A Brief History of Professional Indemnity Insurance (PII) for Privately Practising Midwives (PPMs) in Australia...
For a more detailed account of the intersecting issues of Medicare rebates, 'eligibility'' and collaborative arrangements, we recommend reading Dr Rachel Reed's blog 'The Future of Midwives and Homebirth in Australia'. Rachel describes in detail how the introduction of Medicare for Privately Practising Midwives (PPMs) was a double-edged sword which both increased access to homebirth for women and led to GPs becoming the 'gate-keepers' of homebirth.
The birth of AHPRA
Prior to 2010, PPMs were regulated by the Australian Nursing and Midwifery Council (ANMC) and did not require Professional Indemnity Insurance. They worked collaboratively with other health professionals (GPs, hospitals, OBs) in accordance with the Australian College of Midwives (ACM) Consultation and Referral Guidelines. There were no 'visiting rights' for PPMs to act as primary care giver in the event their client needed to transfer to hospital.
The Australian Health Practitioner Regulation Authority (AHPRA) formed in 2009 and replaced the ANMC. AHPRA's role is to regulate all health care professions, including midwifery. The Nursing and Midwifery Board of Australia (NMBA) operates within AHPRA and is responsible for the professions of nursing and midwifery.
AHPRA registration requires all health professionals to have PII for all aspects of their practice. This left PPMs in a difficult position, as there was no insurance product available to them which covered the intrapartum (labour and birth) period when providing care to a woman at home. If midwives continued to provide care to women giving birth at home, they would be in breach of their registration requirements.
The Australian Health Practitioner Regulation Authority (AHPRA) formed in 2009 and replaced the ANMC. AHPRA's role is to regulate all health care professions, including midwifery. The Nursing and Midwifery Board of Australia (NMBA) operates within AHPRA and is responsible for the professions of nursing and midwifery.
AHPRA registration requires all health professionals to have PII for all aspects of their practice. This left PPMs in a difficult position, as there was no insurance product available to them which covered the intrapartum (labour and birth) period when providing care to a woman at home. If midwives continued to provide care to women giving birth at home, they would be in breach of their registration requirements.
The Mother of all Rallies
To protest this impossible situation that PPMs and homebirthing women were in, Homebirth Australia organised the 'Mother of all Rallies' on the 7th of September, 2009. The night before the rally was scheduled to take place, Nicola Roxon MP (Labour Health Minister at the time) announced that the Federal Government would issue an exemption for PII to PPMs for the intrapartum period at home. The next morning, over 3000 people from all around Australia rallied outside Parliament House in the freezing cold and pouring rain to defend their right to give birth at home.
Sydney PPM Jane Palmer has some great videos of the rally on her YouTube channel, which you can view below.
Sydney Morning Herald article on the Mother of all Rallies, 8th September 2009.
Sydney PPM Jane Palmer has some great videos of the rally on her YouTube channel, which you can view below.
Sydney Morning Herald article on the Mother of all Rallies, 8th September 2009.
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The exemption
The exemption to PII for PPMs was applicable to those providing intrapartum services at home, as there was an insurance product available already for the antenatal and postnatal periods. No insurance company was willing to provide a product for the intrapartum period at home, citing the size of the market and difficulty working out the probability of a claim. The initial exemption was due to expire in June 2015, but it was extended until June 2016.
This has been the pattern ever since - the exemption deadline approaches and PPMs and women planning to birth at home are left wondering whether it will be extended again, or whether homebirth will essentially become illegal. There has been talk on and off throughout the years about potential insurance products and whether they would limit access to homebirth by requiring certain screening tests in order to be deemed 'low risk' enough to have a homebirth.
There are many views among the homebirth community regarding insurance for homebirth - many believe that an exemption is our best solution for now because it allows midwives to continue attending homebirths without insurance, (so long as they follow the ACM guidelines for consultation and referral) and they are concerned that an insurance product for homebirth will make homebirth inaccessible to many women due to increased cost and potential limitations with risk factors (VBAC, for example).
