media

Herald Sun today
HOME births would be driven underground by new maternity laws, a Senate committee has admitted.

The community affairs committee said that without special insurance, midwives would be unable to legally practice. ...


Geelong Advertiser

Fight for right to homebirth

Nick Wade
August 18th, 2009

MELISSA McFarlane is devastated expectant mothers could soon be denied the right to the intimate and private homebirths she received. ...


Sydney Morning Herald

Midwife laws may force homebirths underground

Mark Metherell and Kate Benson
August 18, 2009

A SENATE committee has acknowledged that proposed legislation for midwives may ''drive homebirths underground''. ...

Medical Observer

Midwife indemnity plan may spark GP obstetrician exodus

Andrew Bracey - Friday, 14 August 2009

GP obstetricians could ‘down tools’ as a result of Federal Government plans to allow midwives to practise independently with subsidised indemnity insurance.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has warned the move could drive up doctors’ insurance premiums and force them to quit practice.

“Obstetricians may be called in too late to manage an obstetric emergency and have to face the blame for a poor outcome, when an earlier referral may have averted a crisis,” the college said.

“[If] premiums rise, that could be a considerable driver for doctors [to exit] the obstetric workforce, and we are already on... a knife edge with workforce,” RANZCOG president Dr Ted Weaver said.

The college warning comes as three pieces of legislation were introduced to Federal Parliament that would expand MBS and PBS rights for midwives and nurse practitioners, and provide the former with federally subsidised indemnity cover.

In submissions to a Senate inquiry into the legislation, doctor groups have called for clearer detail on the proposed collaborative models of care, amid fears the legislation will lead to fragmented and lower standards of care (MO, 31 July).

The Federal Health Department has indicated midwives would pay around $7500 annually for a policy. GP obstetricians, on average, pay more than $10,000 for cover, while obstetricians pay close to $50,000.

AMA president Dr Andrew Pesce told MO that the tendering process now underway to find an insurer for midwives was premature, given the lack of detail regarding the necessary collaborative care models.

A spokesperson for Health Minister Nicola Roxon said MBS and PBS rights would only be eligible to midwives involved in collaborative arrangements with appropriate referral pathways.

“Under these circumstances, there is no basis to assume that there would be upward pressure on premiums for obstetricians,” the spokesperson said.





MATERNITY COALITION MEDIA RELEASE: Monday 17 August 2009

“Senate Inquiry”- committee supports homebirth but legislates it out of existence.

Six Senators, three parties and nearly 2000 members of the public expressed their support for women’s right to choice in birth care, in today’s Senate Committee Report.

The Senate Community Affairs Legislation Committee today reported on their inquiry into the “Medicare for midwives” Bills, currently before Commonwealth Parliament. Although the Report is divided into majority, minority and dissenting reports, all reports recognise the benefits to women from granting Medicare for midwifery services, and the need for women to have access to homebirth care with a registered midwife.

“The clear message from this Senate Committee Report is that an insurance solution must be found to allow ongoing access to homebirth as a safe choice for Australian women”, said Lisa Metcalfe, President of birth consumer group Maternity Coalition. “The Government Senators majority report fails to provide a solution in their recommendations.”

“In the 1,915 public submissions to the inquiry Australian women are saying that they will continue to make independent choices about their births, but they will not be afforded the basic right to access a registered midwife for birth at home if the Midwifery Bills are passed as they stand.” said Ms Metcalfe

“Maternity Coalition is appalled that in less that 12 months from now, the only choice for women birthing at home will be to use an un-registered carer. Where is the safety or sense in that?” said Ms Metcalfe

“The Senators join Australia’s midwifery and nursing organisations, consumer groups, and international experts in recognising midwives as skilled caregivers, and homebirth as a legitimate choice. The responsibility is now squarely back on Minister Roxon’s shoulders to deliver a comprehensive insurance solution before July 2010 which allows every woman to have every choice in their birth care”, said Ms Metcalfe.

