twrama 1841_august_2.. - AMA WA

Desperately seeking
FEATURE
by Pauline Costins
Eligible midwife
collaboration
Collaboration’ is not a dirty word. Far from it. The
National Health and Medical Research Council
(NHMRC) defines collaboration as “a dynamic process
of facilitating communication, trust pathways that enable
health professionals to provide safe, woman-centred care.
Collaborative maternity care enables women to be active
participants in their care. Collaboration includes clearly
defined roles and responsibilities for everyone involved in
the woman’s care, especially for the person the woman sees
as her maternity care provider”.1
An eligible midwife is able to provide comprehensive
midwifery care for women who choose this model of care.
Of course, an eligible midwife:
• must have insurance
• must have a Medicare provider number
• requires collaborative arrangements
• women can claim a rebate for services
• can provide diagnostic tests; and
• can prescribe once endorsed (course current at Flinders
University).
An eligible midwife requires collaboration in order for the
midwife to claim the Medicare rebate utilising her provider
number. This process was set out in the National Health
(Collaborative Arrangements for Midwives) Determination
2010.
The collaboration can be in several formats – a formal
collaborative agreement, a referral letter, or the midwife
needs to clearly document the process of collaboration with
acknowledgement from the collaborating doctor (this last
point is difficult and arduous).
The course for pharmacology has been endorsed and
commenced at Flinders University. Once this is completed, the
eligible midwife becomes an endorsed midwife and is able to
prescribe from an approved formulary.
A continuity of the Midwifery Care Model can be offered
to all women regardless of the risk category. If at the booking
visit (eight to 10 weeks), a risk factor is identified (as per
ACM consultation and referral guidelines) the woman will
be referred to an obstetrician or GP obstetrician as soon as
possible for assessment and further advice. Some private
practice midwives would like to continue to provide midwifery
care for this woman together with obstetric care.
If the woman is low risk, then she will be booked in for a
hospital visit at 19–20 weeks where she will have her booking
appointment and if all is well, will continue to see the
midwife until 36/40 weeks where another hospital visit will be
scheduled.
Most women want a hospital birth (99 per cent) with
continuity of midwifery care. They want antenatal care in
the home and support at home for early labour. The woman
will labour at home until an established labour and will then
proceed to hospital for a planned hospital birth. The midwife
will care for the woman within the hospital setting and then
if all goes well, will transfer her home four to six hours post
birth. Furthermore the new mother will be provided with six
weeks postnatal care at home if she requires or requests this.
If the woman is low risk and requests a homebirth, this too
will be facilitated.
Eligible midwives work in a variety of settings and several
have some form of collaborative agreement with a GP
obstetrician. However, this does not yet include intrapartum
care. Current collaborative agreements in WA do not cover
intrapartum care. The state is not unique; with this issue
presently, there are about three collaborative agreements
throughout Australia that include all facets of care of which
Dr Andew Pesce is engaged in one. Presently in WA, only
two hospitals facilitate continuity of care for these women by
employing the midwives on a casual basis for the birth.
WA Health is developing a framework that includes
credentialing and access agreements but progress is slow. In
all other hospitals, the midwife accompanies the woman as a
support person – the women find this option unacceptable as
they have employed a midwife, not a doula.
Benefits for the women include true choice and better
outcomes. For the system, women are being diverted from
overcrowded hospital waiting rooms – early labour at home
prevents blocking labour ward beds.
There is countless evidence to suggest that women who have
continuity in labour have better outcomes. The woman will
bring a midwife to the labour room, again relieving pressure
on a busy labour ward...then a six-hour discharge and followup
care for six weeks if they so choose. GP obstetricians/
obstetricians can refer women to eligible midwives for
postnatal care, therefore discharging women earlier from
hospital.
Some benefits for doctors are that they can refer women to
an eligible midwife for shared antenatal and postnatal care to
free up busy surgeries. This can be easily achieved by referring
women to eligible midwives and this is a type of collaborative
arrangement2. This would then enable the woman/midwife to
claim Medicare using her provider number.
The legal responsibilities are the same for any health
professional; you work within your scope of practice and
ensure correct referrals are in place. Shared care utilising
Continued on page 24
August MEDICUS 23