ACM Homebirth (interim) Position Statement;

Dear Members,

Please take the time to read and comment on the ACM's interim Homebirth position statement and guidance for privately practicing midwives;

Interim Position Statement on Homebirth

Interim Guidance for privately practising midwives providing midwifery care for a planned homebirth

ACM has requested comment on both the interim position statement and the interim guidance for privately practising midwives by close of business 23rd September 2011.

Send submissions by email to info@midwives.org.au or by post to PO Box 87, Deakin West ACT 2600. Only submissions with identified senders and a return address will be considered.

Please comment on the Homebirth Policy for WA

The Women's and Newborns' Health Network is seeking comments on a draft Home Birth Policy and Guidance for Health Professionals, Health Services and Consumers. The Review of homebirths in Western Australia released in August 2008 made recommendations for conducting home births in WA which have been incorporated into this Policy.

The Policy will be applicable to qualified health professionals (i.e. registered midwives and/or medical practitioners) working in the Western Australian public health system when caring for women who make an informed choice to give birth at home.

Please send an email to healthpolicy@health.wa.gov.au to request a copy of the Policy and a Feedback Form. The deadline for comments is 31 March 2011. Date has been extended to Friday 8 April.... please send in your comments:

Kind regards

Dr Janet Hornbuckle and Assoc Prof Graeme Boardley
Co-Leads, Women's and Newborns' Health Network

Safety and Quality Framework for Privately Practising Midwives attending homebirths:

The Safety and Quality Framework for Privately Practising Midwives is up on the AHPRA website..... click her to read whole framework;

IMPORTANT CLAUSE:

284 Exemption from requirement for professional indemnity insurance arrangements for midwives practising private midwifery
(1) During the transition period, a midwife does not contravene section 129(1) merely because the midwife practises private midwifery if—
(a) the practise occurs in a participating jurisdiction in which, immediately before the participation day for that jurisdiction, a person was not prohibited from attending homebirths in the course of practising midwifery unless professional indemnity insurance arrangements were in place; and
(b) informed consent has been given by the woman in relation to whom the midwife is practising private midwifery; and
(c) the midwife complies with any requirements set out in a code or guideline approved by the National Board under section 39 about the practise of private midwifery, including—
(i) any requirement in a code or guideline about reports to be provided by midwives practising private midwifery; and
(ii) any requirement in a code or guideline relating to the safety and quality of the practise of private midwifery

(2) A midwife who practises private midwifery under this section is not required to include in an annual statement under section 109 a declaration required by subsection (1)(a)(iv) and (v) of that section in relation to the midwife’s practise of private midwifery during a period of registration that is within the transition period.
(3) For the purposes of this section, the transition period—
(a) starts on 1 July 2010; and
(b) ends on the prescribed day.

The framework is to ensure safe high quality of care of th woman and her baby when choosing homecare by a private practising midwife;
It is good to see that the ACM Consultation and Referral Guidelines and the prinicpoes and practices in the NHMRC document are also key elements in this framework.

KEEPING BIRTH NORMAL:

Thanks Carolyn (Thinkbirth)for this link: and yes Carolyn you are correct in saying every item could be a blog on its own......

The World Health Organization (WHO) definition of normal birth is: ‘Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition’.

It is a pity not every State and Territory in Australia adopts this policy TOWARDS NORMAL BIRTH: NSW is leading the way: the policy is aimed to increase normal birth and decrease surgical intervention. Western Australia needs to take a leaf out of the NSW book: I may even suggest it to our Minister of Health and our Chief Nurse and our Midwifery Advisor to see if we could not adopt this proactive lead to ensure that Normal Birth is the focus; even better I might give them Carolyn's 21 strategies to keep birth normal........