The full report is available from:

http://www.aph.gov.au/Senate/committee/clac_ctte/health_leg_midwives_nurse_practitioners_09/report/report.pdf

Maternity Coalition’s fact sheet on the current threat to homebirth is at:



Media contacts:

Maternity Coalition National President Lisa Metcalfe, Phone: 02 4268 1675 or 0437 577 576

Australia’s national maternity consumer advocacy organisation

Homebirth Whisperer

Guest Blogger Robyn Thompson writes, in response to an article in the Herald Sun On-Line, August 11, 2009

HOMEBIRTHS will be driven underground by Rudd Government moves to force midwives to be insured.
“Some 200 midwives could be driven to practice clandestine homebirthing because they will be denied indemnity insurance, the Opposition says”.

True. Australian private midwives, given the green light at the Senate Inquiry (8/8), are safe to continue to practice without insurance, so long as they don’t use their well earned academic Title MIDWIFE.

On the cusp of critical Australian Health Reform, evolutionary generations of Australian ‘Homebirth Whisperers’ are on the horizon.

Midwives, likely insurers and the Health Minister are damned if they do and damned if they don’t. In fairness the Australian Health Minister never intended this political and professional debacle, she warned the professions from the outset to reach a workable solution. Why this debacle? Because some high profile medical and nursing leaders found it too difficult to talk with the country’s most experienced midwives. Instead, they continued on a destructive pathway of supremacy.

The crux of this debacle about the legislation linking unavailable indemnity to registration for midwives providing homebirth services is compounded by collusion. The plot – leave the nucleus of private MIDWIVES out of the debate, no consultation. The consequence – In the absence of the voice of expert midwives, propaganda and innuendo transformed their gold standard professional services into a disproportionate, fear driven campaign against the safety of Australian homebirth. Oppression of private midwives linked to planned suppression of their practice stimulated the unprecedented rise of Australian women, directly affected by insularly controlled bureaucratic decision making, challenging their democratic and human rights to place-of-birth.

Why the eleventh hour turn around by the Senate Inquiry to invite a private midwife to speak? Private midwives had nothing to lose with their MIDWIFE future under threat of extinction. Midwives had enough initiative to inaugurate the Australian Private Midwives Association (APMA) uniting privately practising midwives nationally to deal with deathly politics. And because of persistent, dogged, political lobbying, some intelligent Senators understood the real issues of exclusion and propaganda, inviting at the eleventh hour a politically savvy privately practising midwife, to speak at the Senate Inquiry. Finally there was one voice.

This debate is also compounded by historical marriage. Members of medical and nursing organisations are realising they have to divorce historical control over Midwifery. From July 1, 2010 midwives and nurses will be separated with two distinct Registers. Midwifery re-emerges as profession in its own right, no longer controlled by nursing or obstetrics. While the professions will continue to work together with midwifery and medicine consulting in the best interests of women and their babies, women will retain the right to choose whatever service best suits them.

What does all of this mean? The crystal ball- medical income could be affected as more Australian women over time may decide to seek the services of Medicare ‘eligible’ midwives. That does not mean that obstetric s will be negated. What it means is obstetrics will provide respected, highly skilled institutional medical services for women. Healthy women without medical complications may seek to have their full scope of care provided by Medicare ‘eligible’ midwives in various geographical settings via a range of creative models including private homebirth.

Meanwhile, until the issues are sensibly resolved around the dollar, it is highly likely that women seeking to employ the full scope of private care at home will continue with experienced ‘Homebirth Whisperers’ to fill the void from July, 2010.

Robyn Thompson
RM, RN, M&CHN, BachAppSc, BF Cons
PhD Student
Charles Darwin University NT
www.melbmidwifery.com.au
midwife@bigpond.net.au
Mob: 0418 324 058
Pregnancy, Birth and Breastfeeding Whisperer maybe!

Individual submissions to Senate inquiry ...

