Safety and quality guidelines for privately practising midwives

The Safety and quality guidelines for privately practising midwives (the guidelines) protect the public by articulating a robust regulatory framework to support the safe, professional practice of privately practising midwives (PPMs). The guidelines provide PPMs with current, evidence-informed regulatory information to enhance the provision of safe, high-quality care, facilitate workforce flexibility and improve access to midwifery services.

PPMs practise in a range of settings which are usually outside the routine governance arrangements of a health service. These guidelines describe the regulatory and clinical governance requirements that PPMs must comply.

Compliance with the guidelines is a requirement for all PPMs including PPMs seeking an exemption from holding professional indemnity insurance (PII) for the provision of intrapartum care during the course of a homebirth. Compliance is monitored through regular practitioner auditing.

PPMs are midwives who practise¹  the midwifery profession in a private capacity. PPMs can be sole practitioners, work in partnership models, operate their own business and/or attend homebirths as the second health practitioner. They can also be employed by a private midwifery business, contracted by a private business or practise in a voluntary capacity. PPMs who are credentialled with a health service can also provide private midwifery care to a woman that is admitted to the health service. Whist providing private midwifery services in this capacity they are not employees of the health service.

Midwives who are employed by, or contracted to a private health service, a private obstetrician, obstetric group practice or Aboriginal Community Controlled Health Organisation (ACCHO); provide non-clinical midwifery services on behalf of a government, agency, authority or deliver policy, research, academic services or consulting are not considered PPMs for the purpose of these guidelines. If these midwives also offer private midwifery services i.e. they practise as the primary midwife during the course of a homebirth, practise as the second health practitioner during the course of a homebirth or provide non-intrapartum clinical care, education and/or midwifery advice to women and their families in a private capacity (whether paid or unpaid), they are considered PPMs for this aspect of their practice. This means compliance with the requirements of these guidelines, for this part of their practice, is mandatory.

PPMs practise in a range of contexts that includes, but is not limited to:

• midwifery services in a woman’s home (including antenatal care, homebirth, postnatal services and newborn care / sleep support),
• preparation for parenthood care, education and/or advice in a clinic or via technology-based consultations,
• antenatal care or antenatal education and/or advice in the home, in a clinic or via technology-based consultations,
• postnatal care (including newborn sleep support services) in a woman’s home, clinic or via technology-based consultations, and
• perinatal services (including mental health support, pelvic floor/continence services, lactation consultancy) in a clinic, via technology-based consultations or in the home.

All PPMs in Australia are accountable for the care that they provide to women and their families regardless of their context of practice, type of renumeration or services provided.

The guidelines apply to PPMs who provide direct clinical care, education and/or midwifery advice to women and their families in a private capacity, whether paid or unpaid. This includes:

• PPMs who hold the Endorsement for scheduled medicines for midwives (the Endorsement) or who are working towards the endorsement,
• PPMs, endorsed or not endorsed, who provide clinical care, education and/or midwifery advice in all or some discrete areas such as preparation for parenthood, antenatal care, postnatal care and/or specialist lactation or newborn services, and/or
• PPMs, endorsed or not endorsed, who require an exemption from holding professional indemnity insurance (PII) for providing intrapartum care for homebirths (under section 284 of the National Law).

Midwives who practise in multiple roles i.e. as an employee of a health service (including ACCHOs) and as a PPM, must comply with the requirements of these guidelines for all aspects of their PPM practice.

To optimise safe, professional private midwifery practice, compliance with the requirements of the guidelines is mandatory for all PPMs who provide direct clinical care, education and/or midwifery advice to women and their families in a private capacity, whether renumerated or voluntary. This includes PPMs who practise via technology-based consultations and electronically e.g., via social media, digital health and so on.

PPMs who practise as the second health practitioner during a homebirth must comply with all requirements of the guidelines to be eligible for the PII exemption for delivering intrapartum services in the home.

To comply with the guidelines, PPMs who practise as a second health practitioner must meet each requirement relevant to the role of the second health practitioner and take all reasonable steps to ensure the primary PPM satisfies, or will satisfy, the full requirements of the guidelines.

The NMBA, under section 94 of the National Law, has developed the Registration standard: Endorsement for scheduled medicines for midwives (the Endorsement). The Endorsement sets out the necessary skills, knowledge, and experience required for midwives to prescribe schedule 2, 3, 4 and 8 medicines and to provide associated services required for midwifery practice in accordance with relevant state and territory legislation. Midwives who hold the Endorsement are commonly referred to as ‘endorsed midwives’.

