By chance I did hear the interview this morning and agree Vanessa Owen did
an excellent job.
However it was disturbing to hear the limited understanding of Penny Gregory
as the Chair of the committee charged with advising the NHMC on this issue.
I have drafted a letter from ACT Maternity Coalition addressing some of the
comments Penny made. I am wary of getting her offside since she could be
influential in coming months - any comments of the letter would be welcome
ASAP so i can send it... (I know it's a bit long but there are some ACT
issues we had to address, since Penny Gregory is also the Head of the ACT
Department of Health).
regards, Barb Vernon....
Dr Penny Gregory
Chairperson
Jurisdictional Working Party of the Australian Health Ministers Advisory
Council
C/o ACT Department of Health & Community Services
CANBERRA ACT 2601
Dear Dr Gregory,
Professional indemnity Insurance for Independent Midwives
We were encouraged to hear your comments on Radio National this morning that
the Jurisdictional Working Party of the Australian Health Ministers Advisory
Council (AHMAC) will be looking into a range of options for consideration by
Health Ministers to address the professional indemnity insurance crisis
currently facing Independently Practicing Midwives (IPMs).
However several of the comments you made during the interview suggested you
may be unfamiliar with what independent midwifery entails and of why this
issue carries such significance for birthing women in the ACT and indeed
nationally.
Firstly, you gave the impression that you see independent midwifery as
relating only to a small minority of women who choose to birth at home. As
the College of Midwives President, Vanessa Owen, rightly pointed out during
the same interview, the issue is one of access to a midwifery model of care;
a model of care which international experience has proven to be best
practice both in terms of outcomes for women & babies and in terms of cost
effectiveness for government funding bodies (see WHO 1999 Care In Normal
Birth). This issue therefore affects all birthing women.
Women who choose homebirth do contract an Independently Practicing Midwife
(IPM) as it is currently the only way to have a birth at home in most
States, including the ACT. However, women also contract IPMs to provide
continuity of carer and birth in hospital or a birth centre because it is
only through engaging an IPM that women have true continuity of carer
throughout their pregnancy, birth and postnatal period. It has been
demonstrated in clinical trials overseas and in Australia that women who are
accompanied by a known midwife have less need of obstetric interventions and
better outcomes for both the mother and baby. We would be happy to provide
references to this research.
Secondly, you commented this morning that women making an informed choice to
birth at home with an independent midwife lack obstetric backup, implying
that homebirth is less than safe and therefore less worthy of being
seriously considered as an option that governments ought to ensure is
available to birthing women in Australia.
Again, this impression is not supported by scientific evidence. Studies
have shown that birth in the home attended by an accredited independent
midwife is one of the safest options available to women experiencing normal
pregnancy. IPMs have the skills and experience to refer women to tertiary
obstetric care as needs be. Such referral is typically only necessary for a
very small percentage of women (around 10%) with the majority experiencing
successful birth without the need for obstetric intervention when cared for
by an IPM. Again it is the model of care rather than the location of the
birth which is the important factor.
Thirdly, we were interested to hear your view that women in the ACT have
access to a strong team based model of midwifery care, which provides
continuity of care. We presume you were referring to the Canberra Midwifery
Program (CMP) that provides women with access to the Canberra Birth Centre
at the Canberra Hospital.
Many Œconsumers¹ would disagree with this claim. With around 4,500 births
per year in the ACT and the current capacity of the Birth Centre at 520
births per year, it is clearly not accurate to assert that this model of
care is available to ACT birthing women in general. We understand that the
CMP is turning away 8 to 14 women per month that request midwifery based
care. They are fully booked even though they do not advertise their services
to consumers or potential referring medical practitioners.
Nor does the CMP program guarantee continuity of carer, even though it aims
for this. A team of midwives cares for women. While it is hoped that a woman
will meet with all midwives on the team throughout her pregnancy, when she
arrives at the birth centre it is quite possible she will be cared for by a
midwife she hardly knows. There is a transfer rate of 70% for first time
Mums and 49% overall.
The Birth Centre is moving toward a Œcase load¹ model of care later this
year with half of the midwives taking on individual women and the other half
the existing system of Œrotational care¹. This is an improvement in the
style of care but is not an increase to resources. It also falls
considerably short of international best practice and recommendations made
in 1997 when the Community Midwives Pilot Project was evaluated. Three of
the recommendations made in the report of the evaluation of the pilot
project are as follows.
