Delivering continuity of midwifery care to Queensland women

Hybrid private and public models
Women may be able to receive continuity of midwifery carer with their midwife in private
practice for antenatal and postnatal care, and with their midwife working in employed
public hospital practice for intrapartum care. This model will depend on good collaboration
between private midwives and public hospital management.
Rural GP-obstetricians frequently work under arrangements of this type.
Section 19.2—Rural and remote public facilities
Section 19.2 of the Health Insurance Act 1953 allows specific public facilities to be enabled
by the Commonwealth minister to work under different rules. Section19.2 allows public
hospital employees to provide MBS-rebated outpatient services in declared rural and remote
locations. In these locations eligible midwives might work as employees while providing
MBS bulk-billed outpatient care.
See: www.health.qld.gov.au/publications/Guidelines_COAG_19.2.pdf
Aboriginal medical services or other entities
An eligible midwife employed in an Aboriginal Medical Service (AMS), which also employs a
GP-obstetrician, would meet the requirements of option 1 for ‘collaborative arrangements’
(see 5 (1) (a) in the Determination, Appendix 13.02). Such a midwife could also be employed
by a public facility for provision of intrapartum care.
Midwives employed by private obstetricians or GP-obstetricians
Some private specialist obstetricians or GP-obstetricians may employ eligible midwives in
their practices. These midwives could potentially provide care in private hospitals as well as
doctors’ rooms.
Private hospitals
Eligible midwives could potentially provide intrapartum care in private hospitals, in private
midwifery practice. This would require cooperation with private obstetricians and supportive
hospital management.
Possible implications for Queensland Health maternity services
It is hard to predict how the gradual introduction of eligible midwives into the maternity care
system will affect public maternity services. Possible options include:
• A state-wide process and document set is being developed to support collaborative
arrangements between public hospitals and eligible midwives. This will include
credentialing for visiting access, in order to support intrapartum care by eligible midwives
in public hospitals.
• Midwives working in public MGP models will find gaining eligibility much easier than
many midwives in other models and consequently may have more options for practice.
• Women could be referred, by public hospitals or hospital clinicians, to eligible
midwives for antenatal or postnatal care (if by a doctor, this may create a ‘collaborative
arrangement’).
• It is conceivable that employed eligible midwives could be granted ‘right to private
practice’, like doctors and create new revenue options for public facilities.
• Contractual arrangements with eligible private midwives might be used to provide
services when public facilities are running at or over capacity.
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Delivering continuity of midwifery care to Queensland women