10 Steps
1. Have a written normal birth policy/guidelines, along with other
relevant policies, that are routinely communicated to all health care staff

2. Train all health care staff in skills necessary to
implement this policy

3. Provide or facilitate access to midwifery continuity of carer programs in collaboration with GPs and obstetricians for all women with appropriate consultation, referral and transfer guidelines in place

4. Inform all pregnant women about the benefits of normal birth and
factors that promote normal birth

5. Have a written policy on pain relief in labour that includes the use
of water immersion in labour and birth

6. Have a written postdates policy/guideline that is routinely
communicated to all health care staff (All women have an agreed due date of birth
documented in their health record)

7. Provide or facilitate access to vaginal birth after caesarean section
operation (VBAC) that is supported by a written vaginal birth after
caesarean section operation policy/guideline (develop statewide workshop of GPs, midwives and obstetricians to exchange views and skills regarding VBAC)

8. Provide or facilitate access to external cephalic version

9. Provide one to one care in labour for all women experiencing their
first labour or undertaking a vaginal birth after caesarean section
operation, vaginal breech or vaginal twin birth (implement local guidelines/protocols that discourage activities that separate midwives from the woman in labour. This includes the use of centralised monitoring systems as they discourage midwives from being with the woman in the labour room)

10. Provide formal debriefing in the immediate postpartum period for all women requiring primary caesarean section operation or instrumental birth with the opportunity for further discussion and information transfer

What I really like is Carolyn's inspirational and passionate list: this is how it should really read....in plain simple language that everyone understands....

Carolyn's 21 Strategies to help keep birth Normal:

1. Avert the medical 'gaze'

2. Be powerful and able to negotiate as equals to doctors

3. Establish a "round table culture'

4. Dispel 'urban myths' about birth

5. Support women to choose upright positions in labour

6. Educate teenagers

7. Promote the use of positive images of birth

8. Look at system issues: promote and change to woman centred midwifery models

9. Discuss what normal birth means to us and ensure we are talking about the same things

10. Listen to women with respect - what does the woman want?

11. Encourage women in labour to stay home as long as possible

12. Establish and provide support structures to help women stay at home in early labour

13.Establish and provide support structures so women can choose to stay home to give birth if desired

14. Examine our own attitudes to 'being with woman' in pain and uncertainty

15. Seek to establish a relationship with each woman

16. Allay fear: let woman know what birth is really about

17. Address anxiety of support people and other health professionals

18. Pay attention to the language we use

19. Have confidence in women's ability to give birth

20. Pay attention to our body language as body language conveys meaning: what are we saying?

21. Set up birth space intentionally - find out what makes each woman feel safe and do that.

Yeah AHPRA coming to the party; Good News;

After some frustrated phone calls to the College and a few letters to AHPRA it is good to see that AHPRA are listening and things are becoming easier; it pays to voice your opinion and it is even better when the other party comes to the table; well done to the ACM (Barb Vernon EO) for going in to bat for us and well done to AHPRA for considering the issues on the table and resolving them....... here is some of the good news;

I have just had confirmation from AHPRA that: (via the ACM)

1. MPR certificate will from now on be taken as sufficient evidence of
c. Current competence to provide pregnancy, labour, birth and post natal
care to women and their infants;
d. Successful completion of an approved professional practice review
program for midwives working across the continuum of midwifery care;

2. Professional references can now be provided by a midwifery colleague. The requirement for a reference from a ‘member of the multidisciplinary team’ (obstetrician) has been dropped

3. References do not need to address every element of the ANMC competency standards. They are able to be a general third party statement of support for your application from a midwifery colleague or manager

As for my application I am happy to announce that;

AHPRA has also agreed that they would be happy for ACM to reissue MPR certificates to existing applicants with wording that confirms their review was in relation to their competence across the full scope of midwifery practice. I am still waiting on a response to my questions relating the 3 year / 5 year requirement on the application form & the criteria for certifying documents;

Fantastic; now all I have to wait for is that the college will send a certified copy directly to AHPRA on my behalf, (which won't take long) and I will get the amended original for my midplus folder to replace the current one.... then I will get my notation; yeah!

Step one; MPR completed;
Step two: Eligibility completed: next Medicare!

Keep watching this space............

