Rural and regional women could lose access to professionally attended homebirth from 1 January 2027
A new insurance regime intended to make homebirth safer could instead remove registered health practitioners from homebirths and force private midwifery practices across Australia to close and freebirth rates to skyrocket.
Maternity Consumer Network is calling for urgent federal intervention before the professional indemnity insurance exemption for homebirth ends on 31 December 2026. From 1 January 2027, every privately practising midwife providing care at a homebirth, including a midwife attending as the second practitioner, will be required to hold appropriate professional indemnity insurance.
Maternity Consumer Network founder Alecia Staines said the result would be a "regulation-created workforce cliff".
"The Government set out to insure homebirth, but unless it urgently fixes the second-midwife gap, its solution will make professionally attended homebirth impossible in many Australian communities."
The Government's own Midwife Professional Indemnity Scheme supports insurance for eligible endorsed midwives with MIGA the sole provider of this insurance in Australia. This means non-endorsed registered midwives who currently attend homebirths as second practitioners have no practical, affordable pathway to obtain the required cover.
"This is a safety paradox. A reform described as protecting women and babies will actually remove registered health practitioners from births," Ms Staines said.
The current NMBA framework already requires a second registered health practitioner to be present at a planned homebirth; for some rural and regional areas without surplus private practicing, endorsed midwives, has meant that paramedics, nurses with neonatal resus training and hospital midwives have provided an important skilled 2nd practioner for homebirths.
Under the new arrangements, a non-endorsed midwife attending in this limited supporting role would need to become endorsed to access the available insurance product. This is not possible for paramedics, nurses with appropriate training. And midwives who work primarily in hospital and only attend a handful of homebirths a year, it is not feasible.
Endorsement is principally an authority relating to scheduled medicines, prescribing, Medicare and diagnostic services. It is not a homebirth-specific qualification and is not clinically necessary for many of the tasks performed by a second midwife.
"These midwives are not asking to operate full private practices or prescribe medicines," Ms Staines said.
"Many are experienced hospital midwives who provide occasional backup to a private midwife in their community. Requiring them to undertake postgraduate prescribing education and purchase full private-practice insurance for a handful of births simply will not be financially viable."
Under the endorsement standard currently in force, a midwife must have completed the equivalent of 5,000 hours of clinical practice within the previous six years, as well as an approved postgraduate prescribing qualification. The NMBA has consulted on removing the 5,000-hour requirement, but a final revised standard has not yet been published.
Women will carry the cost
Private homebirth already commonly costs families between $6,000 and $7,500, with limited Medicare rebates. Medicare provides rebates for some antenatal and postnatal care and for limited out-of-hospital labour care, but there is no Medicare item covering the homebirth itself.
If private midwives are able to continue practising, the additional costs of securing and insuring second midwives will inevitably be passed on to women.
Others will be unable to meet the regulatory requirements at all and will close their businesses.
Rural and regional communities will be hit hardest because they already have the smallest pool of private and endorsed midwives and the fewest publicly funded homebirth options
"Women will face fewer midwives, higher fees and longer travel distances. That is if they can find a midwife at all," Ms Staines said.
"Some will be forced into a hospital model that does not meet their needs. Others may feel they have no acceptable alternative except to give birth without a registered health professional present; freebirth."
"Women should never be forced to choose between giving birth in a setting where they do not feel safe, paying increasingly unaffordable fees, or giving birth without qualified clinical support."
Homebirth remains a small but growing part of Australian maternity care. The proportion of Australian births occurring at home increased to 0.7 per cent in 2023, while research and emerging publicly funded programs have reported high consumer demand and geographically limited access.
"Nobody is asking the Government to abandon insurance or compromise safety," Ms Staines said.
"We are asking it to insure the workforce that actually exists, rather than impose a model that will make that workforce disappear. Women who are pregnant today need certainty. The Government has five months to prevent an entirely foreseeable collapse in access."
Urgent action required
Maternity Consumer Network is calling on Federal Health Minister Mark Butler and the Australian Government to act before women currently pregnant reach their due dates in 2027 by:
Extending the existing exemption until a workable insurance solution for second practitioners is operating.
- Calling an urgent roundtable to find a workable solution, including with the Department, endorsed midwives, MIGA and consumer organisations.
Allowing the primary midwife's insurance to cover the second practitioner under a documented peer, employment or mentoring arrangement.
Publishing an urgent rural and regional workforce impact assessment before the current exemption expires.