The 1915 individual submissions to the Senate Inquiry are now available for review.

What assumptions underly the costing of the Government's midwife indemnity scheme?

[An excerpt from the Proof Committee Hansard (p CA 68) of the Senate Community Affairs Legislation Committee permitted some light to be thrown on the Department's (lack of) substantial evidence to support its recommendation to exclude homebirth from government supported private midwifery practice under the new legislation.]

Senator BOYCE—I have a few questions on the actual costings and the way you worked out the indemnity scheme. What were the assumptions underlying how you costed it? Where did
you get to with that?

Ms Hancock—I understand you are asking about the assumptions used underlying the costings for the professional indemnity component of the package?

Senator BOYCE—Yes.

Ms Hancock—I am hoping that I am giving you the information that you are looking for.

Senator BOYCE—You start and we will see. It was deliberately broad.

Ms Hancock—We had some assumptions about the likely number of midwives to be covered and some assumptions concerning the possible rate of claims and size of claims. Those were based on advice given to us by the Australian Government Actuary on the basis of a fairly large amount of information that he had considered, both from medical indemnity insurers and from other information sources.

Senator BOYCE—Would that be historical information? I ask that because no-one has been insured since 2001 in the midwifery field.

Ms Hancock—Yes, that is right, being both historical information and information from other countries. We also used information concerning claim rates relating to birth related
incidents from medical indemnity insurers who currently insure obstetricians.

Senator BOYCE—Can you give us some more detail about those figures? You are saying you made some assumptions about the number and size of claims that will be made.

Ms Hancock—The costings are based on a claim rate of 1.1 incidents per 1,000 births and an average claim size of $227,000.

Senator BOYCE—Those are for the 2010-2011 year?

Ms Hancock—Well, that is overall the likely situation. The claim rate is the same throughout the four years, I believe.

Senator BOYCE—That is an average for the four years?

Ms Hancock—Yes.

Senator BOYCE—Are you able to give us any tables or anything else on that? Does it vary from state to state?

Ms Hancock—That is essentially a high-level extrapolation from all the data that had been gathered from that wide range of sources with a huge amount of consideration fed into
those kinds of answers at the end. My suspicion is that it is an actuarial assumption and if you got different actuaries to sift through the figures they would probably come up with slightly different scenarios. The Australian Government Actuary is our best source of information and actuarial advice.

Senator BOYCE—Taking the 1.1 incidents per 1,000 and the $227,000 per claim, what do they give us for a year? What is the average costing? I am not doing the birth rates so I do not know.

Ms Hancock—I cannot remember. The entire package is for $25 million over four years.

Senator BOYCE—Would you happen to know what the average claim rate for obstetricians is?
Ms Hancock—I think it is still about 1.1 per 1,000 births.

Senator BOYCE—So you are anticipating that midwives would have about the same claim rate as
obstetricians. Is that right?

Ms Hancock—It is more that the actuary did not have sufficient information concerning midwive-led care in Australia to come to a conclusion other than that the rate of birth
related incidents would be roughly the same.

Senator BOYCE—As we have been discussing, homebirths have been technically removed. Was that
considered in your assumptions?

Ms Hancock—What we were doing was working out how to cost the indemnity component of the package, not in essence how to inform a decision about whether homebirths should be
included or not. The basis of those costings was that homebirths would not be included but my
recollection is that the actuary was unable to say what difference the inclusion of homebirths might make. He did not have sufficient data on which to base conclusions.

...

VICTORIA TO PILOT NEW HOME BIRTH OPTION

PRESS RELEASE From the Minister for Health

VICTORIA TO PILOT NEW HOME BIRTH OPTION
Friday, 07 August 2009
Victorian families will more birthing choices thanks to a Brumby Labor Government pilot program.
Health Minister Daniel Andrews said a pilot program would be established at two Melbourne hospitals to trial public home birth services.