Red tape of AHPRA:

Next installment of my application for eligibility; here I was Miss Perfect at following instructions and I haven’t got it right; I had all my documents certified by a lecturer at the university stating "this is a certified copy etc"to be informed that this was not correct: for your information these are the certified people for AHPRA;

Who can certify documents?In Australia, the following people are authorized to certify documents:

Justice of the Peace, Bail Justice, Registrar or Deputy Registrar
Commissioner for Declarations, Commissioner for Oaths, Commissioner for Affidavits
Lawyer
Accountant (member of the ICA, ASA, NIA OR CPA)
Registered members of the teaching profession (not university)
Member of the police force
Sheriff or Deputy Sherriff
Public Notary
Permanent staff member of AHPRA

Alas this means I have to do it all over again; photocopy and resend. Second problem, the letter from my past employer was not sufficient, it was not enough to say that I had been employed across the spectrum of midwifery and that I was deemed competent by the institution, the manager has to address the ANMC competencies as well, this is a step too far… I have completed the Midwifery Practice Review which addresses each competency……I am a patient woman and I understand that you need to ensure that midwives are competent…. But this really is going overboard.

What I thought was going to be a relatively smooth process is turning into a mind field of red tape and bureaucratic nonsense; there is something to be said about waiting until the first batch have gone through to iron out all the problems, however one would not consider that there would be so many issues and the goal posts moving.
Watch this space: Pauline

Check out the Determination for Medicare Provider Numbers

Please have a look at the Health Insurance (Midwife and Nurse Practitioner)Determination 2010Health Insurance Act 1973
I, NICOLA ROXON, Minister for Health and Ageing, make this Determination under
section 3C of the Health Insurance Act 1973.
Dated 4 October 2010

This determination comes into force 1 November; Midwifery services and fees range from $31.10 - $724.00 and providing a service fee for 6 weeks postnatal period...

We have to remember that this does not cover homebirth and we need to continue to put pressure on the government to pass this midwifery services fee onto women who choose to have a homebirth.....

Cycling around Australia...Where is Marg Phelan up to

Here is an Update from Marg.... see where she is now;they have done really well, what an achievement to cycle across the Nullabor, I remember many years ago driving across and thinking my God miles and miles of complete nothingness...but spectacular at the same time.. I couldn't imagine cycling across.....what a phenomenal group of women... here is part of Marg's email letting us know where she is.....

Hi all
We are half way across the Nullabor. We are at Eucla for 2 nights and move on tomorrow. We have been out of phone and internet cover for the past week so unable to contact anyone.
Hope all is good for you and everything is going as planned.
Cycling going well in spite of head winds, cool temperatures and some rain. Robyn is doing a great job with Muriel (name of the van) and the roadies duties
We have 6 more days of no coverage till we get to Ceduna.

Check out our website www.gogirlaustralia.net.au as Su has put more photos on and some more on the blog.

Love and hugs to you all
Gogirls xxx

Marg Phelan, Midwife

www.gogirlaustralia.net.au
Cycling for midwives, women
Normal birth & breastfeeding

Radio National's Life Matters program, after the 9am news.

Liz Wilkes and Ted Weaver are sheduled to debate the "collaborative arrangements" problem tomorrow/Thursday morning, on Radio National's Life Matters program, after the 9am news.

Please listen in and take any opportunity to make comment.

For those who'd like to hear the online audio, download the podcast, or make comment, the website is:
http://www.abc.net.au/rn/lifematters/

Collaborative Arrangements – What can you do?

Australian College of Midwives - E-Bulletin

Collaborative Arrangements – What can you do?

Dear Members and Consumers

As you would be aware a key component of the National Maternity Reform Package implemented by the current government was to give midwives and the women they care for access to Medicare rebates and to the Pharmaceutical Benefits Scheme (PBS). In September this year midwives will be able to begin applying for a Medicare provide number in preparation for the implementation of the legislated reforms on 1st November.

The most recent developments around the recent release of the Determination (or secondary regulations) that now define the detail of collaborative arrangements are concerning and will restrict the way midwives will be able to practice. The Determination was signed into law by the Governor General on 16th July and released just prior to the announcement of the election.

