BY KAMALA EMANUEL
HOBART — Insurance industry costs are threatening the delivery of home-birthing services across Tasmania.
The Australian Nursing Federation ordinarily pays insurance fees for nurses as part of their membership fees. In early April, however, it cancelled insurance for midwives because of a massive increases in premiums. Insurance costs for all other nurses had doubled since the previous year and coverage for midwives would have been an additional $100,000.
State hospital-based midwifery services are continuing, because staff are covered by government insurance. The change leaves independent midwives, who offer antenatal (pre-birth), delivery and postnatal services at women's homes, without insurance.
Home-births cost $1500-1700, and there is no Medicare rebate. The federal government abolished a $1500 grant for home-births five years ago. Each hospital birth costs the public health system an average of $4000.
Childbirth Information Service volunteer co-ordinator and independent midwife Terry Stockdale told 91×ÔÅÄÂÛ̳ Weekly: "Studies in Tasmania, Canberra, Adelaide, Western Australia and around the world have shown that home-birthing is better or at least as good as birthing in hospital, in terms of safety and cost-effectiveness.
"The results of the pilot study we undertook in Tasmania showed women giving birth at home experienced less physical and emotional trauma than those in a hospital setting. There was less drug use by women and therefore less risk for them and their babies, less suturing and therefore quicker healing.
"Having the same midwife throughout the pregnancy enables the midwife to care for the woman according to her. Most independent midwives also offer at least a week, and sometimes up to a month, of follow-up care."
The midwives have been unable to find any other insurer. Stockdale estimated that the cost of a home birth would double or treble if the midwives had to pay the extra premium themselves.
Independent midwives have been asking clients to sign a disclaimer to enable them to continue to provide the service. The Tasmanian Nursing Board has a discretionary power to deregister nurses who work without insurance. Board CEO Moira Laverty has stated that during the current crisis it will not discipline midwives for working without insurance, but that the issue needs to be addressed before registration renewals fall due in August.
"The same thing has been happening in other states", according to Stockdale. Stockdale believes most midwives favour a New Zealand-style system. Under this "no-blame" model, the state acts as the insurer, providing all care for the injured person if an injury does take place. Midwives are paid by the state, and women have the choice of giving birth at home or in hospital.
The midwives may fund-raise to cover the insurance this year, but this will not be sustainable for long.
A protest was held outside state parliament on April 18 to call for government assistance to enable home birthing to continue. Health minister Judy Jackson has ruled out state government insurance for independent midwives.
From 91×ÔÅÄÂÛ̳ Weekly, May 1, 2002.
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