Sunday, October 4, 2009

A framework for private midwifery practice

There has been a lot of talk in midwifery circles lately about a *framework* that will enable eligible midwives to practise privately within the new environment promised under the government's package of midwifery reform. We have been informed that an "advanced midwifery credentialing framework" will be required for eligible midwives, who will also be "appropriately qualified and experienced"; "working in collaboration with doctors".

Midwives who continue practising privately without insurance in the 2-year period (2010-2012) have been told we will be required to participate "in a quality and safety framework which will be developed ..."

I am very concerned about the misuse of the concept of a regulatory framework, which seems to be interpreted by the government as redefining what midwifery is (to suit vested interests), rather than embracing a wonderful profession. Our professional College, ACM needs to be strong in demanding that the principles of midwifery be used at the foundation of any statements about midwifery in this country.

What is