The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study

Published:August 10, 2020DOI:



      In Australia the majority of homebirths are attended by privately practising midwives (PPMs). In recent years PPMs have been increasingly reported to the Australian Health Practitioner Regulation Agency (AHPRA) mostly by other health professionals.


      to explore the experiences of PPMs in Australia who have been reported to the AHPRA.


      A qualitative interpretive approach, employing in-depth interviews with eight PPMs was undertaken and analysed using thematic analysis. A feminist theoretical framework was used to underpin the research.


      The majority of reports made to AHPRA occurred when midwives supported women who chose care considered outside the recommended Australian College of Midwives (ACM) Consultation and Referral Guidelines. During data analysis an overarching theme emerged, “Caught between women and the system”, which described the participants’ feelings of working as a PPM in Australia. There were six themes and several sub-themes: The suppression of midwifery, A flawed system, Lack of support, Devastation on so many levels, Making changes in the aftermath and Walking a tight rope forever. The findings from this study reveal that midwives who are under investigation suffer from emotional and psychological distress. Understanding the effects of the process of investigation is important to improve the quality of professional and personal support available to PPMs who are reported to AHPRA and to streamline processes.


      It is becoming increasingly difficult for PPMs to support the wishes and needs of individual women and also meet the requirements of the regulators, as well as the increasingly risk averse health service.


