Upon graduating from Midwifery in early 2009, after a very hard year of training in the hospital. I set out to do what I had planned from the beginning. I set up a business as a private midwife and attend to women choosing to birth at home. It had always been the plan, I didn’t know how I was going to do it. But I knew I didn’t want to continue working in a hospital. So there I was 24 years old, fresh out of my training and with no idea where to go. I got a tip to call Robyn Dempsey. She had a reputation for giving new midwives a leg up into private practice. She welcomed me with open arms, and not long after Jane Palmer offered her time and expertise also.
For 6 months I followed them around like a little duckling, learning everything I could.
Establishing my business systems, trying to understand the industry, and gaining new midwifery skills. Additionally, to learn how to be with women at home. They filled me with confidence and by the end of the year, I had an established business. A business with enough bookings to keep me busy. All seemed well in the world of private practice. I felt organised and competent and able to meet the legal and administrative requirements expected of me by the governing bodies and my clients. When I started out all you had to do was get registered. Next is to buy a kit and start providing midwifery care, and that’s what I did.
As 2010 went on, the grapevine started talking about registration and insurance reform. This made the world of private practice became uneasy. Conspiracy theories abounded and angry letters and campaigns flew back and forth. For the most part, I kept my head in the sand hoping that my happy little world would not collapse. Hoping it would all blow over. I signed petitions that were sent to me. I attended protests as they occurred, always with the assumption that this would all just pass.
As the July 2010 date loomed the campaign to save homebirth intensified.
I realised that things would be changing, there was going to be a new world order and for private midwives. It would be a sink or swim scenario. My husband asked me, ‘what if homebirth becomes illegal, will you go back to the hospital?’. I knew in my heart that I just couldn’t and I wouldn’t. I needed a plan to survive myself and to help other midwives survive too.
In July 2010, after the changes to midwifery registration occurred.
The need for personal indemnity insurance was realised and the possibilities for private practice increased. I hosted a brainstorming meeting to ‘send out the feelers’ to midwives who might be interested in joining together. This is to form a private group practice as a way of navigating the changes to private practice midwifery. After some further meetings, discussion and collaboration, in September 2010 Robyn Dempsey, Jane Palmer, Hannah Dahlen and I formally collaborated. We collaborated to form ‘Midwives at Sydney and Beyond’, private midwifery group practice. Robyn and Jane contributed their many years of experience both in and out of private group practice. They were pivotal in the direction of ‘Midwives @ Sydney and Beyond’. This would go and provide the scaffolding on which our group practice is based.
It has been approximately a year and a half since Midwives @ Sydney and Beyond formed.
Since that time we have developed a standardised set of handheld notes for our clients. We have a streamlined reporting system to ensure speedy and effective communication with each other and other health care providers. We gained Medicare eligibility and referral rights and developed a mentoring system. This system is designed to integrate midwives into private practice. We have used this to expand our practice to 6 midwives, and maintain a full client load. This helped us set up effective business management and finance strategies and fully comply with all the legislative requirements without compromising our approach to care or our clients’ autonomy. The care we provide is the same as it was when we worked in sole practice. But our business strategies, paperwork and approach to administration are streamlined and sophisticated.
The formation of a midwifery group practice was not initially designed to be for our clients.
While we were sure they would benefit nonetheless. Ultimately we formed the group practice to support midwives so that we could stay strong, competent, and equipped. Also to be effective in caring for our clients amongst the sea of change that was swelling around us.
We meet monthly and communicate daily to be a constant support to each other. And practically assist where needed, like the day we simultaneously hosted a pregnancy and parenting network meeting. This meeting is for our clients, attended 2 births, an antenatal visit and flew abroad to a conference; that was quite a day! Upon reflection Robyn said to me, ‘this is where group practice comes into its own’, she was right. We have been able to do more for our clients together than we would have ever been able to do apart.
In 2010 the face of Private practice midwifery changed.
Privately practising midwives went from having no access to indemnity insurance, Medicare or PBS, to then gaining access to all of these along with national registration requirements and a more formalised Quality and Safety Framework for privately practising midwives, which included the arrangement of collaborative agreements between collaborating hospitals and maternity care providers. With these changes came more accountability and transparency for privately practising midwives and much more regulation and paperwork. While Midwives at Sydney and Beyond believe that these changes will ultimately benefit women and children. By expanding birth choices, the changes have been confusing, tedious and time-consuming for midwives attempting to conform to the new regulations.
Our aim was to join together so that as private midwives we could thrive under the new legislation without compromising the quality of care we wish to provide to our clients.
We see ourselves as a buffer for our clients against the increased legislative requirements on private practice and on homebirth and seek to absorb any disturbance this might cause to our clients.
I won’t lie, the legislative changes are confusing, annoying, and time-consuming. It generates a lot of paperwork and stress. I would have loved for things to have stayed the way they were. But the fact is, they aren’t how they used to be. And it will never be that way again, so instead of resisting, giving up and fighting against these changes, we have put our energy into embracing and moving on with them. We can see both positives and negatives to the changes but as a group practice. We work together to adapt to them and expose our clients to all the benefits. Examples like not needing to see a GP for a referral and Medicare rebates and protecting them from the negatives.
ABOUT THE AUTHOR: Melanie Jackson lives in the Blue Mountains with her husband and two children and has been a midwife in private practice, and providing homebirth services, since 2009. She has a passion for providing minimal intervention care and has respect for the physiological process of pregnancy, birth and the early postnatal period. Melanie loves to see the powerful process of birth unfold and watch families blossom as pregnancy and birth unfolds. Her passion for midwifery-led her to complete her PhD, called “birth outside the system”.