For years women and midwives have campaigned for Medicare for midwifery services. In 2009 Maternity Services Review recommended Medicare rebates for midwifery services with the exclusion of homebirth. Personally I felt angry at the exclusion of homebirth, but I also felt very hopeful that Medicare would open up women’s access to midwifery care. So I waited for the 1st of November 2010 not quite sure what to expect.
In the lead up to November it was difficult to get a clear picture of what I needed to do to be Medicare eligible and there was much misinformation around. It became apparent that there were quite a few hoops to jump through. The first step was choosing the right professional indemnity insurance product. Then I had to make sure that my midwifery practice conformed to the new reporting requirements and the Australian College of Midwives Guidelines for Consultation and Referral. All of which proved a steep learning curve.
As a midwife to get a Medicare Provider Number you have to be an eligible midwife. To be an eligible midwife you have to apply to Australian Health Practitioner Regulation Agency (AHPRA). As AHPRA was new, only starting operation on the 1st of July 2010, they initially didn’t they have the process for eligible midwives in place. This made applications very difficult at the time. An application form was developed and I sent mine in and waited. Once AHPRA initiated the process of assessing the applications there were a few challenges but nothing that wasn’t over come. Applying to Medicare was the easy part – it was simple and straight forward with a rapid response. I was then presented with my Medicare provider number – it was quite exciting.
The next step was obtaining collaborative relationships and this has proven to be the most difficult part of the process. For women to claim Medicare rebates a collaborative relationship must be in place. Slowly but surely I have been working on this and more and more women I am seeing are able to access Medicare. Mind you forging collaborative relationships remains my greatest challenge. At least now some homebirth clients are able to claim for pre and postnatal care – so they are able to get back a portion of their out of pocket expenses.
Access to Medicare has opened quite a few very positive things for me as a midwife. I am now able to order pathology tests and ultrasounds for women. Streamlining the care I am providing. The open lines of communication that have resulted from a few of the collaborative relationships developed have yielded some really positive outcomes for the women being able to access the care they need without the usual challenges and a greater level of respect is being displayed by some of my medical colleagues. I also now am able to directly refer to paediatricians and obstetricians should this be required.
At this point midwives are unable to prescribe as there are no accredited prescribing courses for midwives. The list of medicines in the midwifery formulary excludes things such as Syntocinon, Konakion, Anti D and Xylocaine which I feel is very short sighted.
While there is much work to go until we have an ideal set up – the current Medicare rebates are a very big step in the right direction.
Originally published in April 2011
Jane Palmer is a mother, birth activist and midwife in private practice located in Sydney, Australia. With additional qualifications as a childbirth educator and lactation consultant, Jane works to improve pregnancy, birth and parenting options for families.