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        • Scarf V.L.
        • et al.
        Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: a systematic review and meta-analysis.
        Midwifery. 2018; 62: 240-255
        • Hutton E.
        • et al.
        Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: a systematic review and meta-analyses.
        EClinicalMed. 2019;
        • AIHW
        Australian Mothers and Babies 2016 -in Brief.
        Australian Institute of Health and Welfare, Canberra2018
        • Catling-Paull C.
        • et al.
        Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years.
        MJA. 2013; 198: 616-620
        • Sassine H.
        The Needs and Experiences of Women Who Choose Homebirth in Australia: a National Survey.
        (Unpublished Thesis) Western Sydney University, 2017
        • AIHW
        Australian Institute of Heath and Welfare - Nursing and Midwifery Workforce 2015.
        2016 (Retrieved March 15, 2018, from https://midwifery-workforce-2015/contents/focus-on-midwives)
        • Dahlen H.
        • Jackson M.
        • Stevens J.
        Homebirth, Freebirth and Doulas: Casualty and consequences of a broken maternity system.
        Women Birth. 2011; 24: 47-50
        • Rigg E.C.
        • et al.
        Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study?.
        BMC Pregnancy Childbirth. 2017; 19
        • Bueskens P.
        Gaye Demanuele and the Politics of Homebirth.
        (New Retrieved from:)2016
        • NMBA
        Safety and Quality Guidelines for Privately Practicing Midwives.
        (Retrieved Dec 15th, 2017 from:)2017
        • Vedam S.
        • et al.
        Nurse-midwives’ experiences with planned homebirth: impact on attitudes and practice.
        Birth. 2009; 36: 274-282
        • Dahlen H.G.
        • Caplice S.
        What do midwives fear?.
        Women Birth. 2014; (Online)
        • O’Boyle C.
        ‘Just waiting to be hauled over the coals’: home birth midwifery in Ireland.
        Midwifery. 2013; 29: 988-995
        • Ball C.
        • et al.
        Under scrutiny: Midwives’ experiences of intrapartum transfer from home to hospital within the context of a planned homebirth in Western Australia.
        Sex. Reprod. Healthc. 2016; 8: 88-93
        • Denzin N.K.
        • Lincoln Y.S.
        The Sage Handbook of Qualitative Research.
        3rd ed. SAGE Publications Inc., California2005
        • Borbasi S.
        • Jackson D.
        Navigating the Maze of Research.
        3rd ed. Mosby Elsevier, Chatswood, Sydney2012
        • Hesse-Biber S.
        Feminist Research Practice.
        (Vol.)2nd ed. SAGE Publications Inc., USA2013
        • Walsh D.
        • Christianson M.
        • Stewart M.
        Why midwives should be feminists.
        MIDIRS Midwifery Digest. 2015; 22: 154-160
        • Edwards N.
        • et al.
        Attacks on Midwives, attacks on women’s choices.
        AIMS journal. 2011; 23: 3-7
        • Dahlen H.
        • et al.
        Home birth and the national australian maternity services review: too hot to handle?.
        Women Birth. 2011; 24: 148-155
        • NSW Government
        Provision of Private Midwifery Services by Eligible Midwives in NSW Public Hospitals.
        (Retrieved from:) NSW Health, 2015
        • Ribbens J.E.R.
        Shifting Layers of Professional, Lay and Personal Narratives: Longitudinal Childbirth Research Feminist Dilemmas in Qualitative Research.
        SAGE Publications Inc., 1998
        • Braun V.
        • Clarke V.
        Using Thematic analysis in psychology.
        Qual. Res. Psychol. 2006; 3: 77
        • Leslie H.
        • McAllister M.
        The benefits of being a nurse in critical social research practice.
        Qual. Health Res. 2002; 12: 700-712
        • Australian College of Midwives
        Position Statement on Homebirth Services.
        (Retrieved April 4, 2017, from:)2014
        • Taylor J.
        The Rise of Freebirthing. 7.30 Report.
        Australian Broadcasting Corporation, Australia2017
        • Symon A.
        • et al.
        Examining autonomy's boundaries: a follow-up review of perinatal mortality cases in UK independent midwifery.
        Birth. 2010; 37
        • Cheyney M.
        • Everson C.
        • Burcher P.
        Homebirth transfers in the United States: narratives of risk, fear, and mutual accommodation.
        Qual. Health Res. 2014; 24: 443-456
        • Vedam S.
        • et al.
        Nurse-midwives’ experiences with planned homebirth: impact on attitudes and practice.
        Birth. 2009; 36
        • Garrat R.A.
        Connecting With Women: the Working Lives of Independent Midwives and Their Perceptions of the Mother-midwife Relationship.
        • Newnham E.C.
        Birth control: power/knowledge and the politics of birth.
        Health Sociol. Rev. 2014; 23: 254-268
        • Alexander C.R.
        • Bogossian F.
        Midwives and clinical investigation: a review of the literature.
        Women Birth. 2018; 31
        • Calvert I.
        • Benn C.
        Trauma and the effects on the midwife.
        Int. J. Childbirth. 2015; 5: 100-112
        • MacLennan A.H.
        • Spencer M.K.
        Projections of Australian obstetricians ceasing practice and the reasons.
        Med. J. Aust. 2002; 176: 425-428
        • Hood L.
        • Fenwick J.
        • Butt J.
        A story of scrutiny and fear: Australian midwives’ experiences of an external review of obstetric services, being involved with litigation and the impact on clinical practice.
        Midwifery. 2010; 26: 268-285
        • Robertson H.
        • Thomson A.M.
        A phenomenological study of the effect of clinical negligence litigation on midwives in England: the personal perspective.
        Midwifery. 2014; 30: e121-e130
        • Symon A.
        Litigation and defensive clinical practice: quantifying the problem.
        Midwifery. 2000; 16: 8-14
        • McCool W.F.
        • et al.
        Closed claims analysis of medical malpractice lawsuits involving midwives: lessons learned regarding safe practices and the avoidance of litigation.
        J. Midwifery Womens Health. 2015; 60: 437-444
        • Peyman A.
        • Nayeri N.D.
        • Bandboni M.E.
        Legal complaints about midwives and the impact on the profession.
        Nurs. Ethics. 2017; (
        • Garratt R.A.
        Connecting with Women: the Working Lives of Independent Midwives and Their Perceptions of the Mother-midwife Relationship, in School of Nursing and Midwifery.
        De Montfort University, United Kingdom, Lesicester2014
        • Toose L.
        Privately Practising Midwives in a Cycle of Death by Regulation – How the Medical Model and an Unfounded Perception of Risk Is Leading to the Removal of Choice for Women in Australia.
        (Unpublished Masters paper)2016
        • Keedle H.
        • et al.
        Women’s reasons for, and experiences of, choosing a homebirth following a caesarean section.
        BMC Pregnancy Childbirth. 2015;
        • Rowe R.
        • et al.
        Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study.
        BJOG. 2016; 123: 1123-1132
        • Cheyney M.
        • et al.
        Outcomes of care for 16,924 planned home births in the United States: the midwives alliance of north america statistics project, 2004 to 2009.
        J. Midwifery Womens Health. 2014;
        • Fischbein J.
        • Freeze R.
        Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births.
        BMC Pregnancy Chilbirth. 2018; 18 (