Contact: President of the Australian College of Midwives Associate Professor Jenny
Gamble 0404080518; National Media Spokesperson ACM, Associate Professor
Hannah Dahlen 0407643943
MEDIA RELEASE 9 November 2009
Midwives reject doctors’ veto over their ability to enter
private practice and provide care to women.
The Australian College of Midwives has grave concerns that the proposed amendment to
the Health Legislation (Midwives and Nurse Practitioners) Bill, proposed by federal
Health Minister Nicola Roxon last week, will do nothing to improve women’s access to
collaborative midwifery and obstetric care - the objective of the reforms.
The proposed amendment will require a Medicare eligible midwife to have a
collaborative agreement with a medical practitioner(s).
“It’s hard to see the amendment as anything other than an attempt by the medical
lobby to ensure doctors have a power of veto over the regulated professional practice
of a midwife” said ACM President, Assoc. Professor Jenny Gamble.
“Insisting on agreements with individual privately practising doctors is simply not
workable.” Gamble said. “In rural and remote Australia sometimes there is no doctor
available within hundreds of kilometres and those available are often locums who
change every three months or so, making collaboration with a single doctor
impossible.”
“Even in the cities, if a woman’s midwife has an agreement with a particular private
obstetrician, that doctor may not be available when the woman requires medical care,
such as a caesarean section.”
“Maternity hospitals have many different doctors, so is the midwife to have
agreements with 12 different doctors on 12 different terms? There has to be a system
of care that supports each midwife and the women she cares for in evidence based
collaborative arrangements regardless of the individuals involved.”
“The proposed collaborative arrangements, are not just unworkable, they are potentially
unsafe and undermine regulation of the midwifery profession.” Gamble said.
“Midwives are committed to collaboration with doctors in the interests of pregnant
women and their babies. Such collaboration is already a daily occurrence. Midwives’
competency standards, against which they are registered every year, require collaborative
practice. Failure to practice in accordance with these and other professional standards
can lead to disciplinary action by the Board.
Contact: President of the Australian College of Midwives Associate Professor Jenny
Gamble 0404080518; National Media Spokesperson ACM, Associate Professor
Hannah Dahlen 0407643943
The proposed amendments will give power to medical practitioners to essentially
decide which midwives will be able to practice privately or not, have insurance or not
and access Medicare or not. Instead of the regulatory authority – the Nursing and
Midwifery Board of Australia - determining safe and competent practice by
midwives, it will be down to the whim of individual obstetricians. This will not pave
the way to safe, high quality, collaborative care for women and their babies”
“There is no argument that women who choose an MBS eligible midwife to provide their
care will need timely and seamless access to medical care if and as they require it. An
agreement between a midwife and a private obstetrician (GP or specialist) may be one
option for some midwives and women. But this must not be the only way. It is essential
that midwives can forge agreements with public maternity services as an alternative way
of working collaboratively and meeting the requirements of the Act. We are concerned
that the proposed amendment does not provide for this.” Gamble.
The World Health Organisation recognises the midwife 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."
Midwifery care has received the highest scientific endorsement in the past year, with
a systematic review of 11 randomised controlled trials involving over 12,000 women
from around the world demonstrating that outcomes for women receiving continuity
of care from known midwives were better than for women who received fragmented
care from multiple midwives and doctors. Midwives can be trusted to refer and
consult when needed.
“This amendment will be especially problematic for midwives providing homebirth
services, as medical organisations are publicly opposed to woman’s choice of
birthplace. They need only urge their members to refuse to collaborate with
midwives if they provide homebirth services. Homebirth will go underground and
midwives will not be able to register to provide current and accountable care to these
women. This is a serious safety concern for Australian women wishing to make this
choice.”
“Collaboration is about mutual trust and respect and professional cooperation focused
on the needs of individual women and babies. It’s not going to work if it’s a forced
relationship with someone who holds all the power and can choose whether or not to
collaborate. It’s like one hand clapping”.
“The ACM urges the Rudd Government to consider the interests and safety of women
and babies and to leave the collaborative arrangements in the regulations or at the
very least to change the amendment to make clear that midwives can have agreements
with maternity services, as an alternative to having one with an individual private
obstetrician.” said ACM President, Assoc. Professor Jenny Gamble.
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