Hitting a Brick Wall

The National Health (Collaborative arrangements for Midwives) Determination of 2010 (This instrument determines the collaborative arrangements with the kinds of medical practitioners that an eligible midwife must participate in when providing midwifery treatment in order to satisfy the definition of 'authorised midwife'.). This Determination is clearly not working and needs to be amended or rescinded.

Obstetricians benefit from Eligible Midwives not being able to practice. Is it fair and equitable that this group can monopolise the market? Should the role of a collaborator be given to a Health Service or an independent body rather than a ‘named obstetrician’?

I am an Eligible Midwife and have a Medicare provider number. The government introduced the Maternity Reforms in 2010. With these reforms came the Determination for Midwives 2010. At the time of the Determination the then Minister of Health Nicola Roxon acknowledged that there were issues with the AMA but encouraged us (Midwives) to try and make the determination work. We are almost at the 2 year mark and this determination is not working. There is a multitude of evidence to show that obstetricians do not want to collaborate with midwives.
Here are some comments from Obstetricians

‘ I will do the birth you can do the rest’
‘I will not collaborate, I am happy with the status quo’
‘we do not support homebirth regardless of the risk, therefore I will not collaborate’
’I am very comfortable with the situation as it stands and I am not interested in supporting your model of care’

It seems that there is a condition with an offer to collaborate, which means that as a midwife I cannot work to my full potential. On the other hand, there are some private midwives so frustrated with the current political system, they have rescinded their registration and are working as birth attendants. These birth attendants support and assist women’s birth choices and are not responsible to any regulatory authority and are not insured. I wonder is this the answer?

This piece of legislation is a bad law it needs to be changed urgently to allow the Eligible Midwife to work as they were intended. That is to give women more choice, more continuity of midwifery care and for women to claim a Medicare rebate for those services.
Call or email your local member of Parliament and have you say: Ask for your right to see a Midwife and claim your Medicare rebate:

Medicare and the Midwife

The journey to obtaining Medicare Provider number has been an interesting one..... Now to learn all the things I need to know about what and how I can claim......
The Medicare provider number is a unique number issued by Medicare Australia to registered health professionals. They are also used to identify health professionals. As a health professional you need a provider number for each location you work..... Therefore I have two... one for the office and my home is the other one.
Currently a midwife can use the provider number to refer to a specialist or for pathology and diagnostic imaging, once we have done the required course in pharmacology then we will be able to also prescribe......
A provider number does not necessarily mean you can attract Medicare benefits for the services you provide.
Before a health professional can attract a Medicare benefit, they must satisfy legislative requirements set out in the Health Insurance Act 1973 which for midwives is the Determination – see Midwife Reform Legislation Fact Sheet.
Medicare has a great online service which makes it easier for you to do business with Medicare Australia; It will make claiming and downloading forms much easier.....also online e-learning, I just completed a couple of e-learning packages.. can't wait for the prescribing course.... one would think that this would of been in place already.
I think it is great that women will be able to claim for midwifery services.... it is long overdue....

Time for Medicare Provider Numbers; it has only taken 24yrs

On the weekend I was in Melbourne and I was fortunate to hear this piece of information which made me sit up and think.... has much changed over 24yrs?..and if we miss this chance will it take another 24yrs?

The information comes from " COMMONWEALTH OF AUSTRALIA MEDICARE BENEFITS REVIEW COMMITTEE (2ND REPORT) JUNE 1986 p 230;

Submissions concerning midwifery were received from the National Midwives Association the Royal Australian Nursing Federation, the New South Wales Nurses Association, the Launceston North Coast Home Birth Support Group and numerous Private individuals. ......Most of the submissions proposed that midwife be recognised on an equal footing with medical practitioners in respect of the payment of Medicare benefits for certain services associated with uncomplicated birthing........of the many medical and paramedical issues raised with this committee, the question of the payment of registered midwives generated the greatest depth of paramedical submissions addressed 25% were midwifery related......

Has much changed in 24 years..... we are on the brink of change.

Some midwives are confusing the Medicare Provider Number with the requirement of insurance. However the issue of insurance is a requirement of National Registration s129(1)registered health practitioner must not practise the health profession in which the practitioner is registered unless appropriate professional indemnity insurance arrangements are in force in relation to the practitioner's practice of the profession.

