Giving birth can be one of the most vulnerable, exciting, magical, painful and frightening times - or combination of - in a woman's life, depending on her personal experience.
So many expectant mothers like to plan their birthing journey - or at least, as much as the bub will allow.
A gap in professional indemnity insurance for endorsed midwives is affecting expectant mothers planning on using a private midwife, including the highly-regarded Birthing on Country program for Indigenous women.
In mid-October, it was identified that the only available insurance policy for endorsed midwives has an exclusion for intrapartum care (during labour) provided outside of a hospital after the Australian College of Midwives brought the issue to the health department.
Commonwealth Health Minister Mark Butler said the government was working with midwives and the sector on a solution and was close to announcing a way forward.
"We recognise that midwifery continuity of care is incredibly important and has the best outcomes for women and babies and we will continue to work to make sure that it is accessible and supported," he said.
"We acknowledge that this may disrupt the birth plans of expectant parents during a highly emotional and significant time, and that this disruption will no doubt cause concern and disappointment."
The Australian College of Midwives has said the issue impacts continuity of midwifery care, Birthing on Country models of care and women planning hospital birth but wanting in-home midwifery support during the early stages of labour.
College chief midwife Alison Weatherstone said the gap in insurance cover has significant and negative implications for a woman's choice of care at an extremely vulnerable time.
"It does not allow midwives to work to full scope of practice, particularly in primary care," she said.
"It impacts continuity of midwifery care - the evidence-based gold standard of maternity care."
The gap has no impact on the current arrangements for planned homebirth.
Midwives who provide homebirth services are not required to hold professional indemnity insurance as long as they are covered by an appropriate level of indemnity insurance for their antenatal and postnatal care services.
Alecia Staines from the Maternity Consumer Network told AAP she had been contacted by pregnant women who felt completely blindsided.
"They are completely shocked and devastated," she said.
"To be told suddenly that you're not able to access the care that you want is really traumatising for women."
Some Birthing on Country programs - maternity services designed by and delivered for First Nations women - that use endorsed midwives are also affected.
Claire Clack, acting director, First Nations Health Division at the Department of Health and Aged Care, was one of the speakers at a webinar on the issue this week.
"We are really aware and recognise the consequences that this gap in insurance will have for pregnant First Nations women accessing Birthing on Country services through Aboriginal community-controlled health organisations," she said.
"We recognise that the continuity of care provided by these midwives plays an integral role in First Nations communities and the health outcomes of mothers and babies.
"We are prioritising the negotiation of a permanent resolution to ensure the important relationship between birthing-on-country midwives and their clients is not interrupted so that these women can access the midwife where and when they need to."
Ms Clack said the situation was impacting staff delivering birthing-on-country programs.
"We are consulting early and often to ensure an appropriate solution can be identified that supports the needs and complexities of First Nations women," she said.
"We are cautiously optimistic that a solution will be found in the near future."
Professor Alison McMillan, health department chief nursing and midwifery officer, said it had become clear intrapartum care had been excluded from the medical indemnity policy of the sole insurer, MIGA, since 2010.
Without the indemnity cover, she said once labour had begun the advice to birthing women would be to transfer to hospital to continue.
Antenatal (before birth) care is still covered by the insurance policy.
"The midwife may agree to attend the woman at a place outside the hospital to perform a clinical assessment to determine whether labour has or has not commenced," Prof McMillan said.
"Once the onset of labour is determined by the midwife or another qualified health practitioner, under the current policy wording, the midwife would not be indemnified for intrapartum care outside of a hospital except, of course, in unforeseen emergency situations."
Ms Staines, who has birthed six children, said one of the main reasons women choose private midwives is to ensure continuity of care.
"I tried it with the GP in the hospital and honestly, it was an absolute s***show, having to retell your story all the time," she said.
"It became less about the relationship and more about the clinical practice where we know that the relationship is equally important.
"So, having the midwife know you, your pregnancy and your baby is a big part of the safety and we've seen that other models of care just can't replicate the results with that continuity of care."
