Midwifery in Australia
Qualifications for Midwifery Practice
Currently there are state registered/endorsed midwives and lay midwives. Lay midwifery is not illegal, although not "accepted".
Some women choose lay midwives and in Queensland, there is a very active group of people running a training apprenticeship model of direct entry midwifery.
To be registered/**endorsed** by the state boards, midwives have to have completed an approved course of study and most registered/endorsed midwives have gained a general nursing qualification prior to a midwifery course. General Nursing is a prerequisite for Midwifery in this country, although there are still some Midwives practicing who trained before this requirement was instituted. Some overseas educated Midwives have been able to gain registration after fulfilling stringent requirements set by the various states registration boards.
Australia has 6 states and 1 territory all of which have their own Nursing registration boards. It is necessary to re register in each of the states that a person wishes to practice in. This is not usually a difficult task once registration is granted in one state.
There is no longer a separate register for midwifery, it is added as a qualification to the general nursing register. The State boards require registration to be renewed each year and issue a statement following reregistration, that the person is a registered nurse with an endorsement(authority) to practice midwifery. Nurses, therefore midwives, are unable to prescribe medication at present, this however is under review at the moment. Various states are reviewing the scope of Nursing practice and with the recognition of the advanced Nurse Practitioner role, prescribing rights are recognized as an issue to be addressed.
General Nursing is offered as a three year university course Australia wide. It is a degree course and covers all aspects of Health and nursing. The degree is called a Bachelor of Health Science - Nursing and allows the graduate to work in Institutions associated with Psychiatric, General,Geriatric and Developmentally Delayed Nursing. Some general nurses are employed in some midwifery units, in NICU and the postnatal area.
Admission criteria varies from state to state, generally the universities assist the applicants as much as possible. There are introductory courses to Universities which count for admission credits for those people who are coming back into studying, or who are mature age applicants. The demand for nurses (and midwives) is huge - especially in the country! (everyone likes to work around the coastal edge of Australia!)
Midwifery education is moving to the tertiary (university level) sector in all states, in some states the move is complete, in others it is offered as a hospital based course of one year, as well as the university course. The university course(s) is offered at both Graduate Diploma and at some institutions, at Masters level. Most university courses are of one year duration, some are two years.
The tertiary sector is what we call university education, the final form of education - academia. This is because nursing and midwifery until fairly recently have been hospital based courses. Most university courses are offered in the cities, there are some outreach programs offered and one distance education course for midwifery. Masters level are being offered all over the place as distance education. Applicants are generally required to have two years post graduate (nursing) experience before doing midwifery.
ACMI is the Australian College of Midwives and the central office is in Melbourne Victoria. ACMI has branches in each state and the Territory and sub branches in various areas of each state and the Territory. ACMI provides a three monthly Journal and writes Standards for Professional Conduct, etc. ACMI lobbies on behalf of Australian Midwives, with Governments and the Nurses Registration Boards.
Other associated midwifery groups are:
Most midwifery is practiced in the institutional setting. There are tertiary referral, public, private, small and large midwifery units which employ midwives. Depending on the unit, its' size, location and the perspective of the administration, midwives are involved in birth centre care, Team midwifery programs, Early Discharge Programs, Family Care programs, adolescent care, Prenatal diagnosis, and other initiatives focusing on the health and well- being of mothers and babies.
A tertiary referral hospital is where the intensive care nursery is, and where the Perinatologists reside and are located in the cities. Level 1 and Level II hospitals are more local.
Each state has several Independent or privately practicing midwives. Some hospitals have granted 'visiting rights' to some privately practicing midwives and this status is dependent upon the support of the obstetricians who are prepared to act as backup. Sadly in Queensland, the obstetricians withdrew support from a very successful midwifery practice based in Brisbane and the hospitals concerned withdrew the visiting rights. Independent midwives conduct their practice in either the home and/or hospital setting. The decision regarding place of birth depending upon women's wishes, clinical indication and innovative obstetric collaborative practice in association with institutional acceptance and granting of visiting rights.
