The matter that has occupied a great deal of my time and thinking space lately is the new world of maternity reform that centres on being 'eligible' for Medicare. A summary of the 'New Arrangements for Midwives' is at the MIPP blog.
My application for eligibility has been in the hands of the Nursing and Midwifery Board since early December 2010. I have had discussion with the Board's officer who has processed it, and my application was on the Board's agenda for this past Thursday. However, the meeting was adjourned unfinsihed, and my item was not discussed. It will be on the agenda for the reconvened meeting.
I need patience as I wait for the Board to do it's job, and wisdom as I work through my side of the process. There could be several reasons for the delays, including the new Board and its employees undertaking new processes and tasks.
The Board has asked midwives to obtain references from a midwife manager in hospital maternity unit, or an obstetrician, who is required to give detail of:
"the following aspects of the midwife’s performance and detail of the scope of midwifery practice are required to support the application.
"The referee should address the applicant midwife’s performance in relation to the four competency domains as described in the ANMC National Competency Standards for the Midwife 2006. [The four domanis are: Legal and professional, Midwifery knowledge and practice, Primary health care, and Reflective and ethical practice]
"The referee needs to address how the applicant midwife is qualified to provide pregnancy, labour, birth and post natal care to women and their infants; including the capacity to provide associated services, and order diagnostic investigations; appropriate to the eligible midwife’s scope of practice. This includes whether the applicant midwife has the skills, knowledge and attitudes expected of a midwife to work within the midwifery scope of practice which includes giving:
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
(excerpt from International Definition of the Midwife, adopted by the International Confederation of Midwives Council meeting, 19th July, 2005, Brisbane, Australia)."
This reference is idealistic at best, and meaningless at worst. Let me explain why:
Midwives who have been practising privately in large metropolitan areas for a decade or more, and who have attended women who are planning home birth, have little contact with hospital midwives and obstetricians. These private midwives (I am one) do not cultivate relationships with individuals within the public hospitals with which we collaborate from time to time as the need arises. Positions and job titles within the hospitals change frequently, and when we need to refer or transfer a woman to hospital, we set up a collaborative relationship with the staff who receive that woman.
Any midwife who requested such a reference from another midwife or obstetrician would need to give that person a written reference that meets all the requirements laid down by the Board in its 'Eligible midwife: Professional Reference Guide' (quoted above), and ask that person to complete the reference by adding their name, qualifications and professional registration details, and sign it. This clearly raises concern about the validity of such a reference.
I have written enough for this morning, except to say that I consider the notation of being 'eligible midwife' important for the following reasons:
It is of significant financial benefit to the women for whom I provide midwifery services. A woman receiving antenatal and postnatal care from an eligible midwife will be able to claim an estimated $700-1000 rebate from Medicare
It is a demonstration of professional standing
It opens the possibility of hospital visiting access/clinical privileges for midwives, which is a new model of care, and greater choice for women.
Being an eligible midwife will not, of itself, increase a midwife's caseload numbers or income. An eligible midwife has more paperwork to complete, and must comply with new legislation in regard to collaboration. This process is complex, and at times, fraught. Doctors who do not think collaborative arrangements (as defined by the legislation) are a good idea, can refuse to acknowledge a midwife's request for such an arrangement. Without a collaborative arrangement, there will be no Medicare rebates, even though the midwife is 'eligible'.