A regional NSW midwife says she will have to halve her caseload when federal changes to homebirth insurance take effect next year.
Under changes to the Commonwealth's Midwife Professional Indemnity Scheme, from 2027 only "endorsed" privately practising midwives will qualify for new, mandatory insurance to provide homebirths.
Registered health practitioners are legally required to hold Professional Indemnity Insurance, but privately practising midwives were exempt because no insurance product existed for them.
Endorsement is a higher clinical qualification, held by around 5 per cent of the workforce, that requires extra study and 5,000 clinical hours.
Jenny Spencer is the only full-time private homebirth midwife in Shoalhaven on the NSW south coast.
She said she would have to halve her caseload and increase prices under the new rules.
She said while she was endorsed and insured, a second midwife needed to attend private homebirth legally and none of the six women she used qualified.
"I haven't been able to find a second midwife who is endorsed," she said.
"I have two people working towards their endorsement, the problem is if that can happen by January."
In comments to a community forum last week, shared with the ABC, NSW Health Minister Ryan Park said he agreed with some of the concerns raised.
"I think [federal] government needs to have a rethink of this," he said.
A spokesperson for the Department of Health, Disability and Ageing said consensus among state health ministers was required for any decisions about indemnity insurance under the national law.
Access reduced
Peak bodies and consumer groups have warned the change could result in a huge reduction in the number of homebirth providers and push women to freebirth â a birth undertaken without any medical professionals present.
Ms Spencer assisted the homebirth of Natasha Martin in Nowra in December 2025.
Ms Martin chose homebirth because she wanted to see one provider through her pregnancy, birth and postpartum periods and did not want to give birth in a hospital.
She said it was one of "the most transformative experiences" of her life and she hoped to do the same for subsequent pregnancies.
Ms Martin said she was concerned she would not be able to access a midwife for her next pregnancy, or afford the new fees.
"I've actually even considered freebirthing my next baby, but there's so many risks involved in that," she said.
The College of Midwives said two-thirds of their members were considering reducing caseloads or closing their practices under the changes, and many were reporting their clients were also considering freebirth.
"We are really worried about the potential increase of freebirth, and we don't believe that women are going to choose freebirth because that's what they want to do," chief midwife Kelley Lennon said.
NSW Health said in a statement they "strongly recommend all women birth with a registered maternity care provider".
Insurance change
Who is responsible for limiting the new insurance scheme to endorsed midwives is unclear.
Medical Insurance Group Australia, which is contracted by the Commonwealth, has said eligibility is set by the federal government.
A spokesperson for the department said the Nursing and Midwifery Board of Australia (NMBA) set professional, registration and insurance requirements. The board said eligibility was determined by the insurer.
A spokesperson for the department said endorsed midwives could prescribe emergency medicines and provide Medicare-subsidised services.
"This supports both mothers and babies in the event of an emergency," they said.
Ms Lennon disagreed, saying that while endorsed midwives could prescribe and order tests, those skills were not used during a birth or an emergency at home.
"A registered midwife is trained and skilled to be able to provide the care that a woman needs in a homebirth and all midwives are trained to respond to an emergency," she said.
"It doesn't make a difference if they're endorsed or not."
The College called for insurance to be expanded to registered midwives, or for the endorsement standard to be changed.
A spokesperson for the NMBA said they were reviewing the registration standard, including a proposal to remove the clinical hours.