Despite the government¹s stated intention in March this year of not wanting to provide a right of veto over another health professional¹s practice it would appear that the Determination does just that.

You can view a copy of the determination by clinking on the link below http://www.comlaw.gov.au/ComLaw/Legislation/LegislativeInstrument1.nsf/all/whatsnew/6A0EF93573665149CA257762000BBDEE?OpenDocument

So what can you do about this?
We are encouraging you to phone, write, email or talk to your local federal member – especially when they are out campaigning -

• Let them know you live in their electorate and what your address is (they need this to prove you live there).

• Tell them you are very concerned that the recent determination - the National Health (Collaboration Arrangements for Midwives) Determination 2010 - will enable the medical profession to have veto over midwifery practice and prevent the success of the maternity reforms.

• Plan local activities to let all the candidates in your electorate know how you feel and involve consumers and local media if possible.

• You can also ring Nicola Roxon on 02 627777220 and let her know what you think!
You can find details of your electoral office on the following link http://apps.aec.gov.au/esearch/

Associate Professor Hannah Dahlen
President, Australian College of Midwives

Midwives Insurance options made easy:

If you are a private practice midwife / independent midwife you will need insurance cover: your choices are MIGA and Medisure/Mediprotect - I have discusse these options on a previous blog.... however some midwives have expressed the need for an easier expanation.

What you need to do is read what both companies have to offer: In a nutshell:
MIGA - offers a comprehensive insurance and the cost is up to $7500.00 per anuum, this insurance also has a run off compontent.... and what that means is that it covers you for when you stop working:

Professional indemnity insurance is provided on a claims made basis – this means your policy will only cover you for claims that are made and reported to MIGA while you have a current insurance policy with MIGA
• If, in the future, you no longer need the insurance because you have ceased private midwifery practice, you may require insurance to cover your prior practice. This type of cover is called 'run-off cover'
• Run-off cover insures you for claims made in the future which relate to incidents that occurred in your prior practice
• You need to maintain run-off cover for the whole time that you have ceased practice in order to be protected against claims that may arise in the future.

For a quick easy read, check out Questions and Answers for Midwives
Now also review the Maternity Care Plan Check list by MIGA; click the link.

Medisure / Mediprotect by calling 07 3426 0400 OR Downloading the Application Form, and either Faxing it to (07) 3426 0444 or Via E-mail to admin@medisure.com.au

This insurance does not have a run off cover, if you want to purchase one it comes at a higher price. Also the amount of insurance cover is less than MIGA, the other difference is eligibility....To be eligible for this cover, practitioners need only be registered as a ‘practising midwife’ with the Nursing and Midwifery Board of Australia.

Vero/Medisure/Mediprotect is a cheaper insurance with no run off insurance which allows you to be registered with the NWBA and therefore able to continue to work.... it is not as comprehensive as MIGA..... you will have to decide which insurance will be right for you and your practice!

OF COURSE NO INSURANCE COVERS YOU FOR A HOMEBIRTH

GOOD LUCK.......


Ref cartoon: www.legaljuice.com/judge%20funny%20cartoon%20...

National Health (Collaborative arrangements for midwives) Determination 2010

The day has arrived we know what collaborative arrangements are: here is the document for you to read; I am still absorbing all the information: on the first read I was upset....however after digesting it there is room to move and I am more positive about the whole agreement. It is a difficult paper to read and understand and you have to read it several times to find the areas which we can use to our advantage.....so have a read and then lets discuss our options...click the link

National Health (Collaborative
arrangements for midwives) Determination
20101

4 Specified medical practitioners
For the definition of authorised midwife in subsection 84 (1) of the Act, the
following kinds of medical practitioner are specified:
(a) an obstetrician;
(b) a medical practitioner who provides obstetric services;
(c) a medical practitioner employed or engaged by a hospital authority and
authorised by the hospital authority to participate in a collaborative
arrangement.

