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 on the 28th of July 2023) due to expire on the 30th of June 2025.
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).
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.
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).
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.
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 on the 28th of July 2023) due to expire on the 30th of June 2025.
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).
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.
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).
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.
Our involvement
Homebirth Australia has been aware of discussions between the Federal Government, the Australian College of Midwives and insurance companies for the past few years. We have requested repeatedly to be included in these conversations; however, the most recent development was an in-confidence tender process between government and insurance companies, which even the ACM was not a part of.
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.
View our letter and MP responses here.
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health_minister_letter_may_2021.pdf | |
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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.
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 2024 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 is scheduled for the 11th of June. The purpose of the session will be to gather feedback from PPMs that will inform our approach to the government's consultation process, which we anticipate will begin in the next few months.
On the 6th of June 2024 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. To survey was met with an overwhelming response, receiving over 1500 responses in the first night. At the time of this update, we have over 3100 responses. This survey will close on the 20th of June 2024 to give us time to analyse the results before the government consultation begins.
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.
We have also written to the ACM numerous times requesting updates on their discussions with the Commonwealth Department of Health, but received no response.
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 2024 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 is scheduled for the 11th of June. The purpose of the session will be to gather feedback from PPMs that will inform our approach to the government's consultation process, which we anticipate will begin in the next few months.
On the 6th of June 2024 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. To survey was met with an overwhelming response, receiving over 1500 responses in the first night. At the time of this update, we have over 3100 responses. This survey will close on the 20th of June 2024 to give us time to analyse the results before the government consultation begins.
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.
Page last updated: 10th June 2024