Have your say! submissions due now!

The aim of this blog is to disseminate this information to as many people as possible and for you to read it and make comment. This is legislation that is going to affect your clinical practice, choices for women and the way in which registration and complaints will be dealt with. So please if you have never been proactive now is the time to start. It is time for public consultation and the submissions close 17 July 2009.

This is how we have a voice, by making submissions. We need to find a way to save independent midwifery, there are some very good practitioners out there that want to work in collaboration with our medical colleagues.

The National Registration and Accreditation Scheme for the Health Professionals:
The Health Practitioner Regulation (Administrative Arrangements) National Law Bill 2008 received Royal Assent on 25 November 2008, giving effect to the new national law.

The council of Australian Governments (COAG) in March 2008 signed an agreement to start the ball rolling creating a single national registration and accreditation system for health professionals. To start with, there are 10 health professions; chiropractors, dentists (including dental hygienists, dental prosthetists and dental therapists); medical practitioners, nurses and midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists, and psychologists.

Now it is time for you to review the next phase of this process The Health Practitioner Regulation National Law 2009 (Bill B)
Exposure draft of Bill B released for consultation - submissions close 17 July 2009

The bodies in the new scheme: Ministerial Council, Advisory Council, National boards, State/Territory boards (committees of national boards), Accreditation authorities, and Australian Health Practitioner Regulation Agency (AHPRA).

What does this mean to you as a Midwife – in a nutshell this is what is important:

Independent accreditation will be independent of governments – the final decision on whether the accreditation standards, courses and training programs are approved for the purposes of registration is the responsibility of the national board.

National accreditation standard which exist prior to the commencement of the new scheme are to continue until they are replaced by new standards.

Existing external accrediting bodies such as the Australian Medical Council are expected to continue.

CHANGES TO THE REGISTER;
- There will be both general and specialist registers available for the professions including medical and dentistry

- Separate register for nurses and midwives

OTHER IMPROVEMENTS TO QUALITY AND SAFETY OF HEALTHS SERVICES;
- Mandatory reporting of registrants – who is placing the public at risk of harm
- Reportable conduct

- Criminal history and identity checks

- Simplified complaints system

- Students registrations – students will now have to register from 2011

- PRACTITIONERS WILL BE REQUIRED TO HAVE SUITABLE PROFESSIONAL INDEMNITY INSURANCE during the period of their registration. (see clauses 69, 73, 75, 80, 83, 101 and 125)

73 Professional indemnity insurance arrangements
(1) Professional indemnity insurance arrangements in force in relation to
individual are appropriate for the purposes of registering the individual
in a health profession only if:
(a) the arrangements will not expire before the end of the
individual’s period of registration, and
(b) the National Board established for the health profession
considers the type and level of cover provided by the
arrangements are sufficient in the circumstances.
(2) A National Board may accept as evidence that there is, or will be, in
force in relation to an individual professional indemnity insurance
arrangements:
(a) written advice from an insurer or insurance broker that an insurer
has agreed to issue a professional indemnity insurance policy or
that the premium has been received and accepted by the insurer
for the issue of a professional indemnity insurance policy, or

These are some of the major changes, but for independent midwives the death nail is the requirement to have indemnity insurance with registration. See the above clauses within the Bill. The second most important issue is that of complaints. From my limited understanding at this early stage is the there will still be an office in each state – I will update you all on this section when I have finished reading it.

Please visit the http://www.nhwt.gov.au/natreg.asp site and make a submission:

go one just hit the hyperlink and have a read!

Great news for Australian Midwives:

This is great news for midwives, read the full report;

THE HON NICOLA ROXON MP Minister for Health and Ageing:
Maternity Services Report:

Recommendations in a nutshell:

Improving choice for Australian women by supporting an expanded role for midwives

Consideration of the expansion of access to Medicare and the PBS for midwives – but only if accompanied by stringent professional requirements for midwives

Consideration of support for professional indemnity insurance for midwives

The development of new national cross-professional guidelines to support collaborative multidisciplinary care in line with best practice

Consideration of the establishment of a single integrated pregnancy-related telephone support line

Improved data collection and analysis, and further research

Providing increased support for the maternity workforce, particularly in rural Australia

The release of this report has generated many different responses: here are a few:

Rural doctors welcome maternity review
The Rural Doctors Association of Australia (RDAA) has welcomed the Australian Department of Health and Ageing’s Maternity Services Review Report. The association has said it provided a strong way forward for improving access to maternity services in the bush.
For a long time now maternity services in rural areas have been under increasing pressure and at least half of rural maternity units have been closed down over the past decade.
It is a well known fact that pregnant rural women are increasingly having to travel great distances to give birth as there is limited maternity services available for them.

The Maternity Services Review Report provided an opportunity for all stakeholders including consumers, doctors and midwives, and government to focus urgently on getting much-needed maternity services back into the bush.

The next question that has raised debate is that of indemnity insurance for independent and private midwives. I think that it is fantastic that the Commonwealth government is considering indemnity insurance for midwives. National Registration will be introduced in 2010 and all midwives will be required to have indemnity insurance to be registered. This will prove difficult if we do not have government assistance and we will lose many midwives.
Women are intitled to choose where, who, how, they will be assisted with their birth.

6 Minutes.com.au, reported this story:
GP obstetricians will be angry

if they have to foot their own medical indemnity insurance while midwives received government help, a leading obstetrician says.
The federal government’s new Maternity Services Review says subsidies for indemnity insurance would help private midwives who risk financial ruin by being sued.

The Age.com.au reports:
Furore over midwife report as doctors go on the attack
THE Australian Medical Association has accused Federal Health Minister Nicola Roxon of being "gung-ho" about the role of midwives and misrepresenting the findings of the Government's maternity services review.