5 Collaborative arrangements — general
(1) For the definition of authorised midwife in subsection 84 (1) of the Act,
each of the following is a kind of collaborative arrangement for an eligible
midwife:

(a) the midwife is employed or engaged by 1 or more obstetric specified
medical practitioners, or by an entity that employs or engages 1 or
more obstetric specified medical practitioners;
(b) a patient is referred, in writing, to the midwife for midwifery treatment
by a specified medical practitioner;
(c) an agreement mentioned in section 6 for the midwife;
(d) an arrangement mentioned in section 7 for the midwife.
(2) For subsection (1), the arrangement must provide for:
(a) consultation between the midwife and an obstetric specified medical
practitioner; and
(b) referral of a patient to a specified medical practitioner; and
(c) transfer of a patient’s care to an obstetric specified medical
practitioner.

(3) A collaborative arrangement, other than an arrangement mentioned in
section 7, may apply to more than 1 patient.

(4) However, an acknowledgement mentioned in paragraph 7 (1) (c) may apply
for more than 1 patient.

6 Agreement between eligible midwife and 1 or more specified
medical practitioners
(1) An agreement may be made between:
(a) an eligible midwife; and
(b) 1 or more specified medical practitioners.
(2) The agreement must be in writing and signed by the eligible midwife and
the other parties mentioned in paragraph (1) (b).

7 Arrangement — midwife’s written records
(1) An eligible midwife must record the following for a patient in the midwife’s
written records:
(a) the name of at least 1 specified medical practitioner who is, or will be,
collaborating with the midwife in the patient’s care (a named medical
practitioner);
(b) that the midwife has told the patient that the midwife will be providing
midwifery services to the patient in collaboration with 1 or more
specified medical practitioners in accordance with this section;
(c) acknowledgement by a named medical practitioner that the practitioner
will be collaborating in the patient’s care;
(d) plans for the circumstances in which the midwife will do any of the
following:
(i) consult with an obstetric specified medical practitioner;
(ii) refer the patient to a specified medical practitioner;
(iii) transfer the patient’s care to an obstetric specified medical
practitioner.
(2) The midwife must also record the following in the midwife’s written
records:
(a) any consultation or other communication between the midwife and an
obstetric specified medical practitioner about the patient’s care;
(b) any referral of the patient by the midwife to a specified medical
practitioner;
(c) any transfer by the midwife of the patient’s care to an obstetric
specified medical practitioner;
(d) when the midwife gives a copy of the hospital booking letter (however
described) for the patient to a named medical practitioner —
acknowledgement that the named medical practitioner has received the
copy;
(e) when the midwife gives a copy of the patient’s maternity care plan
prepared by the midwife to a named medical practitioner —
acknowledgement that the named medical practitioner has received the
copy;
(f) if the midwife requests diagnostic imaging or pathology services for
the patient — when the midwife gives the results of the services to a
named medical practitioner;
(g) that the midwife has given a discharge summary (however described)
at the end of the midwife’s care for the patient to:
(i) a named medical practitioner; and
(ii) the patient’s usual general practitioner.

All the above information is taken from the National Health Act 1953 (click the above link for the whole document)

Please feel free to ask any questions

Insurance for Midwives:

There are several choices for midwives in relation to insurance. If you work in a hospital you will be covered by the hospital vicarious liability, you will however need to find out what that insurance covers:

To practice as a private practice or independent midwife you will need some form of insurance in order to be registered with the Nurses and Midwives Board of Australia. Currently these are your choices:

Option 1
The Government Insurance:
MIGA (Medical Insurance Group of Australia) has won the contract to offer midwives professional indemnity insurance, with support by the Commonwealth under the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Act 2010. See blog 14 June
MIGA have a News Flash in relation to collaborative arrangements click here to see more....
Further information about Collaborative requirements appears below.

I am interested in securing formal Collaborative Arrangements, but I don't think I can obtain an obstetrician's or a hospital's agreement to collaborate with me before 1 July. Can I still be covered by the MIGA insurance?
Yes. If you are unable to obtain a Collaborative Arrangement for a particular woman, you will still be covered if you communicate a maternity care plan for that woman to a public hospital that provides obstetric services.

