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Midwives take on AMA over maternity services reform

Has the AMA hijacked the Federal Government’s plans for maternity services reform?

Yes – and it will be to the detriment of the public, especially those in rural, remote and other under-served communities.

That, at least, is the clear imputation of this Crikey article published today by two senior midwives and academics, Professor Sally Tracy and Professor Lesley Barclay, from the University of Sydney.

As the article explains, the country’s most senior academic midwives have signed an open letter protesting against proposed amendments to legislation that they say “are ill-informed, conflict with current regulation of the practice of midwives, and were promoted by a medical union (the AMA), rather than the craft groups most concerned and knowledgeable about women’s needs and safety at birth”.

The midswives say the amendments, proposing that midwives be required to have “collaborative arrangements” with “one or more medical practitioners” before they are eligible for Commonwealth-funded professional indemnity and before their services are eligible for Medicare rebates, are “not informed by evidence, but appear to be based on protection of income and power”.

They warn that the proposed amendment creates a real risk that qualified, competent midwives will lose their licence to practise — at a time when we have acute shortages of qualified midwives in many areas of Australia. “This is likely to further reduce access to optimal or even safe care for women and families who are currently disadvantaged and for whom recent reforms offer most promise,” they say.

For those wondering who else is backing the letter, the other signatories are:

• Associate Professor Hannah Dahlen, University of Western Sydney

• Professor Caroline Homer, University of Technology Sydney

• Professor Sue Kildea, Australian Catholic University

• Professor Jennifer Fenwick, University of Technology Sydney

• Professor Pat Brodie, University of Technology Sydney

• Professor Nicky Leap, University of Technology Sydney

• Associate Professor Deb Davis, University of Technology Sydney

• Professor Maralyn Foureur, University of Technology Sydney

• Associate Professor Sue Kruske, University of Queensland

• Associate Professor Virginia Schmied, University of Western Sydney

• Dr Helen McLachlan, La Trobe University

• Dr Della Forster, La Trobe University

• Professor Jan Pincombe, University of South Australia

• Associate Professor Heather Hancock, Southern Cross University

• Associate Professor Pauline Glover, Flinders University Adelaide

• Ms Jen Byrne, Flinders University Adelaide

• Professor Carol Thorogood, Charles Darwin University

• Professor Susan McDonald, La Trobe Universtiy/ Mercy Hospital for Women

• Associate Professor Jenny Gamble, Griffith University

• Professor Kathleen Fahy, University of Newcastle

Comments 8

  1. john2066 says:

    Typical AMA, its all about their incomes. What were the recent figures – obstetricians taking 2 MILLION DOLLARS A YEAR out of medicare!?

    Its time, more than time, to take on the specialists closed shop.

  2. Mick Vagg says:

    Knowing that it is going to unpalatable for the blinkered cheerleader in this forum on the midwifery side of this issue, allow me to point out that the body lobbying on behalf of doctors has been the United General Practice Australia group who represent the Royal Australian College of General Practitioners, the Australian Medical Association, the Australian General Practice Network, the Rural Doctors Association of Australia, the Australian College of Rural and Remote Medicine and the General Practice Registrars Association. So it’s not just the AMA. A bit of fact checking might help before careering off on the bandwagon.

    Might I also point out that according to the American CDC figures quoted at the following link, the risk of non medically-attended birth is actually significantly higher than is portrayed. http://www.sciencebasedmedicine.org/?p=2392

    As for high incomes for obstetricians…I don’t see any other small business operators let alone journalists, schoolteachers, lawyers, accountants or, dare I say it, midwives who have to pay an average of $60-120K in insurance each year on top of all the other routine business expenses before even turning up to do a day’s work.

    Turning the serious and necessary debate about maternity service reform into a sideshow of doctor-bashing and publicity stunts does little to convince me that midwives will be responsible and accountable if they are granted these very serious clinical privileges.