In order to have a Medicare Provider Number you need to be an eligible midwife... Have a look on the Australian Nursing and Midwifery Board site to remind you what these requirements are;

The Health Insurance (Midwife and Nurse Practitioner) Determination 2010; for the Medicare Provider Numbers... check out the determination; the Midwifery services and fees range from $31.10 -$724.00 also is included 6 weeks of postnatal care...which is excellent for women and will also help provide greater postnatal care....

This is the beginning of new things, an opportunity of greater access for all women... however we must remember that unfortunately this does not include homebirth...therefore we need to more than ever keep the pressure on the government.. to pass this service fee onto women who choose a homebirth.....

The AMA has put out its Collaborative Arrangements:

There is much speculation surrounding this document; yes there are parts of it that make me cringe.... however it must be equally difficult for the AMA, not that any midwife wants to hear that;
Collaborative Arrangements what you need to know? the irony of this document has to make you laugh or cry:

"Working with other health professionals is an everyday feature of clinical practice for a modern medical practitioner. Effective teamwork can improve patient outcomes, create new opportunities for learning,and build a shared understanding of the skills that each person brings to the care of a patient."

Oh yes everyone is a patient even the well woman = this equals paternalism at its best; yes our medical colleagues are great at being paternalistic they feel they have the right to make that decision for the woman because they believe they know what is best; consequently, if the vulnerable woman is not able to make decisions or is not in a position to do so they are often coerced or made to feel fearful therefore making the decision the doctor wants.

“In a sense, this statutory requirement reflects the planned team care arrangements that have set parameters for collaboration in areas where doctors, midwives and nurses have always worked together - our hospitals.”

If we examine this statement they do say that it is “planned team care” and the word ‘collaboration’ means working together – not the GP/Obstetrician is in charge – it means a two way street. It will be interesting to see this work! because the doctors have the power and the money.... and automatically think they are in charge.

For me there are four main points that are important:

If we do not embrace these changes, then pressure will mount on the Government to relax the requirement for collaborative arrangements to be in place. This would risk fragmentation of care to the detriment of patients.

This is the most telling statement of all.... this means the AMA is seriously concerned that if they the doctors do not collaborate then changes will be made......this is in our favour.

Yes they are correct in saying that

“Some doctors will be challenged by the Government’s reforms, which will fund new models of patient care.”

This is clearly an understatement, we as midwives are certainly challenging them and if this collaborative framework does not work it will be changed; The doctors are back pedaling, they are fearful of losing money... so they are picking up stumps and are not going to play.

What should you do when a patient does not want to follow agreed clinical guidelines?

This may place you in a difficult situation.
The AMA believes that the best way of handling this is to ensure that your written collaborative arrangement clearly states that you will only provide care in accordance with accepted medical practice and within accepted clinical guidelines.
It should also clarify what will occur in circumstances where a patient declines to
follow these guidelines. If this occurs and you decide you cannot provide ongoing care for that patient, you will need to ensure that you advise the patient and the midwife/ nurse practitioner so that an alternative arrangement can be put in place by the nurse practitioner/midwife.
How you will address this issue if it occurs needs to be agreed prospectively in order to avoid a situation where you are forced to continue care because of a lack of
alternative arrangements.

This is nothing new, this is how the AMA works in every day practice, so this is no surprise....the only thing that is different is that they are blatant about and it is in writing.... there is no such thing as the clients right to choose the type of care they want or the right to refuse treatment.

Lastly I would like to be able to check the credentials of the doctors...what are their statistics, are they registered? how many women are not happy with their care etc? we should be able to check their register; that would be fair and just, equality.

Despite these issues I do think that we need to push forward, these are challenges put in our way and in time it will seem like a storm in a tea cup.

My vision is that all women will have the choice of continuity of midwifery care with a midwife and the right to claim a Medicare Rebate for fee for services;
Whilst I do not like the wording in this Determination I can see that this is still a historic time for midwifery....Opportunity is knocking..... walk through and make it work...if it doesn't you can always reject it.... but if we don't try we will never know it will always be a speculation

Eligible Midwife Australia.....this is what it looks like

The Nursing and Midwifery Board of Australia has submitted to the Ministerial Council for approval: the Registration Standard for Eligible Midwife and Registration for Endorsement for Scheduled Medicines for Eligible Midwives.