'Visiting rights' means privileges to admit/discharge and practice in the hospital that grants the rights. Midwives who have 'visiting rights' can practice in the home, and move into the hospital with a client that might need transfer. The hospitals offer this privilege in response to community and midwifery advocacy. It is a result of innovative administration and Obstetricians who have a collaborative practice ethos.
There is one independent private birth centre in Melbourne (owned by a doctor) and other birth centres are attached to hospitals. Several hospitals have set up team midwifery programs and the hospitals employ midwives to work on the team. The women can choose this care if they are deemed *low risk*. There are designated birth centre midwives in the various birth centres and the same self selection with a tick of approval from 'the powers that be', if a woman is considered *suitable* for birth centre or team midwifery care.
Australia has a dual system of health insurance. There is basic health insurance called Medicare which funds public hospital and basic medical care.
Every Australian in paid employment contributes to the Medicare fund. I think it is about 1% of wages that is taken with tax for Medicare.
There is a General Practitioner Medical and 'gatekeeper' service, basic fees payable by Medicare. Most charge above the recommended rate, pensioners and social service recipients are usually bulk billed, which means the GP sends the bill into Medicare for reimbursement. Otherwise, the patient pays the fee, collects the rebate for the service from Medicare and absorbs the rest of the fee.
The specialist is accessed on referral from the GP and the financial arrangement is the same as for general practice.
People can also attend hospital clinic services and be admitted to public hospitals, services being covered by Medicare. Private insurance is an option and allows choice of doctor and of private hospitalization.
There are various private insurance companies that provide medical and hospital cover for illness etc. Some have ancillary benefits that cover for so called paramedical services, such as physiotherapists, dentists, occupational therapy and, rarely, some insurance companies will cover herbalists, naturopaths and massage. There is only one fund that I know who will cover a little of a midwive's fees.
These funds are quite expensive and the rate of private insurance in Australia has been dropping steadily over the last few years under the Labor government, which had a commitment to public health and the provision of health services and medicare. The situation has now changed with the election of the Liberal party and it's commitment to private enterprise and ensuring the income of the elite in our society. It will be interesting to observe the effect of the change of government on the status of Medicare ( the national government run insurance scheme) and the incidence of private insurance.
Those people who are privately insured can choose their own doctor and be admitted to private hospitals and claim the 'gap' from the medicare payment on their private insurance. Of course people who are not privately insured can do the same and pay the difference from their own pocket.
Privately practicing Midwive's fees are not covered (generally) by either of these health insurance arrangements. Women have to pay extra for the services of private midwifery care.
1. How long is the midwifery course, usually (after the
General Nursing degree?)
2. Must a midwife work in General Nursing before becoming
a midwife? Is she licensed as a midwife and a nurse?
Family planning education is included in the midwifery course/diploma but is a separate course for specialization. 'Family care' is an initiative by some institutions that employ midwives to care for very disadvantaged women, social problems, drug abuse and adolescents. They see them during pregnancy, and post natally and if they need can accompany them in labour (although this is rare - they are so busy)
The Independent, privately practicing Midwives are endorsed to practice midwifery by the relevant state board. The Australian College of Midwives also accredit midwives as Independent practitioners, although this is not a legal requirement for practice. Some hospitals do request ACMI accreditation before they will grant 'visiting rights' to the applicants.
While there are some tensions between various groups of midwives, as practitioners become more aware of the importance of collaborative care, consistent standards of practice and consumer advocacy, the relationships are improving and will continue to improve.
Personal Profiles of the Writers of this Document:
Overseas Midwives Seeking Registration in Australia
Just heard back from ACMI regarding overseas midwives seeking registration - they need to contact the Australian Nursing Council Inc. in Canberra for the appropriate forms to complete. Their address is 20 Challis Street Dixon, Australian Capital Territory, 2602 and phone number is 06 2577960. to ring into Australia, you use your o'seas dialling code and drop off the 0 before the number e.g. ++ 61 (0) 6 2577960.
Please also see the following additional documents describing midwifery in specific areas:
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This Web version was last updated May 14, 1996 by Donna Dolezal Zelzer, firstname.lastname@example.org