Debates about different models of maternity care have been long-running in Australia. Disputes over evidence on the safety and quality of midwifery-led models of care – which include shared care, birth centres, and planned home births – are at the heart of the debate.
In an attempt to improve maternity services in Australia, the Federal Government has implemented a number of reforms. In November 2010, the Government made some changes to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), so that eligible, privately practising midwives working in collaboration with an obstetrician could prescribe some medications, provide antenatal and postnatal care, and deliver babies in a hospital setting. The Government also agreed to support a professional indemnity scheme for eligible, privately practising midwives.
Despite these reforms, debates about midwifery-led models of care, particularly homebirths, are ongoing. Some privately practicing midwives are unhappy with the current arrangements. Reasons for this include:
- Despite the recent changes to the MBS and PBS, some privately practising midwives cannot get practice rights in public hospitals.
- Private midwives who attend homebirths are not currently required to take out professional indemnity insurance, but some are concerned that this will change when the Safety and Quality Framework for Privately Practicing Midwives attending Homebirths is reviewed in July 2013.
There are ongoing debates about the National Midwifery Guidelines for Consultation and Referral currently in use that help midwives decide when a woman should be referred to an obstetrician for assessment or ongoing care.