What does this mean for the average midwife in Australia?
Requirements
To be entitled to be identified as an eligible midwife, a midwife must be able to demonstrate, at a minimum, all the following:

Current general registration as a midwife in Australia with no restrictions on practice;

Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as a midwife;

Current competence to provide pregnancy, labour, birth and post natal care to women and their infants;

Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;

20 additional hours per year of continuing professional development relating to the continuum of midwifery care;

Formal undertaking to complete within 18 months of recognition as an eligible midwife; or the successful completion of:

an accredited and approved program of study determined by the Board to develop midwives’ knowledge and skills in prescribing, or

a program that is substantially equivalent to such an approved program of study, as determined by the Board.

My understanding of the above is that you can be deemed an eligible midwife and give the undertaking that you will complete within 18 months further study for prescribing and diagnostics.

Now we have to wait for the realise of the courses that we are to do...those from WA who have already completed the Eligible Midwife program which was four units...should get some RPL (recognition for prior learning).....
Until these units are established it seems that midwives are required yet again to jump through hoops to give continuity of care.....

the bottom line is that you will have to have three years experience across the continuum of midwifery before you can become an eligible midwife..... complete your Midwifery Practice Review and do further study.....oh and don't forget you need to be insured.....
We are the midwives paving the way for the future.... don't give up....lets beat the bastards and prove this can be done.....

The road to eligibility for the Midwife:

The question is how long will it take to become an eligible midwife? Gone are the days of qualifying as a midwife and practicing autonomously, now we have to jump through hoops. As you may be aware the laws in Australia are changing from the 1st July we go to National Registration, which in itself is not a bad thing. There will be four categories to the register for nurses and midwives: Registered Nurse (RN): Midwife: Non Practicing Midwife: Student nurse / midwife.

You can register as a RN & Midwife, if you are both you can choose to drop one or the other of your qualifications, that means you can register only as an RN or a Midwife should you choose to….. One thing I urge all RN / Midwives before dropping one or the other of your qualifications you will need to check your employment contract to ensure you have not signed a contract to be both…….
If you do maintain both professions you will have to complete the required ongoing professional development for both professions, and ensure you practice in both within a 5 year period otherwise you will not be able to register. There will be two registers, one for the RN and the Midwife.... there will also be a non-practicing Midwife register, and a student register for more information see the Nursing and Midwifery Board of Australia.
The other major change is that for midwives you need to declare your indemnity insurance, if you work for a hospital this will be easy you will need to contact your employer and ask them who you are insured with and provide this information to the Board.
The Australian College of Midwives is securing indemnity insurance for midwives, antenatal and postnatal care…..currently there will be no insurance for intrapartum (Homebirth).

One of the requirements for “the eligible” midwife will undoubtedly be Midwifery Practice Review (MPR), however the final requirements for eligibility have not been released yet. I have started this process because I want to be “an eligible midwife” even though I consider myself one….. I do not meet the government requirements. As from the 1st November midwives will be able to claim a Medicare number, (by the way midwife is not on the list until after the 1st November) now this is also no easy feat…… there are online courses that need to be completed first…..but you cannot do them until November…..do you feel like we are being screwed…. YES.

What I can do now is get my MPR review out the way…… what does this mean….. it means that you need to give yourself some time to complete this process and you need more than a few hours. I am traditionally one who keeps a portfolio, sets annual and 5 year plans as a rule, so none of this is new to me…. However if you have not done this before then allow yourself more time.

I have just completed the first stage of the MPR, that is; a synopsis of my CV, qualifications, current position, previous positions, professional development and key achievements; this takes about 2 pages. Followed by my Midwifery Philosophy half a page; clear current job description; you are half way now; next, reflect on your practice using the ANMC Competency Standards for the Midwife; you will use the four sub headings; Legal and Professional Practice; Midwifery Knowledge and Practice; Midwifery as Primary Health Care and finally; Reflective and Ethical Practice: you will use examples from your clinical practice to address each competency (we do it every day, we just do not necessarily recognize it or relate our work to our competences) this makes us write done what we do ; Now the bulk of the work is completed…all that is left is your short (12 mths) and long term goals (5yrs), you have to make your goals achievable…… that’s it all done… it took me all in all about 6-8 hours…. a few hours each day. Your synopsis should be submitted to the ACM fours week before your interview….. so that they can review your work to ensure it is all compete and meet the requirements…..then all that is left to do is the hour interview…..the interview will be with two reviewers a consumer and a midwife; Watch this space….
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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