"I trust the evidence": Why Australian midwives practice homebirth without professional indemnity insurance

Professional indemnity insurance (PII) has not been available for intrapartum care at home for privately practice midwives (PPMs) in Australia since 2001.

To examine the effect of the lack of professional indemnity insurance on the private practice of Australian homebirth midwives.

In this qualitative study, semi-structured interviews were conducted with midwives (n = 11), who were currently or had recently been providing homebirth services. Interpretative phenomenological analysis was used to explore how midwives navigate professional and personal risk in their practice.

Three higher-order themes were found that describe how midwives manage their private practice without PII for homebirth: I feel vulnerable without insurance, The system doesn't support my practice, and I have my own risk management processes.

From 2001-30 th June 2025, Australian PPMs provided homebirth services without any PII, putting them at personal and professional risk. Australian PPMs navigate other risks such as the experience of horizontal violence upon transfer from home to hospital, blame culture in the maternity system which may result in an Ahpra notification and ethical distress when trying to provide care for women with complex needs. This research illustrates how PPMs practice in a system that doesn't support them.