Monday, September 20, 2010

Would you throw out the baby with the bath water?

Currently midwives particularly homebirth private practice midwives are up in arms (and rightly so) about the recent Determination where Midwives are to be virtually signed of by doctors. That is as a privately practicing midwife (independent) you need to collaborate with an Obstetrician or GP obstetrician before being able to claim a Medicare rebate for the midwifery services provided. I might add that there is nothing in the Determination to make doctors collaborate with midwives or any benefit for doctors to collaborate.... so I am not sure why they would even consider it as we (midwives) would be competition for them in terms of financial remuneration therefore less money in their pockets..... emm not sure this will work?

If you are a midwife this seems a sort of sellout, Medicare for collaboration; However the woman is able to recoup some funds with this system therefore allowing more women this option of care....that is continuity of midwifery care and also midwifery led care;

Now as I see it there are two schools of thought......

1: If the government does not change the wording of the current determination; you go all out and say no to collaboration as it stands therefore we lose the right to a Medicare rebate and the legislation falls over; and we maintain the status quo as in the past which is no funding or rebates for women choosing private practice midwifery led care.... and it does not go before Parliament again for three years.... and if the government changes we may never have this opportunity for a long long time.... we will still have insurance requirements and regulations, that will not change.


2: we say yes to the collaboration as it stands, work to make it a viable option and see how and if it would work and if it does not work we then collate the evidence and go back to the politicians to lobby for changes to the determination knowing it does not work, rather than speculating that it does not work....therefore whilst we are battling for change women are able to claim a Medicare rebate for midwifery services? and Midwives are recognised for the profession that it is... which should have a medicare provider number.....and be recognised as autonomous clinicians.

Once the system (Medicare) whether it is effective now or not would be beneficial as we can work on changes....but if we never get it in place it will be years before we get back to this position and all our work up to this point would be for nothing as would of achieved nothing and the status quo remains.

What would you do in this situation?


carolinechadd said...

Say "yes" to the colaboration. As it stands it is an insult to our profession, but it does get us a footing on the ladder, the beginnings of some recognition. Once we have a legislative platform to work with, we can only go up - even if its just one step at a time.

Anonymous said...

I agree with carolinechadd. Although it does not give us the autonomy that we deserve, it does give us a foot in the door with the hope that we can prove what works and what doesn't with the system they propose. Megan

Anonymous said...

Diane a student midwife says,
YES YES YES It will be a start and there we then have the ability to demonstrate what SHOULD be done. If we sit back and let it go we then wait 3 more years. Midwives can make this work towards what they want.

InfoMidwife said...

thank you Caroline, Megan and Diane, great to see that you are being pro active and responding and thank you for the support... please encourage others to make comment :) said...

I am commenting as a midwife in private practice who will not be accessing medicare. I don't really know which side of the fence I am sitting on re. your question because there are still so many 'unknowns'. It may indeed open up opportunities for group practice etc. and perhaps greater choice for the majority of women (controlled by obs). However, medicare funded practice will probably be very limited. We don't know what the medicare payments will be but can you really see medicare paying for 2 hour antenatal visits and individualised care? It also goes against the international definition of midwifery and our scope. As a UK trained midwife I have always considers obs as our equals. Not our controllers, controlling something they know little about - physiological birth and woman centred care. It still blow my mind how little respect midwives in Australia have... and accept.
My main concerns are that if the collaborative determination is reflected in the Quality and Safety Framework midwives like myself will be unable to practice (above board). Absolutely no doctor will collaborate with a homebirth, never mind a vbac homebirth.
So by accepting the collaborative determination we might end up restricting women's access to models of care such as 'out of the system' homebirth. My own homebirth practice has changed dramatically since all this regulation and insurance has begun creeping in. Many of the homebirth midwives are ceasing to practice, limiting practice or having to put their charges up to cover insurance (which limits access for women). Above board collaboration is becoming more difficult as we are caught between covering our backs or sharing information with hospitals. Thing were easier for me and the women I care for before all of this and would be easier if the collaborative determination was thrown out.
Just my thoughts from the ground : )

Anonymous said...

It sounds to me as if the midwives in private practice are caught between a rock and a hard place.

I think the only choice midwives have, is to vote yes. Yet, by voting yes, it seems as if midwives are happy to be controlled by obs. Annelize

infomidwife said...

Hi midwifethinking, nice of you to comment thank you; let me assure you I have seen the quality and safety framework and the collaborative determination is not reflected in the Quality and Safety Framework. Look at first i was dead set against this however I would rather have something to work with than nothing at all. Yes you are correct in terms of respect for midwives as compared to the UK, however I feel this is a first step in changing this space.

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