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Second midwife fee clarifications

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Points of clarification for the Second midwife support supplement

Claims for the Second midwife support supplement appear to be going well although the volume of second midwife claims has been lower than anticipated.  The College has received several enquiries. For example, can midwives claim the Second midwife support fee when a backup LMC is required, whether claims can be made when a woman has complex care requirements, and about unplanned home birth? We have summarised the questions and responses below.

     1). I have provided care to woman during an unplanned home birth – a colleague from my midwifery practice came to help – can she claim the second midwife fee?

YES – a second midwife claim can be made for any homebirth (planned or unplanned) where a second midwife attends. There are detailed examples of when a second midwife claim can be made on the Ministry website

     2). I had two women in labour at the same time and called my back up midwife to look after the second woman. Can she claim the second midwife supplement?

NO – not usually. The Second midwife support supplement has specific payment rules and cannot usually be claimed where a midwife LMC requires a back-up midwife (due to multiple women in labour or LMC having time off).

All LMC midwives are required by the Section 88 notice to have a ‘back up LMC’ available 24 hours a day, 7 days a week. A back up LMC is defined as:

“A midwife… who has a formal relationship with the LMC… to provide lead maternity care to women registered with the LMC when the LMC is not available to provide these services.”

So in situations where a midwife is having time off or has two or three women in labour at the same time the back-up LMC would be expected to be called and payment for this service is made by the LMC to her back up midwife through the existing Section 88 payments.

However, if the LMC needs a break before providing care to relieve her back up who is attending the second woman then yes, the second midwife support supplement can be claimed by the backup midwife.

The second midwife supplement aims to support ongoing ‘safe’ care and ensure the midwifery care is not compromised due to fatigue. So if a midwife LMC is providing care to one client and has asked her back up to simultaneously  provide care to her second client as she is unavailable –  once care for the first women has been completed, she can take a break before attending the second woman (in order to mitigate fatigue). The backup midwife can then validly claim the second midwife fee because she is providing care which is designed to mitigate fatigue and support continued safe care.

An example from the Ministry of Health website: An LMC midwife attended a labour and birth the previous evening and got home at 2am. At 8am another client calls to say she is in labour and on her way to hospital. The LMC midwife decides she is too fatigued to practice safely at this time and calls her back-up to attend the woman instead. After a few hours rest, the LMC swaps with her back-up and attends the remainder of the woman’s labour and birth.

Clinical responsibility – LMC transfers this to the back-up LMC who then transfers it back to the LMC eligible to claim labour and birth module – YES

Back-up LMC eligible to claim second midwife support – YES

There are other detailed examples of when a Second midwife support claim can be made in this situation on the Ministry website.

     3). When I provide care in situations where the woman is having an induction of labour or an epidural, is it okay for my practice partner to provide support and claim the Second midwife support fee when I need a break to support safe care in these circumstances?

YES – the Second midwife support supplement has been set up to facilitate payment when a midwife LMC or back-up LMC midwife is temporarily relieved or replaced in order to support provision of safe maternity care. LMC midwives providing care to women who have complex labours are still able to make a valid labour and birth claim under Section 88, the Second midwife support fee is no different.  If the midwife usually continues to provide care to her women when they have complex maternity care requirements and requires relief from that woman’s labour or birth because of  fatigue due to extended provision of labour and birth services then the second midwife can claim the Second midwife support fee.

     4). If I have transferred clinical responsibility to a specialist, but have continued to provide midwifery care to my client, can I call in a second midwife if I need a break?

YES – where an LMC midwife chooses to continue to provide support to a woman after transfer of clinical responsibility, they may have a second midwife either relieve or replace them as long as the other requirements of a claim for a Second midwife support fee are met.


Specific requirements for second midwife claims

Either a. Where provision of maternity care by the midwife LMC alone during labour and birth could compromise the safety of that care, and the midwife LMC reasonably considers it is unsafe for her to proceed alone without the provision of second midwife services alongside the midwife LMC;

Or

 b. Where the midwife LMC transfers clinical responsibility to the second midwife to ensure the maternity care is not compromised while the midwife LMC requires relief from that labour and birth service provision due to:

·         Fatigue arising from extended provision of labour and birth services;

·          Onset of illness or injury to the midwife LMC during provision of the labour and birth services;

·          Unanticipated personal crisis experienced by the midwife LMC during provision of labour and birth services.


Record Keeping

To ensure that these second midwife support claims are recognised as legitimate claims the second midwife making the claim needs to identify in the clinical documentation the following matters:

1). The reason the second midwife support is required, for example:

In order to continue to provide safe care the LMC Midwife needed a break/rest period – so I was requested to provide ongoing midwifery care as a second midwife.

2). The second midwife must include his or her name and registration number.

3). The date and time of attendance must be recorded. It is important that the times the second midwife attendance started and finished his or her attendance are recorded (this must be not less than 90 minutes for a second midwife attendance).

4). The time of transfer of clinical responsibility (if that occurs).