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Homebirth and Medical Negligence

18/08/2009

Most mothers will agree, giving birth is one of the most memorable and life-changing events a woman can experience.

According to research, being in an environment where she feels safe can have a significant impact on a woman's birth experience. Some women feel safest in a hospital setting, with immediate access to care in the event of a complication. Others choose the comfort of home.

The government looks set to remove a woman's right to give birth at home, from July 2010. Under the new National Registration and Accreditation Scheme, midwives would need to have indemnity insurance in order to be registered, but homebirth midwives cannot obtain insurance.

In other words, the proposed laws will make it illegal for a midwife to attend a homebirth.

Putting the argument about a woman’s right to choose aside (and there's a significant argument there), what are the implications of the proposed laws in the event of medical negligence?

At the moment, midwives who work in hospitals acting as employees, are covered by hospital insurance schemes. Homebirth midwives are uninsured, unless they are acting as an agent for a health service. Following the medical indemnity crisis post September 11 2001, homebirth midwives were no longer offered insurance, as this group was commercially unattractive to insurers. As a result, many midwives stopped providing homebirth care.

So currently, lawyers handling medical negligence cases in relation to childbirth, sue the hospital or the private obstetrician. Indemnity insurance covers the compensation costs payable by the hospital where negligence is proven.

Where negligence occurs in a homebirth setting, it’s not so easy to receive compensation. Unless the midwife has significant assets, it is unlikely that they will be able to pay the costs if they are found liable.

It seems sensible then to have people operating inside an insurance scheme. With birth-related medical negligence cases usually involving catastrophic injury to the mother or baby, there will be hefty costs for treatment or ongoing care. If the woman or parent/s cannot meet these costs, and have no means to obtain compensation, where does that leave them?

Were private midwives to be allowed indemnity insurance, this would presumably mean higher fees to cover high premiums, which might remove this as a childbirth option for some women. But if the government can supports GP’s and obstetricians, as they do under the existing scheme, surely this should include midwives?

With the current baby boom, childbirth is clearly a key health issue. The recent NSW government announcement to invest $5.3 million in pregnancy care, in addition to the $46.4 million invested in maternity services last budget, surely proves this.

Shouldn't this also be reflected in legislation that covers all childbirth options, not just those deemed acceptable by the government?

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