Presentation regarding the profession of midwifery and various governance issues, national reform measures, legislative and regulatory changes

1. Dr Belinda Maier
Clinical Associate Professor,
Australian Catholic University
Maier.Belinda@yahoo.com.au
Presented 2011/12

2.  “I would like to respectfully acknowledge
the Traditional
Custodians of the land on which we meet
today and Elders both past and
present.”

4.  National Registration Authority Scheme -
NRAS
 Australian Health Practitioners Registration
Authority - AHPRA
 Nurses and Midwives Board Australia - NMBA
 Australian Nursing and Midwifery
Accreditation Council - ANMAC

7.  The Health Legislation Amendment (Midwives
and Nurse Practitioners) Bill 2009
 Health Insurance Act 1973 for MBS access
 National Health Act 1953 for PBS access
 National Health (Pharmaceutical Benefits)
Regulations 1960
 Health Insurance (midwife and nurse
practitioner) Determination 2010
 Queensland Legislation - Health (Drugs and
Poisons) Regulation 1996.
 Collaborative arrangements for MBS/PBS:
 National Health (Collaborative arrangements
for nurse practitioners) Determination 2010.
 National Health (Collaborative arrangements
for eligible midwives) Determination 2010.

8.  March 2005 Re-Birthing: Report of the Review of Maternity
Services in Queensland. Cherrell Hirst AO
 2009 National Maternity Services review: Improving Maternity
Services in Australia: The Report of the Maternity Services
Review
 Health Practitioner Regulation National Law 2009
 Health legislation Amendment (Midwives and Nurse
Practitioners) Bill 2009.
 Midwife Professional Indemnity (Commonwealth Contribution)
Scheme Bill 2009

9.  Care is safe and feels safe
 Care is open and honest
 Care is local and feels local
 Care is integrated
 Care belongs to consumers
 Carers work together and communicate

10.  Office of the Chief Nursing Officer
Midwifery
Background
 Following Re-Birthing the review of Maternity Services in
Queensland 2005, the position of Midwifery Advisor was
created in the Office of the Chief Nursing Officer.

12.  National Registration and accreditation for Chiropractic,
Dental, medicine, Nursing and Midwifery, Optometry,
Osteopathy, Pharmacy, Physiotherapy, Podiatry, Psychology
and from 2012;
 Aboriginal and Torres Strait Islander Health Practice, Chinese
medicine and Medical radiation Practice.
 Mandatory reporting of registrants
 Demonstration of continuing practice development and
recency of practice
 National boards with the power to delegate all board
decisions
 Criminal history and identity checks
 Simplified complaints arrangements for the public
 Student registration
 Handling of complaints

13.  The intent of NRAS is national registration
aligning all professional bodies with
particular professional requirements

14.  Statutes are also known as ‘Acts’ of Parliament.
 A ‘Bill’ is drafted and introduced into Parliament.
Then it is ‘read’ 3 times, amended as necessary,
before being passed by both houses of Parliament
 (In QLD there is only one house)
 It then becomes known as the Act.

15.  Health legislation Amendment (Midwives and
Nurse Practitioners) Bill 2009 and the
Midwife Professional Indemnity
(Commonwealth Contribution) Scheme Bill
2009.

16.  One registration fee
 professional development mandated
 Australian registration
 Standardisation of professional competencies
across Australia
 Mandatory criminal checks and reporting -
better for us better for our clients/patients

17.  Indemnity Insurance for midwives – excludes
birth at home
 Collaboration requirements – written
requirements with a medical practitioner or
kind or kinds…
 Eligibility criteria for Midwives and Nurse
Practitioners to access MBS PBS

18.  To enable midwives to have access to MBS and PBS
 Must be eligible – therefore must meet registration
criteria, show collaborative arrangements and have
or be exempt from Private Indemnity Insurance

19.  Purpose of the Bill is to allow the Government to
provide for Indemnity Insurance to eligible private
practice midwives.

