No insurer will cover privately practicing midwives who assist with home births – but the DoHAC reckons it’s worth a shot.
There’s a good reason why no insurance company will agree to underwrite home birth attendances for private midwives, doctors have warned the federal government.
The Department of Health and Aged Care is currently considering an expansion to the Midwife Professional Indemnity Scheme that would introduce an intrapartum care insurance product for home births.
The question of whether or not DoHAC should foot the bill for midwifery insurance might seem minor – but it raises the question of how the government can justify subsidising one profession but not others, especially considering that obstetricians pay some of the highest indemnity fees of the lot.
This inconsistency did not escape the RACGP’s notice.
“The RACGP formally requests the government to extend funding … for all providers of obstetric services to ensure costs to patients are reduced regardless of their choice of obstetric provider and no provider is financially disadvantaged,” the college submission read.
Under its preferred proposal, the government would offer 100% coverage of the costs of claims for low-risk home births performed by midwives.
Low risk is defined as at-term singleton pregnancies with cephalic presentation where the birthing location is within 30 minutes of an obstetric hospital.
Women who have conditions listed under level B of the Australian College of Midwives’ guidelines for consultation and referral – e.g. hepatitis C, multiple sclerosis or uterine fibroids – are also included, but the midwife does have to consult with other practitioners.
Both the RACGP and the National Association of Specialist Obstetricians and Gynaecologists took issue with this definition.
“By way of example, how could a 39-year-old with a BMI of 39, who had a previous 5kg baby with a shoulder dystocia, or a previous caesarean and currently has pre-eclampsia be perceived as low risk?” the NASOG submission said.
“A mother with this profile is category B and under the proposed criteria, could be cleared for a homebirth.”
The private practice obstetrics group also noted that the requirement to “consult” with another practitioner is rather vague.
“The process proposed in the criteria is not specific about the qualifications or specialty status of the healthcare provider who is to determine whether a homebirth is safe or appropriate … the midwife just needs to ‘consult’ with an unspecified medical provider and then can continue with their plan for homebirth,” NASOG said.
“This consult can be via telehealth meaning no actual clinical examination can take place.”
While every registered health professional must have indemnity insurance covering all aspects of their practice as a condition of registration, private practice midwives have a specific exemption for intrapartum care – i.e. labour – during home births.
As unlikely as it may sound, midwives who do home births are doing so uninsured for the actual birth, making them personally liable for anything that goes wrong in the intrapartum period.
That exemption, which was intended to be temporary, has now been extended five separate times.
It will expire in July next year.
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No private insurer has agreed to touch the issue over the past 14 years, and it’s looking unlikely that any takers will materialise over the next 11 months.
Hence the proposal for the government to underwrite low-risk home births under its existing midwife insurance subsidy scheme.
NASOG argued that another possible solution would be to integrate home birth services within public hospital maternity units, rather than subsidising private practice midwifery services.
One variation of this option was presented as part of the impact analysis put forward by DoHAC, but was discounted due to the fact that no public home birth services exist in Queensland or Tasmania.
“Women in states without public home birth programs would be unable to choose home birth,” DoHAC said.
“Without access to insured midwives, these families are left vulnerable.
“This option may increase the risk of women using a midwife who is uninsured or choosing to free‐birth without a registered health professional.”
Since that document was published, Queensland has kicked off a public hospital home birth program.
