IMAGE CREDIT: JERUSHA SUTTON
Professional indemnity insurance position statement
Urgent update: Email template for providing your feedback at the end of this page
Importance/Issue
In Australia, AHPRA registration standards require all health care professionals to have Professional Indemnity Insurance (PII) for all aspects of their practice, and for Privately Practising Midwives (PPM’s) this includes intrapartum (labour and birth) care, which is often provided at the woman’s home. There is currently no such PII product available for PPM’s in Australia.
To combat this, an exemption was put in place in 2009, which was extended in 2013 and has continued to be extended over and over, with the most recent extension due to expire in June 2025.
In the latest federal budget in May 2024, it was announced that there would be "prioritised access to homebirth" with the government proposing a solution to the longstanding PII exemption, which would see the government covering 100% of claims costs for privately practicing midwives providing "low-risk homebirth and intrapartum care", with legislation to come and plans to commence as of July 1, 2025.
It is the view of Homebirth NSW that a suitable insurance product is needed to protect midwives and women and to legitimise homebirth in the public view as a safe birth option, but that this product needs to provide cover for ALL women for homebirth to remain accessible and safe.
As more information about the definition of 'low-risk' being used has been released, the urgency of the situation has increased.
Our aims
Homebirth NSW aims to help find a suitable insurance product that the majority of PPMs and consumers are satisfied with.
How will we do this?
We will continue discussions with consumers and midwives to determine their wants and needs for an insurance product.
We want to ensure that the insurance product meets everyone’s needs, is not too expensive and restrictive to prevent women being ‘risked out’ of homebirth more than they already are now, which is the greatest fear in light of these announcements.
We will continue to engage with the relevant politicians to ensure consumers are being consulted throughout this process, and fight to secure government subsidies for any overlapping costs involved with transitioning from one insurer to another, to reduce the financial impact to midwives and women.
Where are we now?
As of May 2024, we have reached out to the Australian College of Midwives alongside our sisters at Homebirth Australia, Maternity Choices Australia, and Better Births Illawarra, to attempt to gain further insight about what discussions have taken place about how this proposed solution will work and the impact of the "low risk" language on the bigger picture of access to homebirth. Unfortunately, ACM had no further information to share.
In senate estimates on the 5th of June 2024, Senator Larissa Waters questioned the Chief Nursing and Midwifery Officer (CNMO), Alison McMillan, about the definition of 'low risk", the involvement of the insurance company in this decision and whether women deemed 'high risk' would still be able to access homebirth with a midwife. The CNMO made reference to publicly funded homebirth programs (which are typically reserved for the healthiest, most 'low risk' women and are incredibly restrictive) when answering the question about definition of 'low risk'. She also mentioned the ACM's National Midwifery Guidelines for Consultation and Referral, indicating that Category A women would be eligible under the new insurance product for homebirth with a midwife. The CNMO commented that the government intends to conduct consultation with the ACM and Consumer Health Forum, with the aim of having all details finalised by the end of December 2024. The changes to legislation would come into effect on the 1st of July 2025.
Following this, Homebirth Australia immediately contacted the CNMO requesting invitation to the consultation process, and then developed and circulated a survey for homebirthing women and privately practising midwives that received nearly 6000 completed submissions. This survey is informing the feedback being provided as part of the consultation process, endorsed by all the organisation who have currently been campaigning together, and Homebirth NSW is also submitting their own feedback response.
We are now making an urgent call out to homebirthing women and families to also make their own personal submissions of feedback as individual 'consumers' of homebirth. Please feel free to use the following email template example for your submission (and scroll down to the bottom of this page for the full details on the proposed low-risk definition as provided by the Dept Health and Aged Care):
Email to: [email protected] (by 12th August)
Subject: Professional Indemnity Insurance for PPMs and Homebirth
Email body:
I am writing as a homebirthing mother (or other appropriate title) to provide my feedback on the proposed insurance product for homebirths.
Under the current definition of Cat A, B and C I would have been classed as XYZ (if you know this detail, if not you can describe yourself such as below examples:)
Eg. I had a traumatic hospital birth and ended up with an unnecessary caesarean section
Eg. I was considered high risk for public homebirth because I had INSERT RISK (had a high BMI, gestational diabetes, was considered geriatric etc)
1.a) Do you think this is an appropriate definition for low-risk homebirth?
*No, I don't think a PII product that only covers 'low-risk' is appropriate.*
As an adult woman, it is patronising to all women to be told where and how I should give birth if I am informed of all the risks and benefits associated with my choice. The decision on whether a woman is eligible for homebirth should be made by the woman herself, in consultation with her chosen and trusted midwife.
