NEW laws will help end gatekeeping of maternity care, according to Hunter private practice midwives.
From November 1, the federal government has removed laws that mandate a collaborative arrangement between doctors and nurse practitioners and endorsed midwives.
The change means that clients can access Medicare rebates and Pharmaceutical Benefits Scheme medication without a medical practitioner's referral.
Newcastle privately-practising endorsed midwife, Ineka Morosoni, said the new laws were a long time coming.
"Now families can self-refer, which means women can have immediate access to specialised midwifery care from the minute they are pregnant," she said.
"Allowing them to come straight to us is absolutely incredible."
Bodily autonomy and choice
She said, depending on the bias of someone's GP, midwifery referrals were sometimes denied and effectively gatekept.
This was partly because of misconceptions that midwife-supported home births were the same as free-birthing, giving birth without any medical attendance, she said.
And while some of her clients chose home births, a large majority stuck with hospitals.
When a GP denied a referral, and blocked a client's ability to claim Medicare, that impacted whether they were able to access midwifery care, Ms Morosoni said.
"I've never had someone who didn't continue care but it was just really frustrating, a lot of families felt as though they had to fight," she said.
Private, endorsed midwives, such as Ms Morosoni, are required to have completed more than 5000 practice hours and approved postgraduate study.
Her clients can claim rebates on antenatal and postnatal care up to six weeks including pregnancy tests, ultrasounds, and prescribing medications but not the actual birth.
She expects to potentially get more clients self-referring after being able to access her services quickly and with less financial burden.
"If women are self determinable and have the autonomy to make their own decision they can decide on their care for themselves," she said.
Accessing care in regional and rural areas
In a statement, Health and Aged Care Minister Mark Butler said the end of collaborative arrangements for nurse practitioners and endorsed midwives would help boost care in rural and regional areas struggling to retain doctors.
"They [Australians] were missing out on high quality and timely care, they were waiting longer for appointments and paying more in gap fees, because of this needless red tape," Assistant Minister Ged Kearney said.
Earlier this year, the Newcastle Herald reported a quarter of GP clinics in the Hunter-New England and Central Coast had closed their books to patients, with almost half showing signs of financial trouble.
Last week, Gosford Private Hospital announced they would end maternity services due to rising costs and falling demand on the Central Coast.
As an endorsed midwife based in Singleton, Di Longworth had seen first-hand the lack of medical choice in more rural areas of the Upper Hunter.
"If you were in a regional or rural area, and you didn't have the opportunity to doctor shop to get a referral, then you wouldn't be able to actually access the [midwife] care," Ms Longworth said.
She estimated the Medicare rebate savings at around $1400 per patient, while Ms Morosni put it anywhere from $1600 to $2000.
With the lack of options in remote regions, accessing a midwife could improve outcomes for babies and birthing people, she said.
She said they could provide early pregnancy care, and support for early pregnancy fatigue and starting ultrasound and testing sooner.
"Providing individualised care makes it safe not only for LGBTQI+ families but for neurodiverse people, culturally and linguistically diverse, and first nation families," she said.
Her client, Maddy Tregenza, chose a private midwife after a traumatic birthing experience at a hospital in 2021.
"The driving force to access a private midwife was to have more control and power over my own body and my own birth," she said.
Ms Tregenza said she appreciated the continuity of care from having a private midwife and the individual care she received.
Doctors oppose move
Australian Medical Association (AMA) president, Danielle McMullen said they were disappointed at the decision to remove the obligation for collaborative arrangements.
"We should be working on better connections in our health system rather than fragmentation," Dr McMullen said.
While nurse practitioners and endorsed midwives had a set of skills beyond other nurses and midwives, Dr McMullen said their services tended to be quite focused and lack a breadth of scope across other health conditions.
She also pointed out that there were collaboration requirements for Medicare rebates in other specialist fields such as mental healthcare plans with psychologists.
"We will continue to be lobbying government to make sure that we are all working teams, so we're not fragmenting care," she said.
