No one is happy with the government’s proposal to subsidise insurance for private practice midwives doing low-risk home births.
Doctors and midwives are finally in agreement on one point: that the Commonwealth’s proposed subsidised funding scheme for private practice home birth is no good.
But on every other point – particularly the issue of whether the proposal goes too far or not far enough – it’s situation normal.
It’s a debate worth paying attention to, if only because it raises the question of how the government can justify subsidising insurance for one profession but not others.
The Department of Health and Aged Care is currently looking to expand its existing Midwife Professional Indemnity Scheme to introduce an intrapartum care insurance product for home births.
This is something that no private insurer is willing to do.
For the last decade, private practice midwives have been operating under an exemption that allows them to perform intrapartum care at home births without the AHPRA-mandated indemnity insurance applicable to all other healthcare scenarios.
Under the proposed government home birth insurance product, midwives would be covered for low-risk births – i.e. at-term singleton pregnancies with cephalic presentation where the birthing location is within 30 minutes of an obstetric hospital.
Women with conditions listed under level B or C of the Australian College of Midwives’ guidelines for consultation and referral would also be included so long as the midwife consults with other practitioners.
Doctor groups are largely against the idea, with the RACGP formally calling for the government to extend funding to all providers of obstetric services “to ensure costs to patients are reduced regardless of their choice of obstetric provider”.
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The National Association of Specialist Obstetricians and Gynaecologists, meanwhile, argued that the definition of low-risk births was too vague and may allow women who would be unsafe candidates for a home birth slip through the cracks.
The Australian Nursing and Midwifery Federation, meanwhile, is of the exact opposite opinion.
“The ANMF has significant concerns regarding the lack of autonomy afforded to midwives to perform their role in accordance with their regulatory obligations as proposed by the … definition for low-risk birth,” its submission read.
“There is also the potential for reduced access and choice for women that is likely to result from a narrow eligibility profile and oversight of risk assessment by the ‘other health service provider or professional’ as included in the criteria.”
According to the federation, the requirement to consult with other clinicians to determine if home birth is safe and appropriate when women have category B or C conditions “disregards midwives’ clinical judgement, autonomy and professionalism … and potentially re-establishes the barriers to access that midwives and women have experienced under collaborative arrangements”.
The Australian College of Midwives was less scathing in its response, but said it would require the adoption of fleshed-out explanations of what midwives were required to do when women had potentially risky pregnancy.
It also recommended the inclusion of a non-abandonment clause – basically that the midwife can’t leave the woman during labour even if she’s declining transfer or emergency services – and protection for midwives treating women who decline recommended care.