Privately Practising Midwives (PPMs) are fully competent to discuss and decide on the safest birth option and if they need, access the public system if something falls outside their expertise (provide personal example here if this was something you experienced)
It's wrong to assume anyone else is more capable of deciding if homebirth is appropriate for a woman than the woman herself. I find it insulting to assume that women and PPMs can't determine the safest place for birth.
The ACM National Midwifery Guidelines for Consultation and Referral were never intended to dictate where a birth should take place. These guidelines allow women to decline certain recommendations, and still continue care with an official record of understanding (ROU).
If/when I birth again I would be forced to… (insert what decision you would make about future births if this product was approved as described)
1.b) Would you suggest any changes to the criteria listed above, and if so, why (provide evidence where possible)?
Yes, I suggest removing the criteria and instead offering an all-risk PII product.
This approach would allow the woman to make the decision on homebirth, with the midwife's support. The current system respects women's choices and midwives provide evidence-based information tailored to each woman's situation.
The proposed low-risk-only approach limits women's choices, reduces midwives' scope, and doesn't account for changes in risk that can happen during pregnancy. It may discriminate against women from cultures where homebirth is the norm.
The suggested changes ignore the necessary pathways for women who decline consultation or referral, as outlined in the ACM guidelines.
1.c) Do you have any other comments regarding the inclusion of a low-risk homebirth Pll product within the MPIS?
PPMs are highly educated and face intense scrutiny, despite having the lowest levels of complaints and insurance claims.
A low-risk-only insurance product could have severe consequences, including increased rates of freebirth (as a reactive choice, not a fully autonomous one), less midwives, an increase in birth trauma resulting in antenatal and postnatal depression, anxiety and PTSD.
Many women fall into higher risk categories due to unnecessary interventions in hospitals, leading them to choose homebirth, which is my story (delete if not the case). Forcing me/ women (delete whichever doesn’t apply) back into the hospital system that caused my/their trauma is unethical.
A low-risk insurance product will restrict women's birthing rights, strain the public health maternity system, and increase reactive freebirth.
At the very minimum, I recommend extending the PII exemption to allow more time to properly review and assess the criteria and consult with homebirthing women, families, and PPMs.
Thank you,
Your name
Your contact information
Download this position statement
Importance/Issue
In Australia, AHPRA registration standards require all health care professionals to have Professional Indemnity Insurance (PII) for all aspects of their practice, and for Privately Practising Midwives (PPM’s) this includes intrapartum (labour and birth) care, which is often provided at the woman’s home. There is currently no such PII product available for PPM’s in Australia.
To combat this, an exemption was put in place in 2009, which was extended in 2013 and has continued to be extended over and over, with the most recent extension due to expire in June 2025.
In the latest federal budget in May 2024, it was announced that there would be "prioritised access to homebirth" with the government proposing a solution to the longstanding PII exemption, which would see the government covering 100% of claims costs for privately practicing midwives providing "low-risk homebirth and intrapartum care", with legislation to come and plans to commence as of July 1, 2025.
It is the view of Homebirth NSW that a suitable insurance product is needed to protect midwives and women and to legitimise homebirth in the public view as a safe birth option, but that this product needs to provide cover for ALL women for homebirth to remain accessible and safe.
As more information about the definition of 'low-risk' being used has been released, the urgency of the situation has increased.
Our aims
Homebirth NSW aims to help find a suitable insurance product that the majority of PPMs and consumers are satisfied with.
How will we do this?
We will continue discussions with consumers and midwives to determine their wants and needs for an insurance product.
We want to ensure that the insurance product meets everyone’s needs, is not too expensive and restrictive to prevent women being ‘risked out’ of homebirth more than they already are now, which is the greatest fear in light of these announcements.
We will continue to engage with the relevant politicians to ensure consumers are being consulted throughout this process, and fight to secure government subsidies for any overlapping costs involved with transitioning from one insurer to another, to reduce the financial impact to midwives and women.
Where are we now?
As of May 2024, we have reached out to the Australian College of Midwives alongside our sisters at Homebirth Australia, Maternity Choices Australia, and Better Births Illawarra, to attempt to gain further insight about what discussions have taken place about how this proposed solution will work and the impact of the "low risk" language on the bigger picture of access to homebirth. Unfortunately, ACM had no further information to share.