20. The Report makes a series of
recommendations in the key
areas of:
1. Safety and Quality
2. Access to a Range of Models of Care
3. Inequality of Outcomes and Access
4. Information and Support for Women and
their Families
5. The Maternity Workforce
6. Financing Arrangements.

22.  Strategic national framework to guide policy and
programme development across Australia over
the next five years
 Focus is Primary Services not specialist
services

23. Woman centered
 Evidence based
 Continuity of care
 Culturally competent
 “Closing the gap”

24. Access
Service delivery
workforce
infrastructure

25. Continuing professional development
(CPD)
Recency of practice
Professional Indemnity Insurance
(PII)
Criminal history
English language skills

26. Current general registration as a midwife in Australia with no restrictions
on practice;
Midwifery experience that constitutes the equivalent of 3 years full time
post initial registration as a midwife;
Current competence to provide pregnancy, labour, birth and post natal
care to women and their infants;
Successful completion of an approved professional practice review
program for midwives working across the continuum of midwifery care;
20 additional hours per year of continuing professional development
relating to the continuum of midwifery care;
Formal undertaking to complete within 18 months of recognition as an
eligible midwife; or the successful completion of:
i. an accredited and approved program of study determined by the
Board to develop midwives’ knowledge and
skills in prescribing, or
ii. a program that is substantially equivalent to such an approved
program of study.

27.  Under section 129 (1) of the Health Practitioner
Regulation National Law, a health practitioner
must not practise the health profession in which
the practitioner is registered unless appropriate
professional indemnity insurance arrangements
are in place.

28.  MIGA requires:
 written collaboration with a named medical
officer OR
 If collaborative arrangements are unable to be
secured, then a MIGA care plan must be
submitted to a maternity facility, by the self
employed (private practice) midwife.
 that the hospital acknowledge receipt of the
care plan.

29.  Exemptions in law until 2013
 No insurance available for birth at home
 Homebirth in itself is not regulated but the risk
is that homebirth attendants are not a registered
professional

30.  (3) Schedule 1, item 70, page 22 (line 2),
at the end of the definition of authorised
midwife, add
 “, so far as the eligible midwife provides
midwifery treatment in a collaborative
arrangement or collaborative
arrangements of a kind or kinds specified
in a legislative instrument made by the
Minister for the purposes of this
definition, with one or more medical
practitioners of a kind or kinds specified
in the legislative instrument”.
 [collaborative arrangements]

32. Misconceptions
Supervisory role
Legally responsible for the
actions of the midwife
Support homebirth
Extra work
Extra on call
Reality
Professionalism
Collegiality
Healthy women and babies
Timely and appropriate access
to medical care
Effective and timely use of
resources

34. Rural Maternity Initiative
Collaborative Arrangements for
Private Practice Midwives
Drug Therapy Protocol - Midwifery
Continuity Models of Care Implementation
Guide
Credentialing for midwives

35.  Policy - Breastfeeding
 Policy - Transfer of a woman and or infant
from a planned home birth to a Qld Health
Service
 Policy - Clinical Governance for Midwifery
Models of Care
 Policy - Normal Birth
 Policy – water immersion in labour
 Policy – admitting rights for midwives

38.  In 2007 the Health
(Drugs and Poisons)
Regulation 1996 was
amended to authorise
Midwives to:
 “the extent
necessary to practice
midwifery: to obtain,
possess, administer or
supply a controlled or
restricted drug, under
a drug therapy
protocol.”
 The HMP Midwifery is a
set of clinical guidelines
that outline the
situations and conditions
under which an
registered midwife can
administer and supply
medications listed in
Appendix One of the
DTP.

39.  DTP Midwifery is a resource for Registered
Midwives employed within Queensland Health.
 PBS is different to a DTP and is for Eligible
Midwives.

40. Private
 Public
 hybrid

41.  Greater access to visiting rights, indemnity
insurance, credentialing…
 Negotiated contracts….
 More public models…
 More rural and remote models that utilise
midwives to full scope of practice….
 Rural/remote midwives with maternal child
health, sexual health and immunisation
qualifications….