Wednesday, March 17, 2010

A landmark day for midwifery in Australia?

Yesterday the federal government's spin doctors announced that the passing of legislation through the Senate "provides long deserved recognition of Australia's highly skilled midwives.
... giving "midwives access to the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) for the first time."
... improving the "choices for Australian women to access high quality, safe maternity care as well as providing support for our talented midwives."
... establishing "a new Government-supported professional indemnity scheme for eligible midwives."

"Today marks a new era for our health workforce - ensuring smarter use of our skilled workforce, and more encouragement to work in multi-disciplinary teams.
This will help deliver better health and better results for patients.
"As a Government, we are extremely proud to be delivering these changes - providing new and innovative options for thousands of women and the community."

The Health Minister's press release makes it all sound great. BUT?

The Australian College of Midwives also welcomes the legislation.
"From 1 November this year, women will be able to choose to see a community midwife, and receive Medicare rebates for their visits to the midwife. The midwives will provide pregnancy and postnatal care in the community, and women may have the option of birth care in hospital from their chosen midwife.
“We welcome Nicola Roxon’s support for women to receive Medicare rebates when they choose the care of a midwife’ Dr Gamble said.
... ‘But we remain concerned to see that access to professional indemnity insurance becomes available for all midwives, including those providing professional care for women who choose to labour and birth at home.”

It's POSSIBLY a landmark day for SOME midwifery. But for miwives like me, who have chosen to be employed privately by women for homebirth or for other private midwifery services, the legislation gives us little to cheer about. Even the promise of Medicare and prescribing rights, to be implemented by November this year, appears to be so wound up in bureaucratic micro-management that we wonder if we will ever be able to meet the criteria. We are doubtful that the Medicare-funded midwife will be able to provide any service that is acceptable to clients, at the same time as providing a reasonable livelihood for the midwife.

The Greens Senator Rachel Siewert spoke up about the systematic discrimination against a small group of midwives and the women who employ us, declaring that "Major parties unite against midwives and homebirths.

"The Federal Government and Coalition have united to ensure that homebirth in Australia will be further marginalised by rejecting amendments to provide midwives with access to indemnity insurance irrespective of the location or venue of the births that they attend
"In addition the government chose to reject Greens amendments that would have taken away the power of doctors to veto aspects of midwifery practice, such as homebirth, that they are philosophically opposed to, despite the near universal evidence that safe low risk homebirth has positive outcomes for mother and child.

"We have consistently said that the Government amendments to their Midwives legislation give doctors too much control over midwives practice," said Greens health spokesperson Senator Rachel Siewert.

"It is extremely disappointing to see the major parties side together against the interests of midwives in refusing a Greens suggestion to broaden the scope of collaborative arrangements between midwives and medical practitioners to include health services, thereby ensuring that doctors can't veto homebirths."

Time will tell whether these legislative 'reforms' actually do what the government is claiming they will do, or if the culture of medical dominance is further strengthened.

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