In senate estimates on the 5th of June 2024, Senator Larissa Waters questioned the Chief Nursing and Midwifery Officer (CNMO), Alison McMillan, about the definition of 'low risk", the involvement of the insurance company in this decision and whether women deemed 'high risk' would still be able to access homebirth with a midwife. The CNMO made reference to publicly funded homebirth programs (which are typically reserved for the healthiest, most 'low risk' women and are incredibly restrictive) when answering the question about definition of 'low risk'. She also mentioned the ACM's National Midwifery Guidelines for Consultation and Referral, indicating that Category A women would be eligible under the new insurance product for homebirth with a midwife. The CNMO commented that the government intends to conduct consultation with the ACM and Consumer Health Forum, with the aim of having all details finalised by the end of December 2024. The changes to legislation would come into effect on the 1st of July 2025.
Following this, Homebirth Australia immediately contacted the CNMO requesting invitation to the consultation process, and then developed and circulated a survey for homebirthing women and privately practising midwives that received nearly 6000 completed submissions. This survey is informing the feedback being provided as part of the consultation process, endorsed by all the organisation who have currently been campaigning together, and Homebirth NSW is also submitting their own feedback response.
We are now making an urgent call out to homebirthing women and families to also make their own personal submissions of feedback as individual 'consumers' of homebirth. Please feel free to use the following email template example for your submission (and scroll down to the bottom of this page for the full details on the proposed low-risk definition as provided by the Dept Health and Aged Care):
Email to: [email protected] (by 12th August)
Subject: Professional Indemnity Insurance for PPMs and Homebirth
Email body:
I am writing as a homebirthing mother (or other appropriate title) to provide my feedback on the proposed insurance product for homebirths.
Under the current definition of Cat A, B and C I would have been classed as XYZ (if you know this detail, if not you can describe yourself such as below examples:)
Eg. I had a traumatic hospital birth and ended up with an unnecessary caesarean section
Eg. I was considered high risk for public homebirth because I had INSERT RISK (had a high BMI, gestational diabetes, was considered geriatric etc)
1.a) Do you think this is an appropriate definition for low-risk homebirth?
*No, I don't think a PII product that only covers 'low-risk' is appropriate.*
As an adult woman, it is patronising to all women to be told where and how I should give birth if I am informed of all the risks and benefits associated with my choice. The decision on whether a woman is eligible for homebirth should be made by the woman herself, in consultation with her chosen and trusted midwife.
Privately Practising Midwives (PPMs) are fully competent to discuss and decide on the safest birth option and if they need, access the public system if something falls outside their expertise (provide personal example here if this was something you experienced)
It's wrong to assume anyone else is more capable of deciding if homebirth is appropriate for a woman than the woman herself. I find it insulting to assume that women and PPMs can't determine the safest place for birth.
The ACM National Midwifery Guidelines for Consultation and Referral were never intended to dictate where a birth should take place. These guidelines allow women to decline certain recommendations, and still continue care with an official record of understanding (ROU).
If/when I birth again I would be forced to… (insert what decision you would make about future births if this product was approved as described)
1.b) Would you suggest any changes to the criteria listed above, and if so, why (provide evidence where possible)?
Yes, I suggest removing the criteria and instead offering an all-risk PII product.
This approach would allow the woman to make the decision on homebirth, with the midwife's support. The current system respects women's choices and midwives provide evidence-based information tailored to each woman's situation.
The proposed low-risk-only approach limits women's choices, reduces midwives' scope, and doesn't account for changes in risk that can happen during pregnancy. It may discriminate against women from cultures where homebirth is the norm.
The suggested changes ignore the necessary pathways for women who decline consultation or referral, as outlined in the ACM guidelines.
1.c) Do you have any other comments regarding the inclusion of a low-risk homebirth Pll product within the MPIS?
PPMs are highly educated and face intense scrutiny, despite having the lowest levels of complaints and insurance claims.
A low-risk-only insurance product could have severe consequences, including increased rates of freebirth (as a reactive choice, not a fully autonomous one), less midwives, an increase in birth trauma resulting in antenatal and postnatal depression, anxiety and PTSD.
Many women fall into higher risk categories due to unnecessary interventions in hospitals, leading them to choose homebirth, which is my story (delete if not the case). Forcing me/ women (delete whichever doesn’t apply) back into the hospital system that caused my/their trauma is unethical.
A low-risk insurance product will restrict women's birthing rights, strain the public health maternity system, and increase reactive freebirth.
At the very minimum, I recommend extending the PII exemption to allow more time to properly review and assess the criteria and consult with homebirthing women, families, and PPMs.
Thank you,
Your name
Your contact information
Download this position statement
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