1.1 Small teams of midwives employing the continuity of care model should
become an option for all women in ACT Maternity Services
1.2 All women should be assured continuity of carer from known midwives
throughout the entire maternity period
2.3 That future community midwife programs give women the right to choose
the place of birth.
In Western Australia and South Australia IPM¹s are contracted to provide
services under state funded programs. These programs are under threat, as
they have required IPM¹s to carry insurance as part of their contract
arrangements. This issue is clearly about much more than homebirth. It is
about women having the right to chose who cares for them whether they give
birth in hospitals, birth centres or at home. It is about State and
Territory Governments being responsible by providing all women with access
to midwife based care.
Overseas experience provides some useful models that Australia would do well
to emulate. In New Zealand, for example, women are provided with a birth
payment so they can choose the type of carer they want‹obstetrician, GP or
midwife. Recent statistics indicate that 70% of women in New Zealand now
choose a midwife to be their primary caregiver. It seems likely that
Australian women would also choose midwifery care in large numbers if such
care were universally available to them, which it is not at present.
We hope this information is of assistance to you and the Committee as you
consider ways to provide reasonable insurance cover for independently
practicing midwives and thereby to protect the rights of women to choose a
midwife as their carer.
We believe that access to professional indemnity insurance for IPMs is
critical to maintaining‹and indeed enhancing‹competition in the provision of
maternity services in Australia. Improved competition would deliver major
benefits for Œconsumers¹ of maternity services‹birthing women and their
babies‹as well as for public health agencies obliged to fund this high
volume area of health care.
We are happy to provide you with any further information or relevant
references. I can be contacted on 6230 2107 or at [EMAIL PROTECTED] We
would appreciate your response to the issues raised in this letter.
Yours sincerely
Dr Barbara Verdun
On behalf of The Maternity Coalition (ACT Branch)
6 August 2001
> From: Sally Tracy <[EMAIL PROTECTED]>
> Date: Mon, 06 Aug 2001 11:06:22 +1000
> To: ozmidwifery acegraphics <[EMAIL PROTECTED]>
> Subject: Re: the campaign
>
> I agree wholeheartedly Joy -
> Vanessa was awesome this morning...SO difiicult to get some of the issues out
> there, much less MOST of them as she managed to do......
> and yes - it's time we had the stats and data to sock it to the
> authorities.......
> I also think we should be calling for evidence that demonstrtates the
> continued
> medical over care for all women ...cant you see the RCT we could devise??!!!
> S.
>
> Johnston wrote:
>
>> Dear ozmid team
>> I want to congratulate everyone who has been involved in the rallies, and
>> the lobbying, and getting media coverage &c&c. I am proud to be one of us.
>>
>> Some of you may have heard Vanessa Owen (ACMI national president) on Radio
>> National thismorning (Mon 6/8) at about 8.15 am. She spoke very well,
>> insisting that the PI issue affects all of midwifery - not just independent
>> midwives.
>> The news from the ABC was that the matter of PII for midwives has been
>> referred to the Health Ministers Working Party on Professional Indemnity,
>> chaired by Penny Gregory. I think this is a good step. Whereas we need to
>> get cover immediately to enable midwives to continue meeting their
>> commitments, the same thing could happen again if there is another monopoly
>> situation of only one insurance company for a small number of midwives. We
>> still have a lot of work to do arguing the legitimacy of midwifery practice
>> (without medical 'supervision') and the legitimacy of a woman's choice of
>> place of birth.
>> The perception that this is going to result in more harm (and therefore
>> more claims on insurance) than the 'standard' model is a huge obstacle. We
>> need published reports from community midwifery projects in WA and SA. We
>> need Sate birth data for homebirths and birth centres. We need articulate
>> consumers and midwives who will become well informed. We can't just be
>> true believers - facts and strong arguments have to be relied upon.
>>
>> Joy Johnston
>> 25 Eley Rd Blackburn South Vic 3130
>> Tel: 03 9808 9614
>> Fax: 03 9808 3611
>> M: 04111 90448
>> www.aitex.com.au/joy.htm
>>
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>
> --
> Sally K Tracy
> Australian Midwifery Action Project (AMAP)
>
>
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