Tuesday, May 19, 2009


I wonder why virtually noone is making any comment about the midwifery changes announced in last Tuesday's budget - indemnity, Medicare and limited prescribing?

The silence covers the newspapers, TV and radio programs that I have accessed, as well as midwifery and maternity-related email lists. I have been with labouring women in two Melbourne hospitals this week - Mercy and Box Hill - and most of the midwives I have spoken to were not aware that anything has happened. Others seem scared that the reforms will be subjected to excessive gatekeeping, effectively setting hurdles that are too high for ordinary midwives to aspire to, and creating a two-tiered midwifery workforce.

I expected at least a few comments on blogs, but on the whole I'm hearing silence.

Midwife Lisa Barrett has put her opinion on her blog. I have left a comment there, and most of what appears below is copied to this site.

Although I am disappointed and frustrated that homebirth has been sectioned off as a 'no-go' zone, for reasons that can not be taken seriously by anyone who understands evidence, I am really pleased that the government has taken such a big step to dismantle the medical monopoly of maternity care. And in my mind the announcements of reform were more wonderful in the wake of the report of the maternity services review which said a lot of nothing and skirted around the real issues.

The budget press releases from the College of Midwives, as well as from Maternity Coalition and Homebirth Australia were, imho, worded in a politically correct way. I am confident that ACM is the best representative we have for midwives, and I have been assured that the defining of such things as advanced practice and collaboration will be acceptable even to ordinary midwives like me who don't have even a bachelor degree, let alone higher academic quals.

I am also wondering what will be done about homebirth in situations or locations where the publicly funded models are not available. I expect there will be some midwives prepared to go 'underground', while others will seek to comply with the new rules. Noone can force a woman to go to hospital.

I have been actively working for maternity reform since 1993 when I started my private practice. We have a long way to go, but from where I sit the 2009 federal budget is the biggest step forward that I have seen so far in my lifetime. I hope the bill passes in the Senate, and I hope those who represent midwives' and women's interests in bringing in the reforms will be wise and courageous.

I have many questions, and I, like others, will have to exercise patience. That's not easy. I have enjoyed the independence that I have had in midwifery in the past 15 or so years. I accept that there will be changes in how I can practise, if at all, after the middle of next year. I hope that by the end of this year I will still be taking bookings for births beyond 1 July.


Lisa Barrett said...

I am hoping that You are right about this. It would be a fantastic opportunity if it were all go for fundng and homebirth.

I really feel that over regulation destroys freedom of choice.

I will not be humiliated or upset if I'm wrong, I will celebrate like everyone else.

Keep writing.

Rachael said...

Joy, I feel like this whole thing is a make over to try and make HB midwives feel not only pressured into attending birth in the hospital, but like it is the superior choice to homebirth. I do not want to practice birth in the hospital, even with 1-2-1 midwifery. I want to attend homebirth. I can only imagine the negative energy flowing from the hospital staffed midwives and have already heard that they are worried about my ability to practice as a independent in the hospital. I do not want my birthing women to feel this in labour. At this stage, I am holding but little hope for this to be positive for homebirth midwifery. I hope I am wrong, but it wasn't that long ago the government allowed unqualified doctors to over see the care of unqualified nurses to attend ANC. That certainly wasn't in the interst of safety. If all this goes through for the best you'll hear me singing from the rooftops from Central Queensland!

Nuraini said...

Hi Joy,

I've been wondering with the new changes, midwives won't be insured for the actual 'birth', but does that mean if women still want to give birth at home, the midwives can still be there but just won't be insured, just like they are practicing now?

We are presenting our homebirth assignment tomorrow, will let you know how it goes :)


Joy Johnston said...

Nu, I don't think anyone knows the answers to questions about what will happen to mothers who want to give birth at home, and midwives who at present are attending these women.

Many of us are like Rachael and Lisa - we would like to continue in homebirth, and we are confident practising autonomously at the primary maternity care level, working in partnership with each woman, and collaborating with other health service providers if an when appropriate.

I agree with Lisa's comment that 'over regulation destroys freedom of choice'. But regulation of health professionals is a reality in our world, and it's purpose is the protection of the public. The way our governments decide on regulations, such as mandatory indemnity insurance for all health professions, is complex, but the decision to require it was made years ago and all relevant government levels agreed.

For this reason I am pleased to see the provision of indemnity for midwives to continue practising privately after November 2010. I don't know how midwives will be required to work, and I don't know how we will put food on our tables between July and November next year. I don't know how women having babies at home during the period of implementation will be 'protected' by the regulatory system. But change is inevitable, and we have overcome obstacles in the past, so we should be prepared to do what we need to do in coming days.