Endorsed midwives are eligible to apply to access the Australian Government Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) so that women and their families can receive benefits for services or subsidies towards prescribed medications.

Under section 129(1) of the National Law, all midwives must have appropriate professional indemnity insurance (PII) arrangements for midwifery practice. Practising the midwifery profession without appropriate PII is a breach of the National Law.

A registered health practitioner must not practise the health profession in which the practitioner is registered unless appropriate professional indemnity insurance arrangements are in force in relation to the practitioner’s practice of the profession.

The NMBA has developed the Registration standard: Professional indemnity insurance (PII) arrangements that details the requirements relating to PII arrangements for all nurses and midwives.

Under section 284 of the National Law, an exemption from holding PII only exists for midwives who practise as a PPM and provide homebirth services if they meet the eight requirements described in Table 1 below.

Professional indemnity insurance exemption

The National Law provides an exemption to PII for PPMs delivering intrapartum services in the home providing the following requirements described in section 284 of the National Law are met:

(1) During the transition period, a midwife does not contravene section 129(1) merely because the midwife practises private midwifery if —

(a) the practice occurs in a participating jurisdiction in which, immediately before the participation day for that jurisdiction, a person was not prohibited from attending homebirths in the course of practising midwifery unless professional indemnity insurance arrangements were in place; and

(b) informed consent has been given by the woman in relation to whom the midwife is practising private midwifery; and

(c) the midwife complies with any requirements set out in a code or guideline approved by the National Board under section 39 about the practice of private midwifery, including—

(i) any requirement in a code or guideline about reports to be provided by midwives practising private midwifery; and

(ii) any requirement in a code or guideline relating to the safety and quality of the practice of private midwifery.

(2) A midwife who practises private midwifery under this section is not required to include in an annual statement under section 109 a declaration required by subsection (1)(a)(iv) and (v) of that section in relation to the midwife’s practise of private midwifery during a period of registration that is within the transition period.

(3) For the purposes of this section, the transition period—

(a) starts on 1 July 2010; and

(b) ends on the prescribed day.

The current transition period for the exemption has been extended to 1 July 2025.

PII is required for all other aspects of midwifery practice. The exemption to PII does not extend to any preparation for parenthood, antenatal, postnatal or newborn services care provided by the PPM, including midwifery advice and/or education delivered via telehealth. PII for any form of preparation for parenthood, antenatal and postnatal services remains the responsibility of the PPM to the standard required by the NMBA’s Registration standard: Professional indemnity insurance arrangements.

This section sets out the regulatory requirements for all PPMs who provide direct clinical care, education and/or advice to women and their families in a private capacity, whether paid or unpaid. Compliance with these guidelines is mandatory, irrespective of context of practice, type of renumeration or services provided.

PPMs must be able to evidence that they meet each requirement described in Table 1 in full.

Table 1: Mandatory requirements for privately practising midwives

² PPMs who do not provide intrapartum homebirth services including but not limited to preparation for parenthood, antenatal education and/or care, postnatal education and/or care or lactation services must be skilled and current in emergency management skills relevant to their scope and context of practice. For example, a PPM who practises in a newborn sleep school or offers lactation consultancy must be skilled and current in adult Basic Life Support (BLS) and neonatal resuscitation. A PPM who only offers antenatal education must be skilled and current in at minimum, adult BLS.

³ A PPM will be considered skilled in obstetric emergency management, adult BLS and newborn resuscitation if the practitioner has successfully completed the following:

• education and/or training in obstetric emergency management that is not part of a NMBA-approved, entry to practice program of midwifery study,

• an adult BLS course consistent with the Australian and New Zealand Committee on Resuscitation’s (ANZCOR) resuscitation guidelines, and

• a basic or advanced newborn resuscitation course consistent with the Australian and New Zealand Committee on Resuscitation’s (ANZCOR) newborn resuscitation guidelines.

⁴ A PPM will be considered current in obstetric emergency management, adult BLS and/or newborn resuscitation if the practitioner has successfully completed relevant education and/or training within two years of each episode of care provided.

⁵ A health practitioner registered under the National Law will be considered skilled and current in obstetric emergency management, adult life support and neonatal resuscitation if the practitioner has successfully completed all relevant education and/or training as described in the previous footnote within two years of each attendance at a homebirth.

