Midwives warn insurance changes could reduce homebirth services

Nicole Miller gave birth to her son Cohen at her home in Farleigh, North Queensland, in February.

She remembers the day fondly: "It's the best feeling ever, really," she said.

"Being in the comfort of your own home is second to none."

But within months, midwives, including Ruth Davison, who delivered Cohen, may no longer be able to practise.

An exemption that has allowed privately practising midwives to attend homebirths without insurance covering claims of error or negligence will end on New Year's Eve.

All midwives outside of a hospital setting will need a Commonwealth-funded product from the Medical Insurance Group Australia (MIGA).

The insurance is available only to "endorsed" midwives, a qualification that requires additional study and 5,000 hours of clinical practice, which may be accrued over the last six years.

As part of the changes, the federal government has covered the total cost of eligible claims made against endorsed midwives performing homebirths since July 1, 2025.

Endorsed midwife shortage

In Australia, a second practitioner is required to attend each homebirth.

Mackay midwife Ms Davison, who is endorsed, said that requirement would be difficult in regional areas.

Ms Davison said the other insured midwife in the region was often out of town, which meant it would be "difficult" to continue her service.

"I can [currently] have a registered midwife, I can have a registered nurse, a doctor or a paramedic."

"But come the first [of January], I'm not going to be able to have that."

Midwife Jessica McGair splits her time between the Mackay Base Hospital and assisting homebirths.

"I only work part-time, and that would look like about six years before I would even be eligible to be endorsed, plus also further study as well," she said.

Concern for 'freebirths'

In 2023, the number of home births had more than doubled, from 923 in 2019 to 2,081, according to the Australian Bureau of Statistics.

The Department of Health, Disability and Ageing said the insurance requirements would provide "important safeguards for practitioners, women and families".

The Australian College of Midwives (ACM) warned up to a third of Australia's 500 private-practice midwives could leave the profession by January.

Chief midwife Kelley Lennon said endorsement allowed a midwife to prescribe medication and order tests.

She said while the qualifications helped midwives provide a "full suite of care" for mothers before and after labour, they were not necessary for a second midwife assisting a birth.

"The concern is that if women aren't able to access a midwife, they may consider to birth without a registered health practitioner, which we know of as a freebirth," she said.

Ms Lennon said she had met with government to advocate for a more accessible insurance product for homebirths.

Regulator considers changes

The Nursing and Midwifery Board of Australia (NMBA), which regulates private and public practitioners, said in a statement the changes were not about limiting homebirths.

"This protects the public from financial and safety risks resulting from a negligent act, error, or omission in a practitioner's conduct."

It said all midwives would need to be appropriately covered by January 1, 2027.

The NMBA said it was reviewing public feedback on its registration process for midwife endorsement, including the 5,000-hour clinical practice requirement.