For the last nine months consumer and midwifery groups have been lobbying hard around the one key sticking point of these reforms – how midwives and doctors will work together. The government stated from the outset that the midwife would be required under legislation to work in a “collaborative arrangement”. Consumers and midwives have argued for the definition of these arrangements to be one which supported women's choice and access, and which did not give doctors control over women's access to Medicare rebates.
After months of suspense, the Determination defining "collaborative arrangements" was quietly signed into law by the Governor General on 16 July, without notification to stakeholders. The Determination can be downloaded from this link.
The Determination provides 4 options for collaborative arrangements. Each option requires the midwife to have some form of permission from a doctor, before a woman can receive Medicare rebates.
The minimum form of permission is an "Arrangement - midwife's written records" (section 7 in the Determination). This option requires a named doctor of a specific type to acknowledge "that the practitioner will be collaborating in the patient’s care", and that the named doctor has received copies of a hospital booking letter and a maternity care plan.
These requirements will make it very difficult for women to access Medicare-funded care from midwives in private midwifery practice. We don't expect midwives in private midwifery practice (working for themselves, not a doctor) to be able to find private doctors who are willing to enter collaborative arrangements with them. In some cases this may be possible under very specific conditions. However it is unrealistic to expect that private doctors will collaborate in the care of women planning homebirths.
Even for women planning births in public hospitals, these requirements for collaborative arrangements will make it extremely unlikely for them to be able to access Medicare-funded midwifery care. There is no reason to expect public hospital doctors to enter the required collaborative arrangements with private midwives. They have no incentive, and there is no sign that state governments are planning to push them.
In March 2010 when the Senate was debating this legislation, the Government stated that "There is no intention to provide a right of veto over another health professional’s practice". However, under intense pressure from the medical lobby, this is exactly what has occurred. Most importantly, it is women's choices and access to care which are being vetoed, to protect medical control of the maternity marketplace.
If these reforms are to deliver the "choice and access" promised to Australian women by Government, the medical veto must be removed. Midwives must be accountable to the women they care for, and to their regulating body, not to another profession.
Go here for today's press release from the Greens on this issue:
Greens Will Act to Help Midwives
The Australian Greens said today that midwives are furious with the Federal Government over recently released regulations governing the way they practice.
Greens spokesperson for Health, Senator Rachel Siewert has committed to immediate action on the regulations upon the resumption of Parliament.
“As soon as the Senate next sits, the Greens will move a motion to disallow the collaborative arrangements regulation,” Senator Rachel Siewert said today.
"Women are outraged that they have been told that Medicare rebates will be available for private midwifery care and now the reality is that this will be limited to those employed in an obstetric model which many women have said over and over again that they don't want," concluded Senator Siewert.
******What mothers and midwives can do right now to try to change this******
- Tell your Federal election candidates that you want them to remove the doctor's veto over women's access to Medicare for midwives. Ask them if they will commit to doing this if elected.
- Tell your candidates that you want them to protect women's rights to choice in birth, and ask if they will commit to this.
- You can give these messages by writing, phoning, or stopping and talking to your candidate while they campaign in your electorate. You can call talkback, write emails to the editor, or wave a placard at an event.
To find your Federal electorate click here.
Please contact MC Qld if you want to know more or if you would like someone to come with you to see your MP/local candidates. Email: firstname.lastname@example.org