⁶ In the event the second health practitioner is unexpectedly unable to attend the homebirth, the PPM must take all reasonable steps to ensure another health practitioner who meets the definition of second health practitioner is present for the birth. This may include engaging a paramedic or consideration to transferring care.

Depending on their context of practice, PPMs need to provide evidence of compliance with relevant requirements from Table 1 above to the NMBA. These requirements will be subject to audit. The audit scope is detailed below in Table 2.

An audit of compliance against the guidelines will usually be undertaken on a three-yearly basis or more frequently as determined by the NMBA.

Table 2: Audit of private practice midwives

Failure to comply with the guideline is likely to result in disciplinary action by the NMBA. Under Part 8 of the National Law, the NMBA has a range of powers when dealing with breaches, including the power to take immediate action:

• section 157 of the National Law requires the NMBA to engage in a show cause process with the registrant before taking immediate action, and

• section 155 of the National Law defines immediate action as suspension or imposition of a condition on the health practitioner’s registration; or accepting an undertaking from the health practitioner; or accepting the surrender of the registration of the health practitioner.

The NMBA and the Australian Health Practitioner Regulation Agency (Ahpra) operate in a co-regulatory model in some jurisdictions i.e. New South Wales and Queensland and may not be the only entities involved in completing an assessment related to a notification that a PPM has failed to comply with the guidelines.

The guidelines will be reviewed as required. This will generally be at least every five years.

The guidelines were last reviewed and approved by the NMBA in February 2023.

The NMBA sets the standards, codes and guidelines that midwives (including PPMs) must meet to be registered in Australia. The standards include five core registration standards which are required under the National Law and other midwifery specific registration standards, practice standards, codes and guidelines. These standards, codes and guidelines provide midwives, employers and the public with information about the minimum standards required to practise safely and professionally as a midwife in Australia.

The NMBA regulates midwives and students of NMBA-approved programs of midwifery study in the following ways:

• developing, reviewing and monitoring compliance with registration standards for initial and ongoing registration under the National Law. The five registration standards are:

• English language skills
• Criminal history
• Professional indemnity insurance
• Recency of practice
• Continuing professional development.

• developing, reviewing and monitoring the NMBA’s professional practice framework for midwifery including the guiding Midwife standards for practice.
• approving accreditation standards for programs of study leading to registration as a midwife
• developing and reviewing registration standards for endorsement including endorsing midwives who hold additional qualifications and specific expertise
• auditing midwives’ compliance with NMBA registration standards and guidelines, and
• managing complaints (notifications) made about a midwife’s health, performance and/or conduct and midwifery students’ health or criminal history.

Midwives who are registered in another health profession are also required to fulfil their regulatory obligations in relation to that profession.

Table 2: NMBA resources for midwives, including privately practising midwives

Table 3: Other resources for midwives, including privately practising midwives

Biennial means every second/other year.

Context of practice means the conditions that define an individual’s midwifery practice. These include midwives working across the continuum of care and midwives who work in a specific area of practice including preparation for parenthood, sexual and reproductive health, antenatal care, postnatal care and specialist lactation support.

Direct clinical care is when the PPM is directly involved in providing clinical care or providing oversight and/or supervision of other PPMs during the provision of clinical care to women and their families.

Endorsed midwife means a midwife who is endorsed by the NMBA via the Registration standard: Endorsement for scheduled medicines for midwives to prescribe schedule 2, 3, 4 and 8 medicines appropriate for midwifery practice. The midwife’s endorsement is entered onto the NMBA Register of Midwives.

Health service includes the following services, whether provided as public or private services

a) hospital services;
b) mental health services;
c) pharmaceutical services;
d) ambulance services;
e) community health services;
f) health education services;
g) welfare services necessary to implement any services referred to in paragraphs (a) to (f);

Homebirth means a birth in which the woman gives birth at her own home or another person’s home (as defined under section 284 of the National Law). This may include locations hired, borrowed or otherwise engaged for the purposes of a birth i.e., Airbnb and hotels.

Incident means an event or circumstance that resulted, or could have resulted, in unintended or unnecessary harm to a woman, her family or consumer; or a complaint, loss or damage. An incident may be a near miss. Incidents may also be associated with omissions where women and their families are not provided with a medical intervention from which they would have likely benefited.

Medicare Benefits Schedule (MBS) is a component of the Australian Medicare program that (as of 1 August 2020) lists more than 6,000 eligible private medical services for which subsidies are provided to health consumers. Subsidies for clinically relevant services provided by MBS-eligible health professionals including PPMs who hold the Endorsement, take the form of ‘Medicare benefits’ paid to the woman.

