Every homebirth needs two midwives. From 1 January, most second midwives will not be allowed to attend

In 49 days, the rules for giving birth at home in Australia change, and the women planning one in the new year are the ones left waiting to find out what that means.

For decades, privately practising midwives who attend homebirths have been exempt from the national requirement to hold professional indemnity insurance, because no insurer would sell them a policy. That exemption, already extended for a final time, expires at midnight on 31 December 2026.

From 1 January, every midwife in private practice who attends a homebirth must be insured. The only product available under the Commonwealth’s Midwife Professional Indemnity Scheme is open to endorsed midwives alone.

Who counts as endorsed?

Endorsement is a higher qualification. It requires extra study and 5,000 hours of clinical practice, and fewer than 5 per cent of Australian midwives hold it. Endorsed midwives can prescribe emergency medicines and provide Medicare-subsidised care.

The catch is in how a homebirth is staffed. Each planned homebirth has a primary midwife and a second midwife. A second midwife in private practice must hold the same insurance, which in practice means being endorsed too. Most are not, and they cannot build up 5,000 hours in seven weeks.

How many families does this touch?

There are more than 2,000 planned homebirths in Australia a year, a number the Australian College of Midwives says is growing quickly, and only about 104 midwives identify as providing private homebirth care.

The money is tight. Indemnity cover for a primary midwife costs around $7,500 a year, with a base tier of about $2,400. A second midwife earns around $500 a birth and attends a median of four births a year, which means a year of seconding would not pay for the cheapest cover.

What do the midwives say they will do?

The college surveyed its members: 32 per cent said they would leave the profession if private practice stopped being viable, and 79 per cent of second midwives said they were likely to cut their hours or leave if they could no longer second.

Homebirth Australia’s survey found 88 per cent of non-endorsed second midwives would be forced to stop attending homebirths, and 60 per cent of primary midwives said they would have to stop offering homebirth without an insured second.

Why are midwives worried about freebirth?

Freebirth means giving birth without any registered health professional there. In the Homebirth Australia survey, 59 per cent of women said they would consider freebirth rather than a hospital birth if they lost their midwife, and 89 per cent of midwives in the college survey expect freebirth to rise.

The college’s chief executive, Mia Dhillon, and chief midwife, Kelley Lennon, have called that trend “a major red flag for women’s safety”. NSW Health says it strongly recommends all women give birth with a registered maternity care provider.

Who can change it?

That is the problem: each body points at another. The insurer contracted by the Commonwealth says the federal government sets eligibility. The federal health department says the Nursing and Midwifery Board of Australia sets the requirements and that state and territory health ministers must agree on changes. The board is reviewing its endorsement standard, including a proposal to remove the 5,000-hour requirement.

The department says the arrangements are designed to support safe care, “not to discourage women from choosing a homebirth”.

NSW Health Minister Ryan Park told a community forum the policy “can have a perverse outcome” and that the federal government should rethink it.

The college wants the insurance opened to registered midwives or the endorsement rule changed, and a cheaper product for low-caseload second midwives. Homebirth Australia wants the exemption extended for second midwives from 1 January and a permanent fix by the end of 2027.

“This is an issue entirely of the government’s making and one that only they can fix,” Homebirth Australia’s coordinator, Katelyn Commerford, said.

If you are pregnant and planning a homebirth next year, talk to your midwife now about whether they will be able to attend, and to your doctor or local maternity service about your options.