It will be interesting to watch what happens and what the expectation will be relating to " expanded role of the midwife" "advanced level of professional education and experience" that will be expected of midwives.
In 2007 some Midwives in WA completed the 'expanded role of the midwife" course in preparation for this role.

Will UK & NZ trained midwives have to complete the expanded role of the Midwife when they come to work in Australia? they already work to this level, autonomously and independently.

The Age also comments

this could potentially allow midwives to prescribe medicines, open private group services and contract their services to hospitals. Midwives would also be given access to the Medicare system, although the report did not recommend Commonwealth funding for home births.

"

It is about time this happened - Women already pay for private services for independent midwives, why should they be disadvantaged for the informed choice they make - why not allow them to claim from the Medicare system.

Specialist doctors argue that Australia's strong safety record for mothers and babies shows that the current system is working, while advocates of home births have accused doctors of being responsible for soaring surgical delivery rates.

It is interesting to use the strong safety record for mothers and babies, however this also works in favour of midwifery, also, I feel it does not indicate the current system is working, if that was the case we would not have women choosing unattended births or freebirth occurring. Why are they happening, because women are not being listened to by obstetricians they feel they have no choice.

It is sad but no surprise that Dr Capolingua uses that "F word" "Fear" to reinforce the medical model in childbirth instead of working together with midwives in a collaborative way.
It was also disappointing to see very little or no support of homebirth via funding.
Another good aspect of this report was to see increased funding and maternity services for Indigenous women.

The report also discusses workforce issues, such as; aging GP's, Obstetricians, and Midwives, the average age of midwives being 45.6 years.

I am delighted to see that finally a Health Minister is listening to what WOMEN want, and that is CHOICE and to recognise that childbirth has become so medicalsied with high intervention, cesarean sections and the poor breastfeeding rates.

Why is it so hard for Doctors to accept working in partnership with Midwives

January 10 The Australian published a story "Doctors firm against role of midwives".
We are all eagerly waiting for the release of the federal health minister Nicola Roxon's report on Maternity Services in Australia. During the process of review the obstetricians have stepped up their campaign against the MIDWIFE.
Lets look at the facts: Midwives want to look after low risk women - Midwives want to offer midwifery-led-care, which is a midwife-focused, woman-focused model of care for low-risk-women.
Women with medical problems, or in a higher risk category will see an obstetrician or the midwife will refer the women if it is required.
Is this so hard to understand?

Why are obstetricians so determined not to work collaboratively with midwives?

Dahlen (Australian College of Midwives) says obstetricians are incorrectly claiming or implying that midwives are seeking to be in sole charge of births.

‘‘We are not asking for midwives to be out there on their own — we don’t want that,’’ Dahlen said.

‘‘What we want, what we have always wanted, is collaborative models of care, where women can have a midwife who cares for her through her pregnancy and postnatal period.

‘‘It’s not about being ‘independent’ — this is about doing what midwives are best at, caring for women, particularly low-risk women, and having support from obstetric colleagues when that’s needed.

‘‘Part of the reason we have such a high intervention rate is because normal, low-risk women are being cared for by highly specialised surgeons trained in surgery.

‘‘We are not saying midwives are not going to work with obstetricians — we are asking for more choice, not less.’’ Dahlen says women are ‘‘marching with their feet’’ to seek better access to midwifery services, based on the number of women prepared to attend rallies and on the number of submissions from individual women to the federal Government’s review.

In December the Government revealed over 900 submissions to the review had been received, most of them from individual consumers.

It is about time someone started listening to what women want.....our maternity services are failing women and this is evident by the number of women who freebirth.
Also the submissions from women indicate that our maternity system has become to focused on medical intervention.

It will be very interesting to see the outcome of Nicola Roxon's report.....we are waiting with baited breath.

Role of the midwife

As I was reading the West Australian paper today I came across a headline which read:

“Baby boom brings new role for midwives”, I thought great, what’s this about? And proceeded to read it and was surprised for two reasons; the first being;
“Midwives would get doctor-style responsibilities such as ordering diagnostic tests and the ability to prescribe drugs under proposals the Federal Government is considering”

– I thought, what a new role? Well, as I did my midwifery in the UK, and worked as a community midwife, this is something that I already use to do and was stripped of this right once I began working in WA as midwives do not work in this capacity here. There are several other countries that also work in this capacity where midwives have diagnostic responsibilities, these are New Zealand and off course Britain.

This is the role a midwife is supposed to have, this is the role midwives are educated for, to provide continuity of care, one on one care, know and recognise the normal and then recognise the abnormal, order diagnostic tests and then refer to the obstetrician when the situation becomes abnormal. The midwife is the expert in the normal pregnancy and birth, the obstetrician in the abnormal.

I am delighted for the profession of midwifery and for the women of this State that we are finally letting midwives work to their fullest capacity.

Secondly I am also delighted that the Health Minister Nicola Roxon has bought this issue to the forefront and is open to dialogue and discussion regarding the prospect of midwives working to their fullest capacity and also considering the option of Medicare provider numbers for midwives and looking at the issue of indemnity insurance.
This is a result of a comprehensive review of maternity services throughout Australia which says “that there is no Medicare benefit payable to midwives for management of labour and delivery and private health insurers offer only limited support for midwifery services”.

It was no surprise to read that the “Australian Medical Association” will oppose this proposal. We should be working in collaboration with each other, midwives and obstetricians, rather than this constant power play, using ‘fear tactics’ and patient/client safety to keep women and midwives in line.

Let the dialogue and discussions begin.

Ref: West Australian 10 September 2008 p12