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nurses and nursing

May 12, 2009

“Landmark” night for maternity services

Caroline Homer, Professor of Midwifery, UTS, writes: It’s a landmark night for maternity services for Australian women. Finally, after more than 20 years of discus

Caroline Homer, Professor of Midwifery, UTS, writes:

It’s a landmark night for maternity services for Australian women. Finally, after more than 20 years of discussion and debate this Federal government has been brave enough to acknowledge that maternity services are provided by a number of health professional including midwives, GP obstetricians and obstetricians.

Tonight’s announcement goes towards redressing the balance in access and equity in maternity care in this country, enabling midwives to, for the first time, to work as private practitioners, provide services subsidised by the Medical Benefits Schedule and prescribe medications subsidised under the Pharmaceutical Benefits Schedule.

The Improving Maternity Services Package is an initiative for all Australian women. It is an important move forwards and is strong evidence that the recent Review of Maternity Services has been addressed, especially for women in rural and remote areas.

Of course the devil is in the detail. What exactly does “subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings” mean for midwives who provide homebirth services? How will an “advanced midwifery credentialing framework” fit with the existing national peer review process for midwives?

This is not the moment to retreat to professional corners.

This is the moment to take a deep breath and develop new and more constructive ways of working together recognising and respecting our different skills and capacities. We must keep women and babies at the centre of the discussion, not our various professional perspectives.

This is the time to move forwards using the available workforce in the best way, ensuring that midwives, GPs and obstetricians can each work to their full scope and capacity to ensure the best possible maternity service for all Australian women.


Justine Caines, Maternity Consumer Advocate – Mother of seven, living in rural NSW, is also calling it a “Landmark Day for Women and Babies”. She writes:

The budget has announced new funding of $120 M over 4 years to introduce Medicare funding for midwives.

This heralds a new age for maternity care.  To date maternity care has catered to the needs of health professionals rather than women and their families.  The all powerful medical lobby has dictated the terms. It would seem that their greed has been a major part of the reform agenda.

In the 4 years since the Medicare safety-net was introduced, Obstetricians have increased their charges by approx 300%. This budget has reeled these obscene costs in with a cap to the safety-net.  By enabling private practice midwifery through Medicare, private health funds will be able to finally offer choice to women. Importantly midwifery care will also have the capacity to reduce unnecessary costs (by reducing interventions, especially caesarean section and associated costs esp when babies are harmed through surgery and spend time in special care nurseries).

With the introduction of Medicare for midwives rural women can breathe a sigh of relief, soon many more women will have the option of primary midwifery care in their local communities.  The social dimension of midwifery is well placed to make in-roads to close the gap for Indigenous Australians, considering the shocking media recently reporting the tragic consequences of foetal alcohol syndrome this is welcome news.

The only down-side is that homebirth is not yet to be funded. It would seem medical groups will ‘die in a ditch’ over funding homebirth services. Perhaps I’m crazy but at the moment it is easier to terminate a pregnancy than to give birth at home.  Men in white coats wrangle to keep control of women’s bodies. Overall thumbs up to Nicola Roxon, I look forward to working through the implementation.

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2 thoughts on ““Landmark” night for maternity services

  1. Joy Johnston

    I wonder why virtually noone is making any comment about the midwifery changes announced in last Tuesday’s budget – indemnity, Medicare and limited prescribing?

    The silence covers the newspapers, TV and radio programs that I have accessed, as well as midwifery and maternity-related email lists.

    I have been with labouring women in two Melbourne hospitals this week – Mercy and Box Hill – and most of the midwives I have spoken to were not aware that anything has happened. Others seem scared that the reforms will be subjected to excessive gatekeeping, effectively setting hurdles that are too high for ordinary midwives to aspire to.

    Although I am disappointed and frustrated that homebirth has been sectioned off as a ‘no-go’ zone, for reasons that can not be taken seriously by anyone who understands evidence, I am really pleased that the government has taken such a big step to dismantle the medical monopoly of maternity care. And in my mind the announcements of reform were more wonderful in the wake of the report of the maternity services review which said a lot of nothing and skirted around the real issues.

    The budget press releases from the College of Midwives, as well as from Maternity Coalition and Homebirth Australia were, imho, worded in a politically correct way. I am confident in ACM’s representation of the interestes of midwives, and our scope of practice. By definition, midwives are able to practise in any setting, including the home.

    Until the homebirth issue is sorted out I am wondering what will be done in situations or locations where the publicly funded homebirth models are not available. I expect there will be some midwives prepared to go ‘underground’, while others will seek to comply with the new rules. Noone can force a woman to go to hospital. Some women will probably use the system for what it provides, and decide at the last minute in labour whether they go to hospital or give birth unattended.

    I have been actively working for maternity reform since 1993 when I started my private practice. We have a long way to go, but from where I sit the 2009 federal budget is the biggest step forward that I have seen so far in my lifetime. I hope the bill passes in the Senate, and I hope those who represent midwives’ and women’s interests in bringing in the reforms will be wise and courageous.

    I have many questions, and I, like others, will have to exercise patience. I have enjoyed the independence that I have had in midwifery in the past 15 or so years. I accept that there will be changes in how I can practise, if at all, after the middle of next year. I hope that by the end of this year I will still be taking bookings for births beyond 1 July.

    My blog url is , and Midwives in Private Practice