Wednesday, July 3, 2013

Is there any progress toward hospital visiting access for privately practising midwives?

"Yes", and "No."
(don't hold your breath!)

Readers of this blog are probably aware that Australian government reforms that were implemented in November 2010 provided pathways, namely professional indemnity insurance and public funding via Medicare, that support eligible midwives to attend women privately throughout the months of maternity care from early pregnancy to six weeks after the birth.  Medicare funding for labour and birth (Items #82120 and #82125) applies only when the birth takes place in a hospital at which the midwife has been granted visiting access/clinical privileges.

So far, Victorian midwives have been unable to achieve the goal: there is no hospital that grants private access for midwives.   

For some of the background to the hospital credentialing process in Victoria, click here, or use the 'search this blog' function in the right column.

Is there any progress toward hospital visiting access for privately practising midwives?

"Yes."  We have been advised that the Maternity and Newborn Program within the Victorian Health Department is in the process of publishing a guide, which gives a framework for public health services (hospitals) to participate in collaborative arrangements with eligible midwives, including admitting and practice rights.

... and "No."  Before we celebrate, we are reminded that there is a big proviso: the individual health services are self governing, and have 'discretion', meaning that this guidance framework from the Victorian government's health department does not have any authority that would require a health service to open its doors to midwives.

Midwives in Melbourne who have written to, and visited, local public hospitals to express interest in being amongst the front runners in this new venture have received professionally polite but distinctly negative responses.   A considerable number of midwives have resigned from their hospital employment after they received their eligibility for a Medicare Provider Number - which applies to private midwifery practice, not employment.  These midwives have expressed frustration at the lack of support in the profession, and in the community, for what many consider to be the most advanced scope of clinical practice for a midwife.  These midwives are now being 'up-skilled' as homebirth practitioners, because homebirth is the only setting open to midwives to provide continuity of care and to attend births.

Midwives who are interested in applying for visiting access at one or more public hospital(s) that provide maternity services will need to prepare for a new round of letters to hospital management.  As we wait for, and lobby for change, we continue to remember that the midwife is 'with woman'; that the best setting for birth is something that is often explored as a woman progresses in labour, and the midwife's actions are intended to ensure the wellbeing and safety of a mother and her child.

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