Australia’s privately practising midwives providing birthing services in the home have been unable to access professional indemnity insurance (PII) since the collapse of HIH in 2001.

Commonwealth, state and territory health ministers have agreed to exempt self-employed midwives from the insurance requirement, which is mandated under the Health Practitioner Regulation National Law, with the exemption now extended until December 31, 2016.

While Medicare-eligible midwives have been able to access the Commonwealth-subsidised Midwifery Practice Insurance Scheme for antenatal and postnatal care and for care to women birthing in hospital as private clients, midwives who are not Medicare-eligible no longer have access to insurance for antenatal and postnatal care after insurance provider VERO ceased offering PII to midwives in April.

The ongoing insurance crisis for privately practising midwives has prompted the Australian College of Midwives (ACM) and Queensland Health to find a solution.

Under a contract with Queensland Health, ACM is developing a Midwifery Practice Scheme, designed to not only increase the confidence of governments, midwives and midwifery clients but to also make PII a viable commercial opportunity for insurance companies.

ACM chief executive officer Ann Kinnear says the scheme is a safety and quality framework of processes, policies and guidelines that’s now being developed to support midwives.

Ms Kinnear says the scheme will provide a model that other states or territories may also embrace, creating the potential for the development of a national scheme for privately practising midwives.

“The current situation with insurance is a poor situation for midwives and mothers to be in,” she says.

“It exposes midwives, if there is any complaint against them that takes them to court or takes them to the Australian Health Practitioner Regulation Agency (AHPRA).

“Midwives could be up for a lot of legal expense, which they are not covered for, and if they are found to be at fault then they may have to compensate their client and also pay their clients’ legal fees, so they are quite exposed to complaints if an error is made.

“Insurers need to know what the risk is that they’re insuring and they need to know that the risk is being mitigated to the extent that it can be.

“Our job is to create the Midwifery Practice Scheme which hopefully will attract a private firm to bring forward an insurance product.”

Under the scheme, evidence-based national guidelines will be developed for clinical practice for births at home and for transfer from birth at home to health services.

The scheme will also provide a statement of midwifery practice requirements, and develop risk management, audit and compliance processes along with support systems for midwives in private practice.

Ms Kinnear says it’s important the guidelines focus on evidence-based maternity care.

“Some current clinical guidelines say the position in which a woman should give birth is the one that is most convenient for the practitioner,” she says.

“Obviously, you would get a better outcome if the woman was able to choose her position of birth that most suited her at that time and she was supported to make that decision.

“That’s an example of where things can be non-evidence-based and they are not actually standards supported by midwives.

“So we want to make sure that when we make statements that they are based on evidence and obviously, in this example, the position that a woman chooses in birth is the one that’s most convenient to her and the one that is most appropriate for her stage of giving birth.”

Work on the Midwifery Practice Scheme began in April and is due to be completed before the end of the year.

A steering committee, chaired by ACM president Professor Caroline Homer, has been created and includes representatives from the Nursing and Midwifery Board of Australia, AHPRA, the Australian Commission on Safety and Quality in Health Care, the ANZ Council of Chief Nurses and Midwifery Officers, the Australian Nursing and Midwifery Federation and Maternity Choices Australia to name a few, and also includes privately practising midwives.

While the scheme will not duplicate the requirements for midwifery registration, it will put in place some additional checks and balances to minimise risk, such as a requirement for open disclosure.

“Open disclosure is simply if a health practitioner feels that something has gone wrong during the provision of a service to a client - then they should explain what’s happened and explain if it’s going to have adverse outcomes or not,” Ms Kinnear says.

“It’s very important that health practitioners provide information to their clients. This is one of the things we would be strongly recommending to midwives, if they don’t already do it, is to have open communication.”

Ms Kinnear says the scheme will also work to assist midwives when it comes to addressing complaints.

“We would like to give them the skills and knowledge to be able to deal with that, and if they have difficulties then we would suggest a mediation process and we would explain how that would work,” she says.

“We want to be able to help consumers work with midwives, get the information that they wish but also have midwives provide good information to their clients.

“This is not saying that midwives don’t already do this but this is giving them the skills and knowledge to make sure they can do it to the best of their ability.”

Under the scheme, privately practising midwives will also be required to complete a program similar to the ACM’s peer-supported Midwifery Practice Review.

“The Midwifery Practice Review allows midwives to think quite deeply about what they do and the skills and knowledge that they require, and to move forward so that they have continuous improvement. A program like this would be a requirement.”

Ms Kinnear says while many privately practising midwives are already implementing many of the proposed measures, the scheme will cement the initiatives as best practice and work to elevate the midwifery profession.

Importantly, access to PII will also give privately practising midwives more security.

“At the moment, it’s a little bit like driving a car without actually having insurance,” she says.

“It will also, I think, raise the profile of midwifery and the profile of home births.”

Midwives are being encouraged to get involved in the Midwifery Practice Scheme. Click here to find out more.