Reforming maternity services in Australia: Outcomes of a private practice midwifery service

Background and aims: recent legislative changes in Australia have enabled eligible midwives to provide private primary maternity care with fee rebates through Medicare. This paper (1) discusses these changes affecting midwifery practice; (2) describes Australia's first private midwifery service with visiting rights to hospital for labour and birth care since Medicare funding for midwives was introduced in 2010; and (3) compares outcomes with National Core Maternity Indicators. Methods: an audit of all client records (n=323) for the survey period from September 2012 to February 2014 was undertaken. Data were extracted and compared with the 10 perinatal indicators using Chi square statistics. Findings: this convenience sample of all-risk women was similar to the national birthing population for age and parity. Compared to national indicators, women were significantly more likely to have spontaneous commencement of labour (79.6% versus 54.8%) (χ²=79.88, p<.001), lower rates of induction (10.2% versus 26%) (χ²=79.88, p<.001), and not require pharmacological pain relief (54.8% versus 23.9%) (χ²=152.2, p<.001). The majority of women had a normal vaginal birth (70.3% versus 55.1%) (χ²=28.13, p<.001). The caesarean section rate (22% versus 32.3%) was significantly lower (χ²=15.64, p<.001) than the national rate. Average gestation of neonates was 39.3 weeks; average birth weight was 3525gms, and fewer required transfer to the special care nursery (8.4% versus 15.3%) (χ²=11.89, p<.001). Discussion: this is the first report of maternal and neonatal outcomes for a private midwifery service in Australia since the introduction of access to Medicare for midwives. Maternal and newborn outcomes were statistically better than national rates. Routinely reporting and publishing clinical outcomes needs to become the norm for private maternity care. Conclusions: this private midwifery caseload model has been instrumental in the ground-breaking change to primary maternity services that extends women's access to safe midwifery care in Australia. The potential impact of private practicing midwives to align maternity care with the best available evidence is significant.