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Midwife Professional Indemnity Legislation Amendment Bill 2011

Speeches in Parliament
Rachel Siewert 16 Jun 2011

Senator SIEWERT (Western Australia—Australian Greens Whip) (18:24):  The Midwife Professional Indemnity Legislation Amendment Bill 2011 has received a great deal of attention. Debating issues around better support for midwives has taken a great deal of the time of many senators. While the Greens were supportive of many of the measures the government introduced last year, we also flagged our concerns about some of the measures that were put in place, such as collaborative arrangements and the impact that the changes would have on those midwives wanting to support homebirth and also on mothers and families wanting homebirth.

I am aware of some of the concerns of midwives who are operating under the current system. I thought it was timely that I raise some of these issues, given that there will need to be some more changes by around this time next year when the homebirth exemptions expire. In other words, we need to start thinking about how we are going to deal with that now. Unfortunately, some of the concerns that the midwives raised at the Senate Community Affairs Committee inquiry and with individual senators appear to have been substantiated by events. For example, I am told at the moment there are approximately 50 eligible midwives under collaborative arrangements. To date, none has been able to provide continuity of care through labour and birth because they do not have visiting access to hospitals. While it looks like there are around 700 claims through Medicare, none of these is for birth care because of the lack of visiting access. That is a very strong concern.

The determination around collaborative arrangements specifies that midwives have to demonstrate collaborative arrangements in one of four ways: being employed by a practice with an obstetrician, being referred by a specified medical practitioner, having a signed collaborative arrangement with a specified practitioner or having an acknowledgement of a collaborative arrangement from a specified medical practitioner. At this stage these are the only ways women can gain a Medicare rebate for midwifery care. Five midwives in Sydney are reported to have a signed collaborative arrangement in place. As far as we are aware, no-one else has a signed agreement. We understand that there are two practices that are using the employment mechanism. One midwife is employed by an obstetrician and two others are employed in an Aboriginal medical service. I have been told the rest of the midwives are struggling to use two of the other available options, which are gaining a referral from a specified medical practitioner or using the arrangement/acknowledgement from a specified medical practitioner.
While this should be generally reasonably straightforward for women who are using the public hospital system—some public hospital obstetricians are happy to provide an acknowledgement of collaboration for women seeking to give birth in a public hospital—unfortunately it is not occurring for those wishing to give birth in private hospitals with a private obstetrician and those wishing to give birth at home. We understand it is virtually impossible to gain a collaborative arrangement for antenatal care or birth. In other words, concerns remain about the collaborative arrangement approach. As I said, these concerns were articulated at the time and it is disappointing to have to report that there are still troubles with gaining access to collaborative arrangements.

The exemption for homebirths is only available until 30 June 2012, only a squeak over 12 months from now. This means, if you look at it this way, that women who fall pregnant from September this year will be back to where they were two years ago. In other words, it will be uncertain whether they will be able to access midwifery care for homebirth. I also understand that the cost of insurance has meant that many smaller midwife practices have ceased to practise, as they cannot afford to pay this insurance, which has particularly affected regional women wanting to have a homebirth. As we know, there are a number of women in regional areas who want to be able to choose to have a homebirth. So we are particularly concerned about that.
As has been stated here on a number of occasions, there have always been concerns about the ability of midwives to access insurance packages. There are rumours that, unfortunately, continue, and that I think need to be looked into, that insurers are refusing to extend insurance packages to include homebirths, due to a lack of data. At the same time, researchers have requested that data around homebirths be made available through the various state perinatal registers which is collected by AIHW nationally. We do not believe it should be claimed that these statistics do not exist; in fact, what somebody needs to do is collate the data. So there is an issue continuing around that.

Another issue that has been raised with me is to do with the prescribing course requirement, where eligible midwives sign an undertaking that they will complete a prescribing course within 18 months of gaining eligibility. That means that, in December, the first 15 midwives will have to have completed this course. Technically, it is possible that the eligibility could be removed because these courses have not been completed. However, at this stage, no prescribing course has been accredited by the ANMC and there does not appear to be a set of standards for which such a course could be developed. So that is another concern that midwives have about these collaborative arrangements.

So I do think there needs to be further engagement by the government in looking into these provisions, because such concerns remain. We also need to be looking at what is going to happen between now and next year in terms of dealing with the homebirth exemption. We had the same issues some time ago with the insurance requirements that meant that homebirths could not occur—in fact, there could potentially be big fines for supporting a homebirth—and, if this issue is not addressed, we will go back to that situation again. That is of course unacceptable to the Greens but particularly to many families out there who do wish to have a homebirth. I repeat: it is no good for the government and the medical profession to just bury their heads in the sand and say, 'Well, we'll just bring in measures to make it harder and harder to have a homebirth.' The situation that will eventuate is that women will what they call free-birth. Nobody can pretend that that will not happen, because people feel very strongly about it. We are much better off having a system where we provide a choice of births for mothers and families. Homebirth is one of those, and we need to ensure that homebirths can be supported in a very safe manner.

I urge the government to look at these issues, to support midwives, to look at the barriers to eligibility and collaborative arrangements, and to address this issue of eligibility, because there are only 12 months in which to do that. Many women who are pregnant in this half of the year will fall outside these exemption arrangements if something is not done fairly quickly. So I urge the government to take those messages on board.

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