“The Brumby Labor Government is taking action to provide Victorian families with world-class health services,’’ Mr Andrews said.

“Home birthing has been a popular option considered by women expecting straight-forward, uncomplicated births.

“The Brumby Labor Government will pilot a public homebirth program at two hospitals, and then evaluate the model to see if it can be more widely offered through the public health system.’’

Until now, the only option for women seeking a home birth has been to engage a private midwife at their own expense - but lack of indemnity insurance is an ongoing issue.

Mr Andrews said midwives employed through the pilots would be covered by their hospital’s indemnity insurance.

“Victorian women now have more options and choices in models of care, more continuity in care and carer and more detailed information, enabling them to make more informed decisions regarding maternity care.

“This new pilot program will give Victorian families greater choice in maternity care and provide women with greater control of their birthing experience.’’

Mr Andrews said that as a result of the new directions set out in the Future Directions for Victorian Maternity Services in 2004 Victorian women now have experienced increased continuity in their care throughout and after their pregnancy.

Mr Andrews said the Victorian pilot model has been established following consultation with consumer groups, maternity health professionals; including leading maternity obstetricians and midwives. It will also draw on the experience and learning’s of programs in Western Australia, South Australia, the Northern Territory and NSW.

“Trailing the Victorian model where homebirth could be part of the public system is consistent with the Commonwealth recommendations, and would ensure that women opting for home births would still fall directly under the umbrella of hospital services should any complications arise,” Mr Andrews said.

Around 166 Victorian women home birth with a mid-wife in private practice each year. The hospitals participating in the pilots will be finalised and announced shortly.


THIS STATEMENT CALLS FOR A FEW COMMENTS:

Firstly, let's get our numbers correct. The most recent published data from the Department of Human Services, the same Department that published this press release, reveal that 253 women gave birth at home in 2007. For more detail on these births, click here. (Where did 166 come from?) The number of midwife-attended* homebirths in Victoria has been increasing each year, and it has been more than 166 since 2004, when 181 homebirths were recorded.

Secondly, we are told that the "Victorian pilot model has been established following consultation with consumer groups, maternity health professionals; including leading maternity obstetricians and midwives." Enquiries made amongst MiPP members, who are the midwives providing homebirth services for almost all the women giving birth at home in this State, failed to identify any independent midwife who had been involved in these discussions. The Department of Human Services knows which midwives provide homebirth services, because we send data forms, with our names on them, to the Department's Perinatal Data Collection Unit, after each birth. Several of our members attend 30+ births in the year; others fewer. We also receive, from the Department, the annual 'Homebirths' report.

The Age article quotes Fiona Hallinan, "an independent midwife who has protested against the Federal Government's changes, says she doubts the scheme will attract sufficient staff to get off the ground."

We shall see!

We understand that the (as yet unannounced) Melbourne hospitals from which the pilot homebirth schemes are to operate will be Sunshine and Casey. Women who live within a relatively small radius of those hospitals may be eligible for homebirth.


Note:
* 'midwife-attended homebirths' distinguishes these births from 'born before arrival' (bba) births and intentionally unattended births (sometimes called free births).

video bar

I have added the You-Tube video bar gadget to this blog - scroll down on the Right. I don't know how to configure it to show the videos I choose, so if anyone can advise me on this, please do. The key words I have set are midwife, birth, homebirth, and breastfeeding.
Enjoy!
Joy Johnston (blogger)

MIDWIVES AND OUR SUPPORTERS AT THE RALLY

Pictures that tell a story!

News story today

CALLING ALL WHO ARE ABLE TO GO TO WANGARATTA TOMORROW - Please gather at

King George garden’s at 11am opposite the cinema for a photo shoot by the local newspaper the “chronicle” regarding an interview about the success of today's rally and about women’s birth rights.

All supporters of private midwifery in the North East of Victoria please come! Bring family, friends, and grandparents for 1100am. Thanks and I look forward to seeing you then!!!

Lisa Chapman