Becoming an independent midwife

Ever since I became a midwife, I have been really interested in independent or private midwifery. The idea of being my own boss and looking after my own caseload of women, without battling hospital politics and birthing philosophies worlds apart from my own, just seems very appealing. On the flip side, not having the security blanket of the hospital and all the other people that are on hand if something goes wrong, is absolutely terrifying. Still, I am interested. I would love to work in a partnership with another great midwife or midwives, to have a support network of professionals with identical philosophies and practices, working together and covering each other’s sick or holiday leave etc.

This is why I was so excited when last year in November the Labour government’s Maternity Services Review included provisions for midwives to become Medicare eligible. This means that eligible midwives are now able to provide maternity care with medicare rebates to women seeking to be treated as private patients. Previously women seeking private midwives had no option of Medicare rebate and instead had to lump the entire cost.

The Nursing and Midwife Board of Australia highlights the criteria to become an eligible midwife.
An eligible midwife will have:

• 3 years postgraduate experience,
• currency across all areas of midwifery,
• completion of a professional review program
• completion of a prescribing course (or within 18 months under transitional arrangements).

I can understand the need for these criteria, but I am irritated by a few things. I agree with the first three points. I don’t mind the fourth point if it were at all possible. There are currently no educational facilities that provide prescribing courses for registered midwives. How is any midwife meant to complete a course that doesn’t exist? AND 7 months into the reforms, with still no prescribing courses for midwives, how would anyone under the so called 18 month transitional arrangements, actually transition?

My next issue is related to the stipulations put on the care eligible midwives can give to women to allow them the obtain the Medicare rebate. Women can only get the rebate for private care for antenatal services, delivery in a hospital (or hospital birth centre) and postnatal services. What about women desiring a home birth with a private midwife? If public hospitals can offer midwifery home birth programs, why can’t private midwives offer home birth as an option?

Also, how is a private midwife supposed to provide delivery care in a hospital? I don’t know if many public hospitals would allow private midwives to have visiting rights to provide delivery care to their private patients. Who’s resources would the midwife use? Would she have to bring all her own equipment? If not, how much would the hospital charge her to use their equipment? Do the hospital’s own women or the private midwife’s women get priority for rooms, medical review, available equipment etc.? The midwife would almost certainly receive backlash or at the very least a begrudging attitude to her taking up “their” rooms and resources. How would we overcome this problem?

The other statement in the maternity reforms outline which is good in theory but impossible in practice, is that eligible midwives must have collaborative arrangements with medical practitioners. This article came up on my google alerts emails. It talks about how in the seven months since the reforms became active, only 7 midwives out of Australia’s 42000 midwives have become medicare eligible. SEVEN!!! Ridiculous!

Apparently doctors willing to sign a collaborative arrangement are more than scarce. Surprise surprise. Why would a doctor sign a document that could mean they have less women seeking their care and no financial benefit? Besides the fact that a doctor would most likely want to KNOW the midwife and her skills and abilities before agreeing to take on any of her women who develop a problem outside of her scope of practice requiring transfer to obstetric care. This eliminates the possibility of any midwives who are already practicing as a private midwife to obtain a collaborative agreement, because for one they don’t work in the hospital, and are therefore unlikely to know any obstetricians personally. What obstetrician would sign an agreement with someone they don’t know from a bar of soap?

All of these factors seems to make Medicare eligibility insurmountable. And I haven’t even touched on the problem of inaccessibility of insurance for private midwives. If the government really wants more midwives to take up the challenge and run the gauntlet of becoming a Medicare eligible midwife, they need to do more, make it easier and help midwives make the transition.

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