Midwife collaboration “disappointing”

ONLY a handful of collaborative agreements have been signed between obstetricians and midwives since reforms were introduced in November, sparking calls for a policy rethink.

Reforms to the Health Insurance Act mean that midwives and nurse practitioners have had access to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) since November last year, provided they have collaborative arrangements with a medical practitioner. (1)

The reforms stipulate that private midwives must have an arrangement with an obstetrician to access rebates;however, obstetricians appear reluctant to sign these agreements, which were described as “controversial” when they were approved by the federal parliament in March 2010. (2)

Obstetricians and midwives who spoke to MJA InSight were united in their commitment to collaboration between the professions; but also in their disappointment with the new model of collaborative care.

In a comment piece for MJA InSight, midwifery researcher and associate professor Hannah Dahlen, of the University of Western Sydney, writes that only three agreements had been signed. (3)

Liz Wilkes, a midwife and board member of Midwives Australia, agreed that only about 3‒5 written agreements had been signed nationwide since November. No official records of the numbers of written agreements are available.

Midwives are still able to offer their patients MBS rebates without a written agreement by demonstrating their collaboration with obstetricians through other methods, such as being employed by an obstetrician, or by having a patient referred to them by a doctor.

Even so, only 37 of Australia’s 1760 registered midwives have registered with Medicare for access to the MBS and PBS. An analysis by MJA InSight found that patients have received 1210 MBS rebates for care provided by midwives since the item numbers were introduced in November 2010 (item numbers 82100-82140).

Ms Wilkes, who established a Toowoomba-based midwifery clinic in response to the regulatory reforms, said some obstetricians were extremely reluctant to sign written agreements.

Six midwives in her practice have a Medicare provider number; however, none of them have been able to secure a written agreement with an obstetrician, despite at least 100 written requests to local private obstetricians since November.

“The obstetricians have been quite strident in their rejection [of an agreement]”, Ms Wilkes said.

“It’s a shame because I think there would be a number of different models that would come from this way of working together. It also opens up a range of professional opportunities in terms of learning and working in a collegiate way”, she said.

Dr Rupert Sherwood, a Hobart-based obstetrician-gynaecologist and president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said obstetricians and midwives had a long history of collaboration and questioned the need for the new collaborative care requirements.

“I think you have to ask the question, how unhappy was everybody with the previous arrangement? What was the real need for maternity reform? If there was a real need for reform … wouldn’t you have expected a bigger uptake of the reforms?”

He said his college had several concerns about the new arrangements, such as the understanding that midwives could sign collaborative agreements with public hospital doctors who were not directly involved in obstetric care, leaving obstetricians out of the equation unless something went wrong.

Ms Wilkes said it would be great if there was a policy rethink, ideally removing the legislative determination that requires midwives to demonstrate collaboration to access the MBS and PBS. (4)

“Or at least having something that’s less complex and doesn’t require the midwife to jump through these hoops to demonstrate that she is collaborating with an obstetrician. For example, having a woman booked in to a hospital that provides obstetric services and having ongoing engagement with obstetricians should be enough evidence of collaboration.”

- Sophie McNamara

1. Midwife Reform Legislation fact sheet

2. Sydney Morning Herald 16 March 2010

3. MJA InSight: Hannah Dahlen: Collaboration or control 14 June 2011 

4. Australian Government: National Health (Collaborative arrangements for midwives) Determination 2010

Posted 14 June 2011

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