The West this afternoon tells us: “Homebirth mothers win reprieve”:
Pregnant women wanting to give birth at home have won a reprieve after Federal Government and the States cut a deal today to allow midwives to continue practising without insurance.
Health Minister Nicola Roxon announced privately practising midwives would have a two year exemption from obtaining medical indemnity cover.
Two years. At least this may offer some women breathing space – the women who were trying to get pregnant right now to avoid the 2010 deadline at which their midwives were to become outlaws.
The article continues:
Homebirth advocates had feared homebirthing would be driven underground because midwives would not be able to get insurance – a requirement of the new National Registration and Accreditation Scheme for health professionals to come into effect mid next year.
While the Federal Government is planning to subsidise insurance for midwives who work in hospitals, it had refused to extend indemnity to homebirthing midwives because of the high cost of providing cover.
Private insurers have also refused to cover homebirths because of the perception homebirths are riskier.
This doesn’t accord with what I’ve read over the past few years at all. As far as I can tell, it is just an unreferenced, passive-voice/agent-deleted throwaway quote from the Maternity Services Review:
My understanding is that the lack of indemnity insurance in Australia isn’t because homebirths are higher risk or because homebirths are perceived to be higher risk than hospital births; it is based around the fact that there is a tiny pool of homebirth midwives, and on obstetric malpractice payouts being enormous. There is no feasible way to share risk between such a small number of midwives, nor do actuaries seem to have any idea of the actual likely risk and cost of payouts – all the stats the Australian Government have been working on have been based on obstetric litigation.
Note also that obstetric malpractice insurance has been heavily subsidised by government for quite some time via the Premium Support Scheme and High Cost Claims Scheme, without a whimper of complaint from the medical profession or the general population.
Back to the West:
Under the deal announced today following the Health Ministers conference in Canberra, midwives will be able to keep practising homebirths provided they warn expectant mothers they do not have insurance, they follow quality and safety guidelines being developed and each homebirth is reported to health authorities.
That second catch is a huge one. It sounds like a motherhood statement, but if you dig beneath the surface, “quality and safety guidelines” can be heavily proscriptive. The “quality and safety guidelines” I’ve seen so far have typically been extremely restrictive, including exclusion from homebirth for such things as being too young, too old, too fat, too thin, having a disability (poorly defined), having a previous C section (which we can see from the Canadian study needn’t be an exclusion), declining certain poorly-evidence-based prenatal screening (such as glucose tolerance, ultrasound, GBS testing), history of postpartum depression, previous baby in intensive care (regardless of cause), and so on.
And Roxon’s clinging to the Maternity Services Review not recommending public funding of homebirth midwifery yet – which the Review author herself, right in the review, said was purely based on political expediency (i.e. not pissing off the medical colleges and associations):
So as long as the AMA and RANZCOG are hostile to homebirth -ideologically, not evidentially – the government is not prepared to stare them down.
More on the Maternity Services Review here: “Maternity Services Review: Medicare payments to OBs up from $77m to $211m since 2004.”
Bottom line? If there’s no “informed refusal to go to hospital” clause, this acclaimed change-of-heart really isn’t likely to improve things significantly for many women.
Addit 4 Sep @1709: Unfortunately, this sort of informed refusal doesn’t seem to be terribly likely, given stuff like today’s NSW Supreme Court decision – upholding the he right to refuse medical treatment, with the following caveat:
When are pregnant women going to be promoted to full personhood?