Midwife means a person whose name is included in the Register of Midwives kept by the NMBA.

The ICM defines a midwife as follows:

A midwife is a person who has successfully completed a midwifery education programme that is duly recognised in the country where it is located and that is based on the ICM essential competencies for basic midwifery practice and the framework of the ICM global standards for midwifery education⁸ ; who has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery and use the title ‘midwife’ and who demonstrates competency in the practice of midwifery.

A midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

A midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and care of the child.

A midwife may practise in any setting including the home, community, hospitals, clinics or health units.⁹

National Midwifery Guidelines for Consultation and Referral means the most recent edition of the Australian College of Midwives resource framework for midwives caring for women at the commencement of care, during the antenatal period; throughout labour and birth; and in the postnatal period.

National Law means the Health Practitioner Regulation National Law, as in force in all Australian states and territories.

National Scheme means the National Registration and Accreditation Scheme for health professions. More information about the National Scheme is available at www.ahpra.gov.au 

Nursing and Midwifery Board of Australia (NMBA) means the national body responsible for the regulation of nurses and midwives in Australia.

Open disclosure is the open discussion of adverse events that result in harm to a woman or her family while receiving health care with the women, her family and/or carers. The elements of open disclosure are:

• an apology or expression of regret, which should include the words ‘I am sorry’ or ‘we are sorry’
• a factual explanation of what happened
• an opportunity for the woman, their family and carers to relate their experience
• discussion of the potential consequences of the adverse event
• an explanation of the steps being taken to manage the adverse event and prevent recurrence.

Pharmaceutical Benefits Scheme (PBS) is an Australian Government program that creates a schedule of all the medicines available to be dispensed to health consumers at a Government-subsidised price. Midwives endorsed by the NMBA can apply for approval as PBS prescribers and may also be referred to as ‘authorised midwives’, that is, they are authorised to prescribe PBS subsidised medications.

Practice means any role, whether remunerated or not, in which the individual uses their skills and knowledge as a midwife. For the purpose of these guidelines, practice is restricted to the provision of direct clinical care, education and/or advice to women and their families only. It does not include working in management, administration, education, research, advisory, regulatory or policy development roles.

Private capacity means, without being exhaustive, practising the midwifery profession either in sole practice, as a partner in a partnership, or as an associate in an association with other practitioners i.e. as a director of a company or as an employee or contracted midwife of one of the aforementioned parties.

Privately practising midwife (PPM) is a midwife who practises the profession in a private capacity.

Professional practice review program (PPRP) means a formal peer or case review that may include maternal morbidity and mortality meetings, quality assurance and clinical audit or other meetings dealing with issues of practice review or clinical risk management.

Restricted birthing practice is defined under the National Law as an act that involves undertaking the care of a woman by managing the three stages (or any part of these stages) of labour or birth.

Scope of midwifery practice means that which the midwife is educated, competent and authorised to perform.

Second health practitioner is a health practitioner registered under the National Law who is who is educated to provide maternal and newborn care, skilled and current in obstetric emergency management,adult life support and neonatal resuscitation and demonstrates recency of practice relevant to their profession and endorsement (where applicable).

Social media describes the online and mobile tools that people use to share opinions, information, experiences, images, and video or audio clips, and includes websites and applications used for social networking. Common sources of social media include, but are not limited to, social networking sites such as Facebook, Instagram and LinkedIn, blogs (personal, professional and those published anonymously), business search and review sites such as Word of Mouth and True Local, microblogs such as Twitter, content-sharing websites such as YouTube and TikTok, and discussion forums and message boards. For the purposes of this code, practice is not restricted to the provision of direct clinical care. For more information see Social media: How to meet your obligations under the National Law.

Technology-based consultations are consultations that use any form of technology, including, but not restricted to videoconferencing, internet and telephone, as an alternative to face-to-face consultations.

⁸ To become a midwife in Australia, an individual must first complete a program of study that has been accredited by the Australian Nursing and Midwifery Accreditation Council (ANMAC) and then approved by the NMBA. Programs of study leading to registration as a midwife in Australia are accredited according to the ANMAC Midwife Accreditation Standards 2021.

⁹ The NMBA has endorsed the International Confederation of Midwives (ICM) definition of a midwife and has applied it to the Australian context.

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