Friday, June 05, 2009

We live in interesting times

I would like to add to my recent discussion and state here that I believe there is a positive future for homebirth, on a much larger scale than the Australian community has known.

Any major reform requires costings and processes to be carefully developed so that it is introduced in a responsible and transparent manner. I know that there is a lot of work happening behind the scenes at the national level to address the detail for the changes that were announced by the Health Minister in the Budget. Also state and territory health departments are working on policies for homebirth and water birth. South Australia has its policies published, and I think some of the other states are also moving ahead well in this area. If anyone reading this blog knows of web links for relevant policies, please pass them on either through the comments or by email

Although the midwifery reforms announced in the Budget (indemnity, Medicare and PBS) are hugely significant to independent midwives and the women who employ us, the reforms are a lifeline to the whole midwifery profession. The midwife's scope of practice in all settings will be freed from some of the unreasonable restrictions that have all but stifled the profession and prevented midwives from practising as defined in the ICM Definition of the Midwife.

I anticipate that, from November 2010, midwifery will move from the obstetrician's-assistant- shiftworker-nurse model to that of a distinct professional who has authority for a unique model of care in which the woman and her known midwife primary carer work in a special partnership, with the purpose of promoting health of both mother and baby through the promotion and protection of physiological processes linked to normal birth and nurture of infants.

I anticipate that Medicare payments will enable health services to set up a range of options that are attractive to both mothers and midwives, in which midwives provide primary maternity care for women, integrating their care with the specialist obstetric and other medical services in the hospitals as and when needed. There will be no need for the cost shifting that goes on now, with women being sent to doctors for the prenatal care to take pressure off the hospital budget.

I anticipate that university midwifery departments will celebrate the reduction of the theory-practice gap that has plagued them for many years. The career options for midwives who want to practise midwifery will be greatly expanded.

I have been in touch with Patrice Hickey, Victorian branch President of the Australian College of Midwives, (ACM Vic) and I would like to acknowledge the work of the ACM throughout this process on behalf of midwives and birthing women.

We live in interesting times!


Melissa Maimann said...

Dear Joy,

Actually, I think this private-midwifey-for-hospital-birth thing will really take off because not only do women value continuity of midwifery care, but the hospitals too will have an incentive to provide care in this manner. What is being proposed can also be seen as a cost-shifting exercise whereby maternity care may be funded by the Commonwealth instead of the State. It makes sense for the hospital to contract the care of women to private midwives who are Commonwealth funded.

Also, I like the recognition placed in the value of continuity of midwifery care, but the changes will open it up for so many more women.

Joy Johnston said...

Yes Melissa. I think the changes will also result in more incentive for public hospitals to provide the option of home birth as part of the caseload midwifery service.

daydreamer and midwife said...

I am hoping for the best regarding this issue for all of you working there - thanks for keeping the rest of the world updated :)