Extending midwife-led models into the community

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Publication: The Queensland Nurse
Date published: February 1, 2012

The QNU have put plans on the table to broaden a trial which would give women greater confidence in choosing a private practice midwife to oversee their pregnancy.

The trial would ensure Private Practice Eligible Midwives (PPEM) could offer continuity of care if women had to be admitted to public hospitals as public patients due to, for example, complications during pregnancy.

The mechanism for interfacing Private Practice Eligible Midwives (PPEM) and their private clients with the public sector has been in place for some months now.

However following directions from the NMBA, the Australian College of Midwives and the insurer for PPEMs MIGA, the QNU were advised that if a PPEMs client was admitted to a public hospital as a public patient for intrapartum care, the midwife could only be present as a support person and not as their client's midwife.

On behalf of midwives as their professional and industrial body, the QNU believed this arrangement was outrageous.

This arrangement would provide a substandard access choice for women, limit the practice of PPEMs, and sap the goodwill of all stakeholders.

At the instigation of the QNU a meeting was convened between our union representatives, Queensland Health (QH), the Association of Private Practice Midwives, the Maternity Coalition and the Health Minister Geoff Wilson in October and November last year.

At this meeting robust discussion occurred about the role of midwives and the government's obligation and commitment to implementing a continuity model for women with greater access to midwife-led models.

Afterwards the Minister clearly indicated that Queensland needed more trial sites with varying continuity and collaborative models to ensure the ongoing viability of PPEMs and admittance rights to a public hospital.

This ministerial group has since developed a flow chart with options that would not prohibit collaborative practice.

Currently only one district is undertaking the pilot to grant PPEMs admitting rights to a public hospital for the birth. The QNU believes this practice needs to be trialled in more than one site, with varying processes.

The number of women being cared for by a PPEM and hence who may be required to change their status from private to public would be minimal.

There are a number of different options to test. They are relatively simple to implement, although so far testing has been limited and produced both positive and negative aspects.

Options include using arrangements to employ PPEMs on a casual basis when required, utilising a process similar to that of the VMO Agreement to facilitate a Visiting Midwife Arrangement or allocate the PPEM to a partial FTE of a caseload model, and exploring the Section 192 exception in rural and remote areas for antenatal and postnatal Medicare rebates.

Caboolture, Ipswich, Gold Coast and Sunshine Coast have been tentatively identified as possible pilot sites for a 3-6 month period.

A Project Officer will be appointed to develop state -wide structural and employment arrangements.

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