Midwives can continue to legally assist with planned home births, even though they’re not covered for it.
With no viable insurance policy to cover midwives who participate in home births, the government has extended its indemnity exemption for the fifth time.
While AHPRA registration standards mandate that all health professionals take out indemnity insurance covering all aspects of their practice, midwives have held a specific exemption for intrapartum care during home births since 2010, the year that the requirement for midwives to have indemnity insurance came in.
All midwives are still required to be covered for pre- and postpartum care – just not birth itself.
Announcing the continued exemption today, Assistant Health Minister Ged Kearney said the policy was for the benefit of midwives and the women in their care.
“This is why the government will work with state and territory health ministers to finalise a solution to the longstanding and entrenched issue privately practising midwives face in accessing appropriate professional indemnity insurance,” she said.
Australian College of Midwives chief midwife Alison Weatherstone said the ability for privately practising midwives to have homebirth intrapartum cover was an important step.
She said the government was in the process of developing an affordable, low-risk homebirth product with potential insurers.
Affordable insurance for midwives in general has been a long-standing challenge – MIGA is currently the sole provider of professional indemnity insurance for private practice midwives, for which it receives financial help via the government’s Midwives Professional Indemnity Scheme.
The guidelines on these insurance arrangements provided by the Nursing and Midwifery Board of Australia specifically state that this government-supported insurance “will not cover the planned delivery of babies in the home”.
This means that when a private midwife oversees a home labour and birth, they are doing so uninsured and personally liable – as improbable as that may sound.
“Insurance claims for [private midwives] are very low,” an article on the Homebirth Australia site reads.
“MIGA announced at a recent ACM panel discussion on professional indemnity insurance (Feb 2022) that the highest number of calls they receive from [private midwives] are requesting legal advice, not to make a claim.
“However, [private midwives] are risking a lot personally by attending homebirths without insurance, because if something were to happen and a claim was made against them, they would be personally liable.”
It’s an unusual arrangement, but the Australian College of Midwives along with the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives provided some insight into its necessity in a 2017 document.
“The lack of access to homebirth services provided by private midwives is forcing women to choose unsafe options such as employing support people who are not midwives, or having unassisted births resulting in less than optimal clinical outcomes for both women and babies,” the submission said.
The organisations also cited a lack of interest from the insurance market when it comes to creating a non-government-funded solution for all midwifery indemnity insurance.
“Insurers require claims history to be reassured about their exposure or be able to quantify their potential exposure,” they said.
“Currently, the only yardstick insurance companies have is obstetrics and the practice of obstetricians, which is not a comparable profession to midwifery.
“Obstetricians, by the very nature of their work with, and responsibility for, high risk women and clinical scenarios, are more likely to be involved in adverse events than midwives, who for the most part work with low-risk women and babies.”
The latest extension to the home birth indemnity exemption will last until the end of June 2025.