  3. drake says:

    Sure, there may be a level of fee gouging going on in various medical specialties (one could mention the dubious ‘overflow’ practices going on in radiology in QLD), but ultimately obstretricians are the people currently taking on the medical risk.

    I won’t be surprised when the midwives that setup these practices start calling for government subsidies for their insurance premiums, complaining about workload (especially in rural and regional areas) and charging healthy fees above the Medicare schedule.

    I don’t have an objection to private midwifery practices – patients should have a choice based on their preference and circumstances. In fact, I think private midwifery will reduce the time-burden on obstetricians and improve affordability of specialist services to average people like me by curtailing the supply/demand problem. I do object to people like john2066 jealously cutting down people who’ve earned a decent income through dedicating their lives, education and personal time (3:00am anyone?) to a specialist medical profession. Go and complain about investment bankers…

  4. john2066 says:

    Typical medical specialist monopoly comments here (‘We’ve got high overheads’ etc etc) without being specific as to what their incomes are at the end of the day. Hint, when you take 3 million bucks out of medicare alone a year, you have to have pretty high overheads not to end up with several million bucks a year.

    The medical specialist monopoly is now a toxic joke in the health care industry in Australia. Home births, like everything else, threaten their incomes so must be stopped. Stop the specialist monopoly now !

  5. john2066 says:

    The other thing that annoys me about the medical specialists is ‘hey we trained hard!’. So do many people in the economy, many people train for many years and many are subject to great pressures. They do not make three million bucks a year out of medicare alone.

  6. john2066 says:

    The time has come to stand up, once and for all, on behalf of Australian taxpayers and patients against the medical specialists.

  7. ST says:

    Putting aside professional differences – the issue that midwives find so unpalatable is the fact that there have been two amendments added, (on the 5th November), to the otherwise workable legislation, (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill. The amendments commit one professional group – already registered midwives – to a Catch 22 where they must be legally contracted to a medical practitioner in order to access professional indemnity, in order to register further as an ‘eligible’ midwife, in order to access MBS and PBS. The legal contract is euphemistically referred to as a ‘collaborative arrangement’. However, there is no precedent for this amongst any health professionals who currently co-exist effectively in the public health system. Whether or not the AMA was the main driver for this amendment, or whether it was a whole group of medical practitioners under the United General Practice Australia group, the result is the same. Midwives have been singled out as a serious ‘risk’ to maternity reform and must be brought under control. Every day in the public system midwives work with obstetricians in the best interests of the women they care for. Neither obstetricians nor midwives could safely practice one without the other. As qualified professionals, midwives engage in practice that is determined by their regulatory body and defined by their scope of practice. Medical practitioners do the same. Would doctors be more than a little aggrieved if they had to find a midwife or nurse to join them in a legally binding contract as a ‘collaborator’ before they could apply for registration for a provider number?
    Collaboration implies that there is an alliance based on trust and respect for each others professional capability. It is not about one profession controlling the other. As the amended legislation stands at the moment – it would take a very rare medical practitioner to sign up to an arrangement with a midwife and not exercise their right to closely scrutinise the midwife’s practice, or indeed veto anything that might bestow liability. Therefore, midwives are insulted and outraged that this restriction has been unfairly placed on their ability to seek ‘eligibility’ to practice in the community outside the public hospital system.
    No-one is taking the seriousness of this situation lightly. We welcome the opportunity to seriously debate maternity reform. However, ‘Mick Vagg’s response is typically defensive and denigrating. Why are we not surprised that rather than defend the position that the United General Practice Australia group have taken, the respondent would shrink from any serious comment and slide behind the tired rhetoric of homebirth risk.

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Closing the Credibility Gap 2013
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Health Workforce Australia 2013
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National Rural Health Conference 2013
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AIDA Conference 2014
Congress Lowitja 2014
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Racism and children/youth health symposium 2014
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Population Health Congress 2015
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