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Midwives working away from labour wards are to be covered by insurance under a pilot scheme, writes John Elder. 

Within the next few days, Chloe Lee will give birth to her second child at home, under the care of veteran midwife Robyn Thompson. If at some point during labour Ms Thompson thinks something is amiss, Mrs Lee is happy to head to hospital. "I trust Robyn . . . and I'm happy to access hospital care if there's a true medical need," she says.

There are concerns that some independent midwives may not want to be affiliated with a hospital-based program because their working methods may be compromised 

Mrs Lee is not a zealot, but she is sceptical that a new plan to establish hospital-run home births can provide the same standard of care as a private midwife.

Under a State Government pilot program to be established at two Melbourne hospitals, midwives assisting home births will be covered by their hospital's indemnity insurance.

The scheme offers something of a reprieve to home birthing, which is threatened by planned Federal Government changes requiring all registered health workers to be covered by indemnity insurance.

The changes, to be introduced from July 10 next year, will effectively outlaw home births performed by independent midwives, who have been unable to access indemnity insurance since the industry crashed in 2001.

Some fear that the changes will force home births underground or encourage some women to go it alone, a practice known as free birthing.

It is believed that the pilot scheme, due to begin early next year, will use in-house midwives and independent midwives under contract. If the pilot is successful, the Government says it may expand it to other hospitals throughout the state.

The program appears similar to those already established in other states, where home births are restricted to low-risk pregnancies and exclude women who have previously had a baby by caesarean section.

Despite her scepticism, Mrs Lee welcomes the trial. "I think it's great that more women are getting access to all the choices available for having their babies," she says. "Having publicly funded home births is going to provide for women who can't avoid to have a home birth privately."

But there are concerns that some independent midwives may not want to be affiliated with a hospital-based program because their working methods may be compromised.

Fiona Hallinan, an independent midwife who has protested against the Federal Government's changes, says she doubts the scheme will attract sufficient staff to get off the ground. "I don't say I wouldn't work in the system again," she says. "But once you work with a hospital system, midwives often don't have a voice in how that practice is run."

Ms Hallinan says safety will be paramount. "[The hospitals] will have stringent systems in place because no one wants a front page with a dead baby . . . But that will exclude many women from taking up this option."

Victorian Health Minister Daniel Andrews says the pilot program will give families greater choice and give women more control over their birth experience.

The Australian Nursing Federation has applauded the scheme.

State secretary Lisa Fitzpatrick says a large number of independent midwives also work in hospital maternity wards, which will help make the scheme viable. "We're supportive of . . . what we see is a collaborative model," she says.

About 166 Victorian women give birth at home under the care of an independent midwife each year.

Source: The Sydney Morning Herald

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