Midwifery Futures recommendations

Increase visibility, governance and leadership

1. The Australian Government fund the development of a National Midwifery Strategy and funded implementation plan.
2. Australian governments recognise the importance of midwifery leadership through the instatement of a Chief Midwife and Office of the Chief Midwife in each Commonwealth and state and territory government, with resources to provide leadership and bring about change. In addition, a First Nations Midwifery Director is established in each jurisdiction to provide leadership for Aboriginal and Torres Strait Islander services and contribute to Closing the Gap.
3. Where there is a maternity service, ensure that leadership is provided by midwives at the government, employers, executive and clinical level.
4. Health services and industrial bodies ensure that midwifery and midwives are adequately represented in jurisdictional industrial agreements.
5. Increase opportunities to promote awareness of midwifery among the general population through media and educational initiatives and through schools and career days

Increase visibility, governance and leadership

6. The Commonwealth Government develop, implement, and fund bundled funding for midwifery continuity of care models as a defined care pathway, to fund midwives to work to their full scope when they practise across different parts of the health care system (including primary and admitted care) which currently operate under separate funding arrangements.
7. Health services and industrial awards must ensure that continuity of midwifery carer models are flexible including part-time and job share opportunities with reduced caseload requirements aligning with full time equivalents for midwives working part-time.
8. Health services must ensure that continuity of midwifery carer models are available to all women regardless of risk status, with access to consultation, referral and collaborative models.
9. Australian governments, health services and education providers adopt an evidence-based framework (e.g., RISE [2] and Replanting the Birthing Trees [3]) to develop midwifery programs for Aboriginal and Torres Strait Islander women.
10. Health services should create flexible opportunities for midwives to fulfil their professional scope through work including in maternal, child and family health practice, sexual and reproductive practice, and women’s health.
11. Health services, industrial bodies, and universities explore clinician researcher positions for midwifery as a career path option.
12. Health services in rural, regional, and remote settings recognise that midwives who do not hold a nursing qualification provide valuable contributions to the provision of care to women, babies and families. With additional training, these midwives can also provide maternal and child health services and/or sexual and reproductive health services.
13. Explore the opportunity to develop multidisciplinary models of primary care with midwives, general practitioner obstetricians, and nurse practitioners providing a range of health services in a rural setting. This needs testing for feasibility, affordability and cost benefits.

Grow the midwifery workforce

14. Universities, health services, and policy makers work to increase the number of midwifery students, starting as soon as possible, by at least 20% - leading to around 1560 students graduating in 2-4 years (depending on the length of the programs).
15. Universities and health services implement quarantined places for Aboriginal and Torres Strait Islander midwifery students.
16. Universities and health services increase pathways to midwifery for prospective students from diverse backgrounds especially those from Aboriginal and Torres Strait Islander, and migrant and refugee backgrounds, including funded cadetship programs.
17. Strengthen workforce planning mechanisms between Ministers of Health and Education, Chief Nursing and Midwifery Officers, health districts, Aboriginal Community Controlled Health Organisations, and universities to collectively plan the number of midwives required, and therefore the number of students to be recruited into universities and health services.
18. Universities and health services work to ensure that midwifery clinical placements increase the opportunity for students to work in continuity of midwifery carer models, contributing to their total midwifery practice experience time.
19. The Australian Government fund an additional Commonwealth stipend to meet additional costs borne by students from rural and remote areas including temporary relocation to receive experience in a larger centre, also addressing Higher Education Loan Program debt relief for midwifery graduates.
20. The Australian Government, universities, and health services develop and fund accessible reentry programs to attract midwives who have left back to the workforce, and/ or attract midwives from overseas.

Support the midwifery workforce

21. Government, health services, industrial and professional bodies to strengthen workplace flexibility, adequate working conditions, and ensure midwives have more career pathway options.
22. Government, health services, industrial, and professional bodies must ensure that midwives who work in shift- or roster-based models of care have adequate working conditions and support to ensure they can provide high quality care and are retained in the health system.
23. Government, health services, industrial, and professional bodies must work together to ensure working conditions and appropriate wages allow midwives to provide evidence-based care, meet existing and emerging policy requirements and be retained in the workforce.
24. Universities and health services ensure implementation of cultural safety education for all midwives at all education levels, including pre-registration education and as part of continued professional development, and evidenced in all guidelines. Any standardised education program must be specifically contextualised to the unique roles of midwives and the locality.
25. Government, health services, industrial and professional bodies to ensure midwives can work to their full scope of practice through funding models, educational opportunities, new models of care, and respectful collaboration.
26. The Commonwealth Government should underwrite professional indemnity insurance requirements for the midwifery workforce, ensuring midwives can work to their full scope of practice in private and public settings.
27. The Australian Government ensure that privately practising midwives have access to the Practice Incentives Program and other similar schemes to help them continuously improve, provide quality care, enhance capacity, and improve access and health outcomes for women and families.
28. Australian governments fund development of a national Transition to Practice Program to mentor recent graduates to build knowledge, skills, and confidence.
29. Government, health services and professional bodies to implement and fund quality mentoring, clinical supervision, and continuing professional development for midwives.
30. Health services, industrial, and professional bodies to lobby government for comprehensive national review to evaluate the value of midwifery to contemporary society and use these data to benchmark salary scales to ensure appropriate remuneration.

Improve data to support workforce planning

31. Through the annual NMBA survey, collect data on the number of midwives leaving employment in Australia each year, the number of qualified midwives joining from overseas, the number of midwives actively working in the profession, and the number of dual qualified midwives working mostly in midwifery.
32. The NMBA to consider a mandatory expanded/refined survey every 3 years to ensure access to a national contemporary workforce data set.