Option 2
Vero insurance policy for antenatal and postnatal care only - the agents for this will be Mediprotect http://www.mediprotect.com.au/
The policy will cover activities such as, the provision care and education services, but will exclude birthing. Midwives will be able to choose between two categories for their activities.
The insurance will cost between $1800 - $3010.00 ( cover will be from $1,000,000 - $5,000,000
Information about the Vero policy can be obtained from the Mediprotect website or by phoning Mediprotect on 07 3426 0440.

To be eligible for this cover, practitioners need only be registered as a ‘practising midwife’ with the Nursing and Midwifery Board of Australia.

Option 3
The ANF is contemplating an insurance option this is still to be confirmed, the best thing to do is to check with your local office....

Watch this space for more information......
Remember there is no insurance cover for Homebirth;

Cheers Pauline

ref for cartoon: www.getmilked.com/.../ThankYouInsuranceMan.html

Will you be an Eligible midwife?

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 release 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.....

What does this mean: 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 have an undertaking do further study within 18 months..... and you need to be insured.....indemnity insurance:

Watch this space!

Cheers Pauline

Maternity Services Reforms: indemnity insurance - what is it going to cost?

Maternity Services Reforms
More choice for women – indemnity insurance for midwives
Indemnity insurance - protection for midwives

As you are all aware from July 1st 2010 National Registration starts: this means that Privately-practising, eligible midwives will be able to access Australian Government supported professional indemnity insurance from 1 July 2010. The Dept of Health and Aging has released this document; Maternity Services Reforms
More choice for women – indemnity insurance for midwives;

I am not so sure about the offer......The premium for a midwife in full time practice is expected to be around $7,500 per year, that is $144.23 per week. However this insurance will not cover the planned delivery of babies in the home – for which there is a two year exemption from the requirement under the National Registration and Accreditation Scheme for midwives to hold professional indemnity insurance. It should be noted that the exemption relates only to the actual homebirth.

I wonder how many hoops midwives have to jump through to be an eligible midwife? I would of thought that after completing the required course to become a midwife you would be qualified to work as a midwife..... but Alas this is not the case in Australia it seems that we have to do even more to obtain the new reforms proposed....they say that....Pregnant women and new mothers will have more choice in maternity care because the clients of eligible midwives with professional indemnity insurance will be able to access services subsidised by the Government through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS).

I feel that women will have less choice because there will not be any 'eligible midwives', and I suppose that will suit the AMA.....what happened to fair play? and equal opportunities? Where is the ethics in all of this?.... it seems that ethical principles have gone out the window....

I ask at what price is this privilege coming and by privilege I mean MBS & PBS..... we are introducing another word, phrase, type, description of a midwife... the 'eligible midwife' who is currently the private practicing midwife or independent midwife.... how many of the current private practice midwives will be able to jump through the hoops...and we do not yet know what those hoops are???? if this offer of indemnity insurance is anything to go by... I suspect we are in trouble......

Definition of a Midwife

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.
The midwife is recognised as a responsible and accountable professional who works in
partnership with women to give the necessary support, care and advice during pregnancy,labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

Reference of definition: International Confederation of Midwives

Go Girl Australia

Cycling for midwives, women, normal birth and breastfeeding
Who is Go Girl Australia you might well ask..... it is someone that you may well know..... Marg Phelan - Midwife

Go Girl Australia
I met Marg in 2003 when she was the was very involved with the College of Midwives (ACM) at state and national level, including a two-year term as National President. "Marg sees pregnancy, labour and birth as a normal physiological process, and believes that for normal pregnancies, homebirth is a safe and enormously rewarding experience. She recently had the honour and privilege to be midwife for daughter-in-law Mei Mei and son Paul during the homebirth of their beautiful boy in December 2008".

Now working in the Darwin Homebirth Service, Marg is able to offer the model of care to which she believes all women are entitled.

Go Girl Australia is a not-for-profit venture that aims to promote continuity of care from a known midwife, normal birth and breastfeeding.

