May 2012
Nursing and Midwifery Board recognises special day for midwives 

The Nursing and Midwifery Board of Australia (the National Board) recognises the important role of midwives in communities across the nation. May is an important month for the midwifery profession with the International Day of the Midwife being commemorated worldwide tomorrow – 5 May 2012.

More than 39,000 midwives are currently registered with the National Board. The International Day of the Midwife has been celebrated since 1991 and in 2012 the commemorative day’s theme is ‘Midwives Save Lives’.

National Board Chair Anne Copeland said the day was a perfect opportunity to reflect on the invaluable contribution of midwives not only in Australia but globally in tackling maternal, newborn and infant mortality. “Midwives working in Australia take pride in their work of caring for women and their babies. Midwives also contribute to the midwifery profession by providing important feedback to the National Board on registration standards, professional codes, standards and guidelines, and consultations relating to midwifery practice”, Ms Copeland said. “Their willingness to engage with the National Board is vital when determining evidence-based standards to guide the profession”.

The National Board plays a key role in keeping the public safe by ensuring that women have access to qualified and competent midwives to provide quality care. “The fact that midwives can now prescribe scheduled medicines as an eligible midwife is an example of progress within the midwifery profession in Australia and is a further service to the community in expanding the right to choose a specific health care provider”, Ms Copeland said.

The National Board welcomed the opportunity to approve the inaugural program of study from the Flinders University, a Graduate Certificate Midwifery (Leading to Endorsement for Scheduled Medicines for Eligible Midwives) on Monday 30 April 2012. The implementation of this approved program of study will enable the existing 114 eligible midwives, once their study is completed, to obtain an endorsement to prescribe scheduled medicines and practice to their full scope of midwifery practice.