There’s a great deal of discussion and debate in the community and in the media at present about midwife-managed models of birthing. The announcement earlier this year that Commonwealth-supported professional indemnity insurance would be provided for privately practising midwives was clearly a step in the right direction to providing flexibility for expectant mothers and midwives alike. However, it is a requirement that midwifery services are part of a collaborative team with doctors and other health professionals, which excludes home births and brings into question the viability of midwife-managed models of birthing care.

There is a great deal of evidence to support midwife-managed models of care in terms of patient satisfaction, rates of natural births, need for pain relief and forceps deliveries. And there’s no question that by international standards, midwife-run maternity units in Australia are first class. I don’t believe that any of these points are in question for serious commentators. Ultimately, even for low-risk pregnancies, there is a small chance that things can go very wrong and this has the propensity to lead to claims of professional negligence against midwives. It seems to me that what is important is that:

a) mothers are given appropriate choices as to how they give birth and under what care

b) mothers fully understand the risks of giving birth under a midwife-managed model of care

c) midwives are given appropriate protection against claims of professional negligence where a mother chooses to give birth under a midwife-managed model of care.

It seems to me that all three of these requirements could be met through legislative provisions that limit a mother’s capacity to pursue claims of professional negligence against midwives. More specifically, if a mother plans to have a home birth, is provided with appropriate information about the risks and formally accepts these risks, then if something does go wrong, she is not entitled to pursue damages against the midwife involved for professional negligence.

Implementing a proposal such as this may well present some challenges in practice, but to prevent a whole range of choices for mothers and professional vocation for midwives purely because of the threat of legal liability seems unfortunate to say the least.

Editor’s Comment – By Martin Bowen
NCAH