Who's Left Holding The Baby?
The Age
Saturday November 1, 2003
Unable to get insurance, many midwives are quitting, reports Marcella Bidinost.
Eighteen months after public liability insurance for midwives was withdrawn, independent midwives are still unable to buy insurance, prompting a third of them to leave the profession or resort to other nursing employment.
While some nursing agencies are forking out enormous sums for cover, Victoria's remaining 20 home-birth midwives continue to practise with no insurance.
``There is a huge need for midwives in the health profession, but independent midwives are a threatened species," says midwife Joyce Johnston, a member of the Nurses Board of Victoria, who spoke at this week's 6th International Conference on the Regulation of Nursing and Midwifery in Melbourne.
In 1999 there were 35 independent midwives practising in Victoria. Despite increases in the number of home births (from 140 in 2001 to 170 in 2002), Victoria now has just 20 independent midwives running busy schedules.
After the insurance industry upheavals in 2001, Guild Insurance, an important insurer of Australian midwives, withdrew its cover of independent practising midwives.
Organisations such as the Australian Nursing Federation (which has traditionally offered professional indemnity insurance to members) and the Australian College of Midwives have failed to resecure insurance from underwriters anywhere in the world.
``For midwives, the law also says professional indemnity insurance can be required as a condition for professional registration. The problem is, no insurer will offer it to us, and (unlike obstetricians, who also lost their professional indemnity insurance) the State Government is showing no signs of offering a rescue package," says Ms Johnston. Access to insurance for midwives is in the public's best interest, she says.
``It's important to protect the right of the consumer to sue if something goes wrong. But unless a midwife has assets of several million dollars, it's probably not worth suing, so it's the consumer who's at greater risk than I am."
Ms Johnston suggests universal, no-fault cover as a possible solution. ``It would mean the person who is injured wouldn't have to prove it happened through negligence or malpractice, but can still get reasonable and realistic compensation."
Nursing agencies were also struck by the insurance crisis. At least one Victorian nursing agency has since forked out 3000 times more for cover from international insurer Lloyds of London. Claire Hudson, managing director of Staffing Synergy, says no Australian insurer would cover her company, one of the largest midwife agencies in Australia. Agency staff are generally employed as independent temporary contractors and are not covered by most hospitals. They are expected to carry their own insurance.
``When I hear doctors complaining of a 300 per cent increase in premiums, I don't have too much sympathy," Ms Hudson says.
``It hasn't been a hard-headed business decision to get this insurance, but it's certainly been an ethical one to support midwives and give them some choices.
``A lot of nurses aren't aware of their insurance status or assume the hospital will cover them. There has been some genuine confusion out there in the industry."
Ms Hudson says securing insurance for her staff is one of the reasons why Staffing Synergy recently won the contract as principal provider of midwifery services to St Vincent's Private Hospital. In the past month, Staffing Synergy's midwife staff numbers have grown by 25 per cent.
``The hospital said our level of insurance and approach to it was better than all the other agencies that tendered for it. That indicates hospitals are becoming more aware and sophisticated in their approach to insurance; it's becoming more of an issue as time goes on."
Meanwhile, Ms Hudson says she takes her hat off to independent midwives. ``They are strong, independent women who won't kowtow to the environment. They want women to have as many options about giving birth as possible."
Warrandyte-based independent midwife Jennie Teskey says, despite working uninsured, she feels relatively safe in practice. Each of her clients signs a disclaimer stating their awareness of her insurance status and their agreement to work with her regardless. Ms Teskey is aware such a document may not hold up in court. ``I don't take on people I feel uncomfortable with. That's not ideal by any means, but I've been in private practice for 15 years and certainly want to continue, so it's something I have to accept."
The Australian Nursing Federation's insurance program has received no claims against independent midwives regarding home births in its 13 years of operation, and, according to the Office of the Health Services Commissioner, no complaints have been made since the office's inception in 1988.
© 2003 The Age
Share This