Legally binding midwives to doctors is not collaboration

Senior academic midwives recently wrote to the Federal Minister for Health (Ms Nicola Roxon) to raise their concerns about the newly proposed amendments to both the Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.

The 22 academics who signed the letter to Minister Roxon represent midwives who lead internationally relevant, NHMRC funded research into maternity care and who teach midwifery across a number of jurisdictions and universities. We are surprised, and disturbed that the government seems to have buckled to what is essentially medical union pressure. Certainly the proposed amendments are not evidence based. Indeed the amendments ignore advice provided to government by high level technical working groups which gave expert advice on Medicare eligibility and access. Further the proposed amendments ignore a process led by the NHMRC to which all stakeholders have contributed in good faith.

The amendments raise the following serious concerns:

Not only is the nature of the collaborative arrangement unclear, it suggests that care provided by one regulated professional could be subject to approval by a different profession. We question the need for written agreements or contracts binding midwives to private medical practitioners. We acknowledge the necessity for regulation to maintain safety and standards; however we fail to see how these amendments can provide a net public benefit. The amendments introduce another level of legally binding regulation of the profession of midwifery which is unprecedented nationally or internationally. Both the midwifery and medical profession are legally bound to practice within their professional regulatory framework of standards competencies and scope of practice. In public hospitals where midwives and staff specialists generate knowledge, teach and apply research into practice in the interests of the women they serve a well supported and efficient regulatory framework currently ensures collaborative practice between all members of the maternity system.

Midwifery is strongly evidence based with a recent Cochrane systematic review1 of eleven randomised controlled trials involving over 12,000 women demonstrating that outcomes for women receiving continuity of care from known midwives were better than for women who received fragmented care from multiple midwives and doctors.

Collaborative agreements with individual doctors in area health services in rural and remote Australia, where around 30% of Australians live, will make reforms unworkable. There may be no doctor available within hundreds of kilometres, and there are often frequently changing locums. Collaboration with a single doctor is impossible. Homebirth midwifery care, already marginalised, may become outlawed.

Doctors are the only group who benefit from these amendments; women, babies, families and midwives are the ones who are disadvantaged. Given the competitive threat that some doctors perceive by allowing midwives access to Medicare the proposed amendments seem to be motivated by power, money and medical self-interest. It is untenable that one professional unionised group has the potential to derail Australia's long awaited maternity reforms. This is contrary to the spirit of the reform articulated by government; that is to build collaboration across maternity systems and providers. It is likely to further reduce access to optimal or even safe care for the women and families for whom recent reforms offer most promise.