- First birth
- Subsequent birth
- Home birth supplies and support
- Labour and birth (exceptional circumstances)
- Labour and birth (rural support)
Relevant clause is Section 88 - DA24
(2) The payment to be claimed depends on whether the birth is a first birth, VBAC, or subsequent birth.
(4) A maternity provider may claim the labour and birth fee if the LMC anticipates that clinical responsibility for the labour and birth is to remain with the LMC and circumstances change and clinical responsibility transfers after established labour to secondary maternity.
(5) The payment for homebirth supplies and support may be claimed only once per woman per pregnancy if a homebirth has occurred.
This module compensates the practitioner for his/her time and efforts during a woman’s labour and birth. There is a fee for a first birth, subsequent birth, VBAC, and labour and birth exceptional circumstances, depending on the woman’s obstetric history and the circumstances of the birth.
To claim for a full birth (first birth, subsequent birth or VBAC), there are criteria in place that must be met-
The LMC or his/her back up is present for the entire duration from when the woman was in established labour to the delivery of the placenta OR
The LMC or his/her back up arrives to attend the woman within 2 hours after the delivery of the placenta OR
The LMC or his/her backup was present with the woman during established labour but had to hand over to secondary care’ OR
The baby was 20+ weeks and/or 400+grams and the above conditions are met.
Examples where a birth can be claimed:
- A woman has a long latent phase but after optimal augmentation she establishes labour with the LMC present. The woman is exhausted and the decision is made to transfer clinical responsibility to secondary care for an instrumental birth
- A woman had a precipitate labour, the LMC is stuck in traffic and trying her best to get the hospital. The LMC arrives 30 minutes after the delivery of the placenta but aids in the suturing and post-birth care.
Example when the full birth cannot be claimed:
- A woman arrives at a primary care unit reporting having “niggles” but not in established labour for the last 2 days. The LMC does a VE and finds she is 1cm dilated. The LMC arranges transport to have her woman transferred to a secondary care facility and waits with her until the ambulance arrives. The LMC does not go with her in the ambulance.
Vaginal birth after caesarean section (VBAC) means an actual vaginal birth for a woman who has had a previous birth by caesarean section and who has not had a previous vaginal birth (Section 88 p. 1046).
It is understood that any VBAC that occurs carries a higher risk regardless of the woman’s previous obstetric history. Whether the woman delivered vaginally her for her first pregnancy, had a C section, then delivered vaginally for her 3rd and 4th pregnancy, there is still a lot of time, planning and effort put in for ALL VBAC deliveries.
However, Ministry business rules will only pay a VBAC payment one time and that is after a woman has her FIRST successful vaginal birth (forceps and Ventouse count) after a C section. Also, a VBAC payment is not applicable if it was a PLANNED VBAC after a woman’s first delivery was a C section but ultimately underwent a C section procedure for her second delivery due to an unexpected complication, for example, fetal distress.
A few points to note related to claiming birth fees:
- If a woman sadly has a stillbirth for her first pregnancy and the baby was 20+ weeks and/or over 400 grams but delivers a healthy baby to term for her second pregnancy, the subsequent birth fee applies.
- If the woman has a multiple birth (twins, triplets etc) - no extra fee is in place to claim. For example if it was her second delivery, the subsequent birth fee is applicable.
- A home birth supplies and support fee can be claimed if a homebirth was planned but there was a transfer to hospital during the birth