Eligibility,  access  and  collabora2on  –  past,  present  and  future  challenges  in  Australia  Dr  Michelle  Newton  Vice-­‐President  –  Australian  College  of  Midwives  

 Obstetric  Malprac2ce  Conference    

22nd  &  23rd  June  2015  Melbourne  

   

Quality  maternal  and  newborn  care  

Renfrew et al (2014). The Lancet, 383.

Childbirth  –  is  it  all  or  nothing?  

“Australia  is  one  of  the  safest  countries  in  which  to  give  birth  or  to  be  born”  (Bryant  2009)  

Improving  Maternity  Services  in  Australia  

However…  the  report  also  iden2fies  a  number  of  issues  with  the  current  maternity  care  system  which  include:  

Care delivered in hospitals

rather than in the primary care setting

Outcomes for Indigenous

mothers and babies remains

poor

Care in normal

pregnancy provided by

obstetric specialists

97% of women give birth in traditional

hospital settings

High rate of intervention in childbirth

“…  current  arrangements  for  the  delivery  of  maternity  services  in  Australia  are  not  serving  all  Australian  women  as  well  as  they  should”  (Roxon  2008)  

Public hospital

care

Team midwifery

Private obstetric

care

Shared care

Eligible midwives

Midwives in private practice

Caseload

Publically funded homebirth models

What  is  an  ‘eligible’  midwife  

An  applicant  seeking  to  be  iden2fied  as  an  eligible  midwife  must:  •  being  currently  registered  as  a  midwife  in  Australia;  •  being  able  to  demonstrate  the  equivalent  of  three  (3)  years  full-­‐2me  post-­‐registra2on  experience  as  a  midwife  and  evidence  of  current  competence  to  provide  pregnancy,  labour,  birth  and  postnatal  care,  through  professional  prac2ce  review;  

•  have  an  approved  qualifica2on  (or  the  ability  to  gain  such  a  qualifica2on  within  an  18  month  period)  to  acquire  the  skills  required  to  prescribe  scheduled  medicines  required  for  prac2ce  across  the  con2nuum  of  midwifery  care.  

 

To  provide  Medicare  rebateable  services  

Eligible  midwives  are  required  to:  •  Have  a  Medicare  provider  number;  •  Be  working  in  private  prac2ce;  •  Have  professional  indemnity  insurance;  •  Have  a  collabora2ve  arrangement  with  a  medical  prac22oner  and  /  or  a  hospital  /  health  service.  

Services  that  can  be  provided  by  eligible  midwives  under  Medicare    

•  Antenatal  care  

• Management  of  intrapartum  care  ▫  for  care  provided  while  admibed  in  a  hospital    

•  Postnatal  care  

•  Telehealth  service  

How  many  eligible  midwives  are  there??  

39

7

53

19

114

3

55 2

So  is  this  the  perfect  storm…..  

Or  the  planets  aligning??  

What  are  the  risks  here?  •  Are  we  crea2ng  another  turf  war?  ▫  Midwife    vs    obstetrician  ▫  Midwife    vs    GP  ▫  Private  midwife    vs    hospital  midwife  ▫  Eligible  midwife    vs    non-­‐eligible  midwives  

•  Do  we  risk  the  poten2al  effec2veness  of  this  model  not  being  truly  realised  ▫  Lack  of  collabora2ve  opportuni2es  ▫  Limited  access  to  public  hospitals    

Why  are  things  so  different  in  QLD?  

39

7

53

19

114 3

55 2

Qld  has…  

And  more  eligible  midwives  than  any  other  state….    

The  QLD  experience  

•  Premier  &  Minister  for  Health  commibed  to  advancing  the  model  through  access  to  public  hospitals  

•  Pilot  for  visi2ng  access  conducted  at  Toowoomba  in  2010  ▫  Project  midwife  employed  to  establish  a  ‘creden2aling’  process  

The  QLD  experience  (cont)  

Collabora2ve  arrangements  –  determined  by  the  CEO  •  Consultant  on-­‐call  for  the  day  for  birth  suite  (i.e.  staff  employed  consultant  covering  the  public  pa2ents  in  birth  suite)  covered  the  back  up  for  private  prac2ce  for  that  day.    

•  VMOs  (without  employment  contracts)  could  choose  to  establish  collabora2ve  arrangements  with  Eligible  midwives    

•  The  consultant  covering  the  antenatal  clinic  for  the  day  also  contributed  to  the  case  review  process  with  the  private  prac2ce  midwives  each  fortnight.  

Eligible midwives

Offering  real  choice  

Relieving  the  burden  on  overstretched  health  services  

Improving  postnatal  support  

• Well  supported  and  resourced  home-­‐based  postnatal  services  

•  Extended  postnatal  care  with  the  poten2al  for  midwifery  care  to  con2nue  for  up  to  6  weeks  

Keeping  women  engaged  with  services  

“Homebirth  is  safe  for  the  right  women  (low  risk  women  who  are  healthy  and  informed),  with  the  right  midwives  (those  who  are  registered,  regulated  and  networked  in  to  the  larger  hospital  network)  and  in  the  right  systems  (with  effecGve  consultaGon  and  referral  systems  with  obstetricians  and  other  providers,  in  a  respecHul  collaboraGve  model)”  

   (ACM  Media  Release  19th  June  2015)  

“Homebirth  is  safe  for  the  right  women  (low  risk  women  who  are  healthy  and  informed),  with  the  right  midwives  (those  who  are  registered,  regulated  and  networked  in  to  the  larger  hospital  network)  and  in  the  right  systems  (with  effec6ve  consulta6on  and  referral  systems  with  obstetricians  and  other  providers,  in  a  respec;ul  collabora6ve  model)”  

   (ACM  Media  Release  19th  June  2015)  

Quality  maternal  and  newborn  care  

Renfrew et al (2014). The Lancet, 383.