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.

letter to doctors

A letter is being distributed to doctors in Victoria who have agreed to participate in collaborative arrangements with midwives.

Re: INFORMATION FOR OBSTETRICIANS AND GPs

Dear Doctor

This letter is being sent to doctors who have worked with midwives in providing access to Medicare rebates for antenatal and postnatal private midwifery services.  We understand that this new option, which has been available since November 2010, has brought about changes in the way midwives and doctors collaborate in maternity care. 

Collaboration

Midwives who have achieved notation on the Nursing and Midwifery Board of Australia (NMBA) Midwives’ Register as ‘eligible’ are able to apply for Medicare provider numbers.  Certain antenatal and postnatal items attract rebate; the proviso being that there is a collaboration arrangement with a doctor for that particular woman.  The requirement for collaborative arrangements between participating midwives and medical practitioners is to provide pathways for consultation, referral or transfer if or when the woman’s care requires it.  Midwives in Victoria are not, at present, able to provide intrapartum care that attracts Medicare rebate for our clients in hospitals.

Midwife prescribers

Midwives are also able to undertake a course in pharmacology which leads to endorsement on the public register. Once endorsed, the midwife may apply for a Pharmaceuticals Benefits Scheme (PBS) number and prescribe certain medications for mothers and babies.  The changes to Victoria’s drugs and poisons legislation which enables endorsed midwives to become prescribers was gazetted 30 November 2012 http://www.gazette.vic.gov.au/gazette/Gazettes2012/GG2012S410.pdf#page=1 .  This document contains the list of medicines from the poisons schedules 2,3, 4 and 8, which midwives are now able to prescribe.

A participating midwife can order some pathology tests and investigations, and can refer women and babies directly to obstetricians and paediatricians.  The midwife is required to send a copy of the results to the collaborating doctor.

Home birth services provided privately by a midwife do not attract Medicare rebates, even if the midwife is participating in the Medicare scheme. Homebirth services may be claimable through certain private health funds.  Hospital backup arrangements for women planning homebirth are made with the nearest suitable public maternity hospital, and may involve a booking in process.  Arrangements for referral and transfer of care to hospital in acute situations are made by the midwife in attendance.

Midwives and insurance

All midwives are required to have professional indemnity insurance. Privately practising midwives purchase insurance that covers them for antenatal and postnatal services. Midwives with Medicare eligibility have access to a Commonwealth-subsidised professional indemnity insurance (http://www.miga.com.au/content.aspx?p=160 ) for the ante and postnatal care they provide, as well as the birth services that they provide in hospitals to their private clients.

If you have any further questions about midwives and Medicare; what services they may provide, or how to work with a midwife who has Medicare, you could contact the Australian College of Midwives.

The midwives whose names and practices are listed below are Victorian midwives who are Medicare-eligible, or who are in the process of obtaining notation for Medicare.  We look forward to continuing professional cooperation between midwives and medical practitioners, in providing effective and safe maternity services for mothers and babies in our communities.

We also take this opportunity to extend to you Season’s Greetings.