Thursday, August 5, 2010

Working as an Private Practice Midwife with the new legislation:

As from the 1st July 2010 all of Australia except for WA has joined National Registration (AHPRA) and therefore requiring indemnity insurance when registering as a Midwife, or Nurse Practitioner. WA is expecting to join National Registration in mid October 2010, until then the Nurses and Midwives Act 2006 applies.

There are a few ways in which this can be achieved in Australia with the new Collaborative Arrangements: If you are already in private practice/independent you can use the exemption clause from the Health Practitioner Regulation National Law Act 2009 s284 (Exemption from requirement for professional indemnity insurance arrangements for midwives practising private midwifery)

During this time the midwife does not contravene section 129(1) which states you need private indemnity insurance to be registered. However the midwife must ensure that he/she has a signed consent form from the woman in relation to having no insurance. However you need to be mindful of 284(1)(c)i “the midwife complies with any requirements set out in a code or guideline about reports to be provided by midwives practising private midwifery; and(ii) any requirements in a code or guideline relating to the safety and quality of the practise of private midwifery.
Codes to note: New Code of Ethics for Midwives August 2008: New Code of Professional Conduct for Midwives August 2008: Midwifery Competency Standards August 2008:

In simple terms you can continue to practice as an independent/private practice midwife and the women you are looking after will pay for your services as per normal and will not be able to claim a Medicare rebate. As per normal you are advised to keep exemplary notes about the care you have provided and audit your practice and outcomes, so when it is time in two years to apply for Homebirth insurance midwives will have the data to prove that homebirth has good outcomes and is cost effective.
Registration standard for Eligibility: to claim MBS and PBS you will need to be an ‘eligible’ midwife, this means three years experience in the continuum of midwifery care. Completion of further studies relating to pharmaceutical and diagnostic investigations and 20 hours of continuing professional development per year.

National health (Collaborative arrangements for midwives) Determination 2010 – National Health Act 1953 – this document outlines the collaborative arrangements for midwives – basically this document states that midwives have to collaborate (although we already do this and is part of our competency standards) – consultation between the midwife and an obstetric specified medical practitioner, referral of women to a specified midwife, or the midwife is employed or engaged by 1 or more obstetric practitioners or an ‘entity’ that employs obstetricians. The Arrangement – midwife’s written record..... this actually means that you have to enter into a written arrangement that both parties agree to about the care of the woman.....strangely enough there is no provision in this document for what the woman may want here...because if the woman chooses something outside the sphere of the realms of normal the midwife will not be able to continue the care because she will probably not have the support of the obstetrician therefore will not be collaborating and the woman is left stranded...... now what do we do...and herein lies the problem........ with having the medical model trying to control midwives.

At this point in time there is nothing that we can do about this Determination..... the horse has bolted......(a determination is allowed or disallowed) nothing will go forward until after the election.....My fear is that with a Liberal government we will go backwards, there is a slim chance with the labour government that we may be able to amend this document however the Greens are showing more positive support for our plight with this unworkable document.... As a midwife I want to be able to offer women the choice of birthing at home without having to have an obstetrician sign off my care..... I am a professional and know my boundaries, I work within my codes.

I see the way forward as lobbying the government to change this determination by having a strategy of safe clinical care, auditing homebirth and outcomes, peer review and supervision process and risk management strategies...without having to have my care signed off by a Dr...... not to mention the cost effectiveness of midwifery led care as opposed to hospital base care. We need to lobby the government find out who you local MP is and send them an email or letter:

“Hi, I am ………………….., my address is ………………and I live in (your electorate’s name). I would like to let you know that I am concerned with the recent determination passed by the ALP government - the National Health (Collaborative arrangements for midwives) Determination 2010. Midwives already collaborate with medical colleagues but I don’t want them to have to enter a “collaborative arrangement” or any kind of signed agreement with a doctor for the purpose of getting Medicare. I also want all maternity care policies to have the right to informed choice (right of refusal) written in to them. I want a long term solution so that women always have an ability to access homebirth care and I want national visiting access to public hospitals for all eligible midwives.”

It is time to be politically your local MP and find out what their position is!

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