Follow Marg's journey..... see the map..... she will be in WA:
Darwin to Broome (April - June 2010)
Broome to Perth (23 July - 2 September 2010)
Broome to Kalgoorlie (August - mid September)

If you know midwives in these areas please forward them this link and let them know when Marg is there area so that we can celebrate her journey..... and help the cause. Go Girl Go

Want to sponsor the cause click here
Go Girl Australia is a self-funded, not-for-profit venture and its purpose is not to raise funds, but to raise awareness and improve education. There are many ways you can support us.
Join us on part of the ride
Make placards and signs to display as we pass through your town
Organise a get-together for women in your area - Marg will be happy to speak at your event
Sponsor us with donations of cash, fuel vouchers, cycling gear, bike parts, accommodation, food
Advertise Go Girl Australia through your business or community group

Can't wait to greet you in Perth Marg and safe journey......

General Meeting with Barbara Vernon the CEO of the Australian College of Midwives:

The meeting was attended by approximately 25 members. It was brilliant to see the student representative’s coming to the meeting.... 3 from Curtin and 2 from ECU.
No guesses what we discussed....what everyone is talking about....the new legislation and National registration. Next week is important as three Bills will be presented to the Senate......that is
Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009
Amends the Health Insurance Act 1973 and National Health Act 1953 to: enable nurse practitioners and appropriately qualified and experienced midwives to request appropriate diagnostic imaging and pathology services for which Medicare benefits may be paid; and allow those health professionals to prescribe certain medicines under the Pharmaceutical Benefits Scheme. Also makes consequential amendments to the Health Insurance Act 1973, Medical Indemnity Act 2002, Medicare Australia Act 1973 and National Health Act 1953.

Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009
Introduced with the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009, the bill establishes the Midwife Professional Indemnity (Commonwealth Contribution) Scheme to provide indemnity insurance to eligible privately practising midwives.
Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009
Introduced with the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009, the bill imposes the run-off cover support payment as a levy on insurers’ premium income for providing insurance cover to eligible midwives.



Other issues discussed were...Medical Benefits Scheme (MBS)....Prescription Benefits Scheme (PBS) and the run off insurance cover.

The most interesting part of the evening for me was discussing the many options midwives will have from this enormous change to the way we work in Australia.... and not before time.... but I have to ask.... Are Midwives Ready for this Change????

How is MBS going to affect midwives?
....women can be private patients of the midwife...therefore claiming a funding rebate... however not for intrapartum care.
....midwives could be contracted to hospitals for intrapartum care
...midwives could setup their own consulting service for antenatal and postnatal care....we just have to be clever how we do it...

What are the implications for midwives with these changes.....well you can be
........self employed, set up your own practice providing antenatal & postnatal care
........be contracted to a hospital for intrapartum care
........participate in midwifery care
........relinquish the nurse component of your registration
........work in the community

Where too from here?

These are very exciting times.... however.......we need to work everyday on these issues.... determining eligibility, designing MBS rebates.... CPD packages on MBS & small business management, searching for indemnity insurance....



What do you think? are you ready for this?

Welcome to all Student Midwives

Welcome to the new Curtin post graduate midwifery students.... it’s always great to meet and greet the students on orientation day.... it’s a who’s who of nursing and previous life experience. I particularly like to hear what everyone’s passion is...and inevitably most of the students tell you that they are here because they have always wanted to be a midwife and the other comment has been “I wish they had direct entry midwifery earlier”. You can feel the excitement and enthusiasm in the air... of course there is anticipation and some trepidation as there is with any new path that we embark upon.... we would not be normal if this did not happen.



This is an incredible journey and often life changing....”The student midwife” one of self discovery..... It is often a spiritual journey one which makes some of you think of your own birthing experiences and come to terms with them.... and if you have not had children.... it may lead you to ask about your own birth.... it is a time to really discover who you are..... Because you share a very privileged time in a woman’s life and she is often dependent on your knowledge and support.... it is a time to learn how to truly be “with woman” and often this about knowing, when to be an advocate, educator, counsellor, silent and above all professional in every way......it is about knowing what the woman wants, listening and letting go of your own ego...... it’s about empowering women to make their own decisions....



