Sunday, November 3, 2013

MiPP today

Midwives in Private Practice (MiPP) is a collective that has operated continuously since the late 1980s, providing peer support, continuing professional education, and a voice for its members.  MiPP has approximately 30 members, some of whom have ‘eligible midwife’ notation on their registration; a few have prescriber endorsement; some are in the process of achieving these; and all are offering their services as midwives with caseloads, providing primary maternity care in a way that is consistent with the ICM Definition of the Midwife (2011).  

A dozen or so midwives have joined the MiPP ranks in recent times.  Most have achieved eligibility for participating in Medicare, and have either resigned their hospital positions, or cut back their employed hours, to enable focus on, and build, their private practices.  Others who have graduated recently do not yet have the three years’ full time equivalent midwifery experience, required for application for notation.

MiPP is a participating organisation in Maternity Coalition.  This governance model has allowed MiPP to focus on professional matters, while supporting, with our membership fees and more, the bigger maternity reform agenda, working with other “individuals and groups who share a commitment to improving the care of women in pregnancy, birth and the postnatal period.” (Maternity Coalition Constitution 2008)

Homebirth is the main practice setting for MiPPs.  No midwife in Victoria has achieved a collaborative agreement with a hospital to cover intrapartum care in the hospital - the only birth option for which midwives are able to purchase indemnity insurance.  This is a matter of ongoing concern to the MiPP and homebirthing community.  Under federal health practitioner legislation, midwives (and all regulated health professionals) are required to have professional indemnity insurance.  However, as there is no indemnity insurance product available to cover private midwives attending homebirth, an exemption has been granted for homebirth, until 2015.

There is no record of the number of women who employ a midwife privately to provide antenatal care, attend them in labour at home, and support them for birth in hospital, with the intention of providing continuity of care, promoting normal birth, and continuing professional services postnatally.  In this model the private midwife is sometimes referred to as “just a support person”, because she has no authorisation by the hospital to practise.  However restricted the role, we note that ’support’ is a legitimate part of midwifery.  Furthermore, we know that the midwife will be judged as a midwife – not as “just a support person”, if actions by the midwife are thought to amount to conduct that is a significant departure from accepted professional standards.  
Having noted that midwives attending homebirth are, at present, exempt from the requirement for professional indemnity insurance, it is clear that there is no such 'exemption' for the practice of providing private support for a woman who is planning to give birth in hospital.  The NMBA Guidelines for Professional Indemnity Insurance for Midwives state that:
"Under section 129 of the National Law, midwives must not practise their profession unless they are covered in the conduct of their practice by appropriate professional indemnity insurance arrangements."

It would appear that the midwife who accompanies a woman to hospital, either when transferring care from planned homebirth, or when providing continuous midwifery support in planned hospital birth, is practising without professional indemnity insurance.  It could be argued that the midwife who has no clinical privileges in a hospital is thereby prevented from practising, but, as noted above, the midwife is still a midwife, and may be judged as a midwife if there is a professional investigation into conduct.

As has been documented in this and other social media and professional sites, maternity reform has been, at times, a bumpy ride.  Legislative change takes many years to accomplish.  There is no easy solution to our professional indemnity problems, on the horizon.

Your comments are welcome.

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