However, there are others who believe an insurance product which covers homebirth is necessary to legitimise homebirth and give PPMs and consumers a level of protection that they currently do not have. Some people believe that an insurance product for homebirth will lead to Medicare rebates for the intrapartum period, allowing greater access to homebirth (financially). There would be a level of protection for PPMs that they currently do not have., if they had access to an insurance product for the intrapartum period at home. This would also be a benefit to those few women who would put in an insurance claim for their homebirth.
This has been the pattern ever since - the exemption deadline approaches and PPMs and women planning to birth at home are left wondering whether it will be extended again, or whether homebirth will essentially become illegal. There has been talk on and off throughout the years about potential insurance products and whether they would limit access to homebirth by requiring certain screening tests in order to be deemed 'low risk' enough to have a homebirth.
There are many views among the homebirth community regarding insurance for homebirth - many believe that an exemption is our best solution for now because it allows midwives to continue attending homebirths without insurance, (so long as they follow the ACM guidelines for consultation and referral) and they are concerned that an insurance product for homebirth will make homebirth inaccessible to many women due to increased cost and potential limitations with risk factors (VBAC, for example).
However, there are others who believe an insurance product which covers homebirth is necessary to legitimise homebirth and give PPMs and consumers a level of protection that they currently do not have. Some people believe that an insurance product for homebirth will lead to Medicare rebates for the intrapartum period, allowing greater access to homebirth (financially). There would be a level of protection for PPMs that they currently do not have., if they had access to an insurance product for the intrapartum period at home. This would also be a benefit to those few women who would put in an insurance claim for their homebirth.
Women need CERTAINTY
Homebirth Australia become aware that discussions between the Federal Government and ACM were taking place regarding a potential insurance product in early 2020. HBA had great concerns that a product would be developed without any consumer engagement, and despite our repeated attempts to be included in these discussions as a key stakeholder representing both PPMs and women seeking homebirth, we were not given a seat at the table.
In September 2020, Homebirth NSW hosted a panel discussion which touched on the topic of PII for PPMs.
The panelists included:
In September 2020, Homebirth NSW hosted a panel discussion which touched on the topic of PII for PPMs.
The panelists included:
- Jo Hunter - Privately Practicing Midwife
- Alecia Staines - Maternity Consumer Network
- Teresa Walsh - Australian College of Midwives (ACM)
In May 2021, Homebirth Australia wrote to all state Health and Shadow Health Ministers, as well as the Federal Health Minister and Chief Nursing and Midwifery Officer (CNMO), to request another extension of the exemption to PII for PPMs for homebirth. We also highlighted the importance of consumer consultation and requested to be included in discussions about potential insurance products for homebirth.
View our letter and MP responses here.
View our letter and MP responses here.

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In the wake of COVID, conversations between the ACM and Government regarding an insurance product for homebirth took a back seat, but the issue remained a concern for women and midwives.
In February 2022, ACM hosted a panel discussion on PII and a representative from MIGA announced that insurance claims for PPMs are very low, and that the highest number of calls they receive from PPMs are requesting legal advice, not to make a claim.
Homebirth Australia wrote again to the CMNO and Federal Health Minister requesting to be included in discussions between government and insurance companies regarding a potential product for homebirth. Their response was "Your contact details are included on the stakeholder list for external consultation when it occurs."
In February 2022, ACM hosted a panel discussion on PII and a representative from MIGA announced that insurance claims for PPMs are very low, and that the highest number of calls they receive from PPMs are requesting legal advice, not to make a claim.
Homebirth Australia wrote again to the CMNO and Federal Health Minister requesting to be included in discussions between government and insurance companies regarding a potential product for homebirth. Their response was "Your contact details are included on the stakeholder list for external consultation when it occurs."
Women and midwives are blindsided...
On the 13th of May 2024, the Federal Budget Announcement outlined some big investments in midwifery, including a commitment to cover 100% of claim costs for privately practising midwives providing "low risk" homebirth and intrapartum care outside of the hospital. According to the Australian College of Midwives, 'This will end the longstanding professional indemnity insurance exemption with a permanent solution.' The government will need to engage in consultation with stakeholders prior to developing legislation but have stated the commencement date as the 1st of July 2025 (the day after the current exemption for PII is due to expire).
Neither the ACM, Homebirth Australia, or any midwifery or consumer body were consulted in the lead up to this decision, as this was an in-confidence tender process between government and insurance companies. Homebirth Australia wrote to the CNMO again on the 30th of May 2024 requesting inclusion in the consultation process for the proposed insurance product. We received a response on the 31st of May advising that "Homebirth Australia is a recognised stakeholder in this space and your organisation's details have been passed on to the division that is coordinating the stakeholder consultation for inclusion.".
On the 3rd of June we posted on social media our intentions to conduct our own consultation with PPMs in the lead up to the government consultation process. This Zoom session took place on the 11th of June and 100 PPMs from around Australia joined the call. The purpose of the session was to listen to the concerns of PPMs and gather feedback to inform our approach to the government's consultation process, which we anticipated would begin in the following months.
Neither the ACM, Homebirth Australia, or any midwifery or consumer body were consulted in the lead up to this decision, as this was an in-confidence tender process between government and insurance companies. Homebirth Australia wrote to the CNMO again on the 30th of May 2024 requesting inclusion in the consultation process for the proposed insurance product. We received a response on the 31st of May advising that "Homebirth Australia is a recognised stakeholder in this space and your organisation's details have been passed on to the division that is coordinating the stakeholder consultation for inclusion.".
On the 3rd of June we posted on social media our intentions to conduct our own consultation with PPMs in the lead up to the government consultation process. This Zoom session took place on the 11th of June and 100 PPMs from around Australia joined the call. The purpose of the session was to listen to the concerns of PPMs and gather feedback to inform our approach to the government's consultation process, which we anticipated would begin in the following months.
A shocking development
In senate estimates on the 5th of June 2024, Senator Larissa Waters questioned the Chief Nursing and Midwifery Officer (CNMO), Alison McMillan, about the definition of 'low risk", the involvement of the insurance company in this decision and whether women deemed 'high risk' would still be able to access homebirth with a midwife. The CNMO made reference to publicly funded homebirth programs (which are typically reserved for the healthiest, most 'low risk' women and are incredibly restrictive) when answering the question about definition of 'low risk'. She also mentioned the ACM's National Midwifery Guidelines for Consultation and Referral, indicating that Category A women would be eligible under the new insurance product for homebirth with a midwife. The CNMO commented that the government intends to conduct consultation with the ACM and Consumer Health Forum, with the aim of having all details finalised by the end of December 2024. The changes to legislation would come into effect on the 1st of July 2025.
This statement has understandably caused alarm in the homebirth community. Category B and C items listed in the above-mentioned guidelines include:
Some midwives have advised that more than 50% of their current clients would be ineligible for homebirth if this insurance product were only to cover Category A women. These proposed changes could potentially limit the access to homebirth and force more women to birth in hospital or freebirth.
- previous caesarean section
- BMI higher than 35
- maternal age over 40
- financial issues
- family and domestic violence
- anxiety and/or depression
- previous 3rd or 4th degree tear
- previous postpartum hemorrhage
- IVF pregnancy
- 42+ weeks gestation
- macrosomia (estimated baby weight >4000g or 90th centile)
- autoimmune disease
- Type 1 or 2 diabetes
Some midwives have advised that more than 50% of their current clients would be ineligible for homebirth if this insurance product were only to cover Category A women. These proposed changes could potentially limit the access to homebirth and force more women to birth in hospital or freebirth.