The midwifery students are from all different areas...rural, SJOG Subiaco and Murdoch, Mercy, KEMH, OPH, AKH, sorry if I have left any out...


“There are precious few times in life when you are fortunate enough to meet people who bring you a truly new perspective on a subject that you thought you knew – people who inspire you to ask different questions and re-evaluate the essence of what you’re doing” Professor Fiona Stanley.



Good luck to you all.... enjoy the journey....

We will be going out to ECU next week so will post the photos when we get them....watch this space.....
Cheers Pauline

Here is an interesting artice relating to medicare rebates

Here is a nice easy read relating to the effects of cutting medicare funded rebates, until last year women could claim 80 per cent of out-of-pocket obstetrics fees after reaching the safety-net threshold. This will change things for both the woman and the obstetrician... and hopefully we will see more women seeking midwifery led care.......Anger over cut to obstetrics

Rebates for private obstetrics fees slashed
Public hospitals swamped by patient demand
Low-risk out-of-area patients turned away

Indemnity Insurance a problem globally

Private practice midwives / Independent Midwives, both mean the same and are used interchangeably. Just to put some issues in perspective this is a global problem and it comes down to money. Why is it we need insurance? ... this is because we live an over-litigious society.

The current situation in the UK....there is no professional indemnity insurance available to Independent Midwives, the bottom line is that they are liable for any negligence claim made against them as is the case in Australia.
The systems are similar between Australia and the UK. Hospital midwives, and Community Midwifery Pogram are covered by the hospital and in the UK by the Trusts therefore covered by vicarious liability through the employer.

Like Australia the Royal College of Midwives (RCM) provided insurance to independent midwives until Australia 2002 and UK 1994. The RCM decided to exclude those members who practised independently from the Private Indemnity Insurance cover, in order to keep RCM premiums at an affordable level. The insurance cover was half a million pounds.....to much to cover... However the UK did still have some insurers that would cover Independent midwives, despite having good outcomes the price still increase to 20,000 pounds per year for a midwife (A$45,000 per year). In 2002 the last commercial insurer withdrew from the market because it was not commercially viable due to the small numbers of independent midwives in the UK.
The UK is considering.... Independent Midwives and Contracting to NHS Trusts....its worth a thought....

Midwives have not had access to professional indemnity (PI) insurance since 2002/03, when Australia faced a medical indemnity crisis that resulted in large premium increases.

Just to add reality to the equation here is a case of negligence that resulted in a payment of $11 million dollars.....

In November 2001 the NSW Supreme Court awarded Calandre Simpson, an infant born at St Margaret's Private Hospital with cerebral palsy, fourteen million dollars (the award was reduced on appeal to eleven million dollars) for the overdose of syntocinon, which caused her birth defects. At that time the award was twice that of the next highest payout. This payout assisted in the collapse of Australia’s largest medical indemnity organisation, United Medical Protection (UMP, now Avant) and brought with it what we know as the ‘medical indemnity crisis’.

From this crisis came the key reforms was the introduction of the Policy Support Scheme (PSS), available to obstetricians, neurosurgeons and rural procedural GP’s.
and off course midwives were not included.... I think we missed the boat here.
Now this is an interesting concept that came out of this....

‘Under the PSS, if a doctor's gross medical indemnity costs exceed 7.5 percent of his or her gross private medical income, he or she will only pay 20c in the dollar for the cost of the premium beyond that threshold limit. In other words, the PSS meets 80 percent of the premium above the 7.5 percent threshold of an eligible doctor’s gross private medical income.

Justine Caines stated....Interestingly the rights of Australian women choosing private midwifery don’t have the same value as those women choosing the services of a specialist obstetrician or a procedural G.P. When I challenged the legal branch of NSW Health with this comment I was greeted with silence.

The Australian College of Midwives continues to lobby and negotiate for possible solutions to this current problem...... so watch this space....

The picture: Laura is my friend we did our Midwifery together at Hertfordshire University.. she is now an Independent Midwife......" midwives have babies too, and I can really empathise with the women I care for now"

Cheers Pauline