8 NEWS
8 NEWS
8 NOVEMBER 2024 ausdoc . com . au
Push to end homebirth loophole
ANALYSIS
Paul Smith Editor at Australian Doctor .
Is the govt finally banning uninsured midwives ?
HOMEBIRTHS with limited hospital backup remain one of the most divisive topics in healthcare .
And it has resurfaced in the media again , with the Federal Government looking to end what , to many , seems a bizarre loophole in the legal demand that every AHPRA-registered health practitioner needs indemnity cover before they lay a hand on a patient .
For the past 15 years , midwives opting to attend homebirths outside the support network of the public hospital system have not needed insurance — no matter what the clinical risks involved in the birth .
It is a result of a Commonwealth exemption introduced in 2010 after Guild Insurance — the only insurer willing to provide cover at the time — pulled out , citing the claims risk as being too great given the limited pool of midwives it was covering and the catastrophic financial consequences if things went badly wrong .
No-one is fully supportive of the exemption . But it has been seen as the one way to provide women who fear ( or are ideologically opposed to ) birthing in the hospital system with a choice that did not involve freebirthing .
For many , the exemption has been
a failing given the argument that there are ethical limits to free choice when a baby , who has no choice at all , is being subjected to life and death risks as a result .
But earlier this year , the government suggested finally replacing its insurance exemption , which is due to end in June next year , with a more permanent fix .
The fix was that an indemnity insurer would cover a private midwife attending homebirths and manage any claims lodged against them but that the government would cover 100 % of the subsequent cost .
Before thinking this would trigger a rapid expansion of high-risk homebirthing , there would be one condition for taxpayer support .
The cover would only apply to midwives attending low-risk homebirths .
An impact paper , drawn up by the federal Department of Health and
The cover would only apply to midwives attending ‘ low-risk ’ homebirths .
Aged Care in June , listed the criteria . They included the following :
• Single birth
• Cephalic presentation
• Pregnancy at 37-42 weeks
• The home is within a catchment area or within a 30-minute drive to an obstetric hospital
• The mother must attend antenatal screening and appointments in line with Australian pregnancy guidelines
• The mother has not previously birthed by caesarean section
If these conditions were not met , it would , in effect , become illegal for any private midwife to attend the homebirth .
The ABC recently interviewed endorsed midwife Katie Low , who objected to the plan , saying it meant the government would be determining where women gave birth .
As yet , the Australian College of Midwives is yet to comment , telling the ABC it is waiting for the next stage of the consultation process .
But the health department ’ s impact paper said one of the benefits of the proposal was that it would help support Aboriginal Community Controlled Health Organisations — which had been affected by “ market failure ”.
Without some kind of cover for midwives to attend homebirths , they warned they would have to close their Birthing on Country services — closures that would include the dedicated Birthing on Country Centre of Excellence being set up in Nowra , NSW .
That could put some of the Closing the Gap targets at risk .
How much would this new insurance arrangement end up costing in an area where negligence settlements could run to seven figures ? The answer remains a mystery . The impact paper says there are “ limited incident and claims history data ” on which to base a liability cost estimate for homebirths .
From the impact paper , you are told that , in 2021 , there were 315,700 babies born .
Some 97 % of these were in the hospital system , 0.7 % arrived before hospital , 2 % were in birthing centres and 0.5 % ( or around 6000 births ) were homebirths .
Many of these would be low-risk homebirths taking place in one of the 15 publicly funded homebirth services with organised hospital backup .
But the number being attended by a private midwife with no indemnity insurance was not clear .
The impact paper could only offer this : “ If the rate and quantum of claims [ are ] significantly higher than predicted , the department would seek advice from the Australian Government Actuary on how to manage the risks , including consideration of amendments to the scope of the homebirth services to reduce the risk .”
The ABC said the government was currently finalising the next stage of the consultation process .
ABC News ; 12 Sep 2024 .
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