The issue, in a nutshell...
Since 2010, the Australian Health Practitioner Registration Agency (AHPRA) has been responsible for the governance of the Nursing and Midwifery Board of Australia (NMBA). Prior to 2010, privately practicing midwives did not require professional indemnity insurance.
In 2010, the NMBA developed guidelines for professional indemnity insurance arrangements for midwives, which require midwives to have professional indemnity insurance in order to be able to practice. Since no insurance product is available for the intrapartum period at home (birth at home), the COAG Health Council have issued an exemption which allows PPMs to attend births at home without intrapartum insurance. This exemption has repeatedly been extended, with the latest extension announced in July 2021 to expire on the 31st of December, 2023 (View the ACM media release here).
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 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.
Insurance claims for PPMs are very low. MIGA announced at a recent ACM panel discussion on professional indemnity insurance (Feb 2022) that the highest number of calls they receive from PPMs are requesting legal advice, not to make a claim. However, PPMs are risking a lot personally by attending homebirths without insurance, because if something were to happen and a claim was made against them, they would be personally liable.
Every time the PII exemption deadline approaches, women come out seeking reassurance of their birth options, which results in further extensions yet nothing being done to find a suitable insurance product prior to the next PII exemption extension deadline.
Women need certainty around their birthing options and the future of Australian PPM’s businesses and livelihoods hang in the balance, waiting for a decision to be made.
In 2010, the NMBA developed guidelines for professional indemnity insurance arrangements for midwives, which require midwives to have professional indemnity insurance in order to be able to practice. Since no insurance product is available for the intrapartum period at home (birth at home), the COAG Health Council have issued an exemption which allows PPMs to attend births at home without intrapartum insurance. This exemption has repeatedly been extended, with the latest extension announced in July 2021 to expire on the 31st of December, 2023 (View the ACM media release here).
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 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.
Insurance claims for PPMs are very low. MIGA announced at a recent ACM panel discussion on professional indemnity insurance (Feb 2022) that the highest number of calls they receive from PPMs are requesting legal advice, not to make a claim. However, PPMs are risking a lot personally by attending homebirths without insurance, because if something were to happen and a claim was made against them, they would be personally liable.
Every time the PII exemption deadline approaches, women come out seeking reassurance of their birth options, which results in further extensions yet nothing being done to find a suitable insurance product prior to the next PII exemption extension deadline.
Women need certainty around their birthing options and the future of Australian PPM’s businesses and livelihoods hang in the balance, waiting for a decision to be made.
Our involvement
Homebirth Australia is aware that discussions have been ongoing for a number of years between the ACM, the Department of Health and insurance companies. As the peak body for homebirth in Australia representing both consumers and PPMs, HBA deserves to be included in these discussions to ensure that any potential insurance product does not risk women out of homebirth more than they already are. Both Homebirth NSW and Homebirth Australia have been trying to get consumer voices at the table for years, to no avail.
In September 2020, Homebirth NSW hosted a panel discussion which touched on the topic of PII for PPMs.
The panelists included:
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, 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.
In February 2022, Homebirth Australia responded to the CMNO and Federal Health Minister requesting again 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."
We have also written to the ACM numerous times requesting updates on their discussions with the Commonwealth Department of Health, but received no response.
View our letter and MP responses here.
In February 2022, Homebirth Australia responded to the CMNO and Federal Health Minister requesting again 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."
We have also written to the ACM numerous times requesting updates on their discussions with the Commonwealth Department of Health, but received no response.
| health_minister_letter_may_2021.pdf |
July 2023 - Update
On the 28th of July 2023, the Federal Government announced a further extension to the exemption for professional indemnity insurance for Privately Practising Midwives (PPMs) . You can read the full announcement here: Supporting privately practising midwives to work to their full scope | Health Portfolio Ministers and Aged Care
We are pleased that the Government has been proactive in announcing this extension well before the expiration date and we are sure that this will be a comfort to PPMs and to women who are currently pregnant or planning to be within the next 12 months. This latest extension expires on the 30th of June 2025.
We are hopeful that the new Albanese Government will honour the commitment from the previous Government to include Homebirth Australia in the consultation process when a potential insurance product is found, to ensure all homebirthing women have coverage, as they do for facility-based births and publicly funded homebirth programs.
On the 28th of July 2023, the Federal Government announced a further extension to the exemption for professional indemnity insurance for Privately Practising Midwives (PPMs) . You can read the full announcement here: Supporting privately practising midwives to work to their full scope | Health Portfolio Ministers and Aged Care
We are pleased that the Government has been proactive in announcing this extension well before the expiration date and we are sure that this will be a comfort to PPMs and to women who are currently pregnant or planning to be within the next 12 months. This latest extension expires on the 30th of June 2025.
We are hopeful that the new Albanese Government will honour the commitment from the previous Government to include Homebirth Australia in the consultation process when a potential insurance product is found, to ensure all homebirthing women have coverage, as they do for facility-based births and publicly funded homebirth programs.
Page last updated: 28th July 2023
