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On September 7, thousands of women protested in Canberra to have their rights to homebirths protected, as private midwives faced the prospect of continued lack of access to medical indemnity insurance, and, as a result, the inability to register with the Government’s proposed National Registration Board. The board, which will officially launch on July 1 2010, is intended to legitimise a number of health specialisations, including midwifery. However, in an ironic twist for private midwives, one of the criteria for registration is medical indemnity insurance, to which they do not currently have access. According to the Private Midwives Association, the peak professional body for Australian midwives, more than 1000 home births take place in Australia each year. Home birthing with a midwife is the preferred option for a small but growing number of women; but it’s one that has come under increasing threat, as debate raged within the medical and health sector and the wider community over the risks of allowing midwives to practice uninsured. Opportunities for newly qualified midwives to enter the home birthing arena have also been jeopardised for the same reason. As Melbourne based midwife Robyn Thomspon explains, there was a time when most private midwives did have medical indemnity insurance. However all that changed with the collapse of the re-insurance industry sector following the events of September 11 2001, as well as growing opinion that the small number of private midwives did not merit medical indemnity insurance. “When the insurance industry crumbled, small insured groups became particularly vulnerable, and with around 200 private midwives around the country, private midwifery inevitably became a casualty,” Thompson says. However signs are now emerging that home birthing will be protected. The protests on September 7 followed an announcement on September 4 by Federal Health Minister Nicola Roxon that the states, territories and commonwealth had agreed to a two year exemption for home birthing midwives. The exemption would allow more time for the issue of medical indemnity insurance, along with other protocols for private midwives, to be established and refined. A number of conditions and requirements were attached to the exemption. These included that a home birthing midwife must disclose to a mother who is interested in having a homebirth that they will not be insured for that procedure. Midwives must also make sure that women are able to make an informed choice about undertaking a homebirth. “We will ask home birthing midwives to report each homebirth,” Minister Roxon added, describing current national data on home births as inadequate. “And we will require participation in quality and safety frameworks, for example, reporting the results of home birthing.” According to coverage in the Sydney Morning Herald following her announcement, support group Homebirth Australia said while the change was a step in the right direction, failure to provide indemnity cover was unacceptable. ''It is patently unfair to have a two-tier system like this,'' said Homebirth Australia secretary, Justine Caines. She added it was unfair that taxpayers should have contributed $1 billion to provide subsidies for medical indemnity for doctors since 2002, much of it going to obstetricians, when no public support was available for home births. Meanwhile Liz Wilkes, president of the Private Midwives Association, said the decision was ''a reprieve and a Band-Aid'' for home births. However, the Australian College of Midwives is in dialogue with the Government and insurers regarding indemnity cover for midwives, and a statement on its website claims that while “nothing has yet been confirmed, we are optimistic that the indemnity problem will be able to be resolved before the national registration scheme comes into effect in July 2010. For Robyn Thomspon, a midwife practitioner, nurse, maternal and child health nurse and lactation consultant with some three decades of experience, the reprieve for home birthing is a welcome one. An ardent advocate for the practice, she contends that, contrary to claims by the medical sector, home birthing is relatively low risk. “Midwifery utilises no surgical procedures”, she says. “Furthermore, midwives’ education is designed to foresee problems before they occur and to deal with emergencies, should they arise, until medical assistance is available.” “I would describe women who choose home birthing as ‘thinking women’. Midwives who specialise in home birthing are generally very passionate about it. We take women through the process with minimal touching and interference. We allow the woman to labour under her own steam in order to birth her baby and breastfeed in a mammalian way. Our presence provides an environment that facilitates her.” It’s worth noting that September’s protests coincided with the release of a Canadian study revealing women who had children by home birth were less likely to need interventions during their birth or to have poor health outcomes, such as severe perineal trauma and haemorrhage. The study also found that babies born at home were less likely to need resuscitation following the birth or require admission to neonatal intensive care. In contrast to Australian mothers, in Canada, women can choose their place of birth and receive funding for midwifery support at home. Canadian midwives also have insurance and visiting rights to hospitals. By Belinda Smart |
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