Listening to women
The video of the CNMO's statements during senate estimates went viral among the birth community, causing fear and outrage. HBA recognised the need to act quickly, so on the 6th of June we released a survey via our social media channels aimed at collecting information from PPMs, families who have had a previous homebirth or are planning a future homebirth. The survey was met with an overwhelming response, receiving over 1,500 responses in the first night. When the survey closed on the 20th of June we had received 5,917 responses.
On the 23rd of July HBA received an invitation to the government consultation process. A definition of 'low risk' was provided, and the 3 questions in the consultation centred around this definition. The deadline for submissions was the 12th of August.
The first stage of our survey results have been analysed and HBA used the survey report to support our submission to the government consultation. You can view the report by clicking on the link below.
We are following this situation closely and are in contact with the ACM and maternity consumer organisations, PPMs and consumers, to form the next steps in this campaign. You can add your voice to this campaign by following our Call to Action steps.
On the 23rd of July HBA received an invitation to the government consultation process. A definition of 'low risk' was provided, and the 3 questions in the consultation centred around this definition. The deadline for submissions was the 12th of August.
The first stage of our survey results have been analysed and HBA used the survey report to support our submission to the government consultation. You can view the report by clicking on the link below.
We are following this situation closely and are in contact with the ACM and maternity consumer organisations, PPMs and consumers, to form the next steps in this campaign. You can add your voice to this campaign by following our Call to Action steps.
View the report HERE
A Momentous Win for Homebirth!
On Friday the 1st of November, one of the biggest (and fastest) wins we could have possibly imagined has happened for homebirth families and midwives.
This major milestone simply wouldn't have been possible without the fierce dedication and advocacy of mothers, midwives, and supporters of homebirth!
6,000 women filled out surveys, more than 1200 sent emails to their local member of parliament and many of you met with your MPs.
Less than five months ago we came together to stop the Government from putting restrictions on where women choose to birth by excluding women. Unfolding before our eyes we saw a pathway where only 'low-risk' women would be able to birth at home with an endorsed midwife.
Yesterday, the government has announced a completely new approach to how midwives will be insured when they support a woman during birth.
They have abandoned the "low-risk" definitions to a framework that truly respects midwives' clinical judgment. Now, intrapartum homebirth services will be covered as long as they comply with the NMBA's Safety and Quality Guidelines (SQG) – a huge win for safe, accessible, and empowered birthing options!
Whilst we pinch ourselves, we know the work is not finished and that as always, we still need to be watchful to protect women's birth choices.
This huge win reflects the power of our collective voices, highlighting how people power can shift the course of policy and make real change for families and providers.
We spoke and the Government listened - this is truly woman-centered care in action.
Thank you to all who raised their voices – the future of homebirth just got a whole lot brighter!
This major milestone simply wouldn't have been possible without the fierce dedication and advocacy of mothers, midwives, and supporters of homebirth!
6,000 women filled out surveys, more than 1200 sent emails to their local member of parliament and many of you met with your MPs.
Less than five months ago we came together to stop the Government from putting restrictions on where women choose to birth by excluding women. Unfolding before our eyes we saw a pathway where only 'low-risk' women would be able to birth at home with an endorsed midwife.
Yesterday, the government has announced a completely new approach to how midwives will be insured when they support a woman during birth.
They have abandoned the "low-risk" definitions to a framework that truly respects midwives' clinical judgment. Now, intrapartum homebirth services will be covered as long as they comply with the NMBA's Safety and Quality Guidelines (SQG) – a huge win for safe, accessible, and empowered birthing options!
Whilst we pinch ourselves, we know the work is not finished and that as always, we still need to be watchful to protect women's birth choices.
This huge win reflects the power of our collective voices, highlighting how people power can shift the course of policy and make real change for families and providers.
We spoke and the Government listened - this is truly woman-centered care in action.
Thank you to all who raised their voices – the future of homebirth just got a whole lot brighter!
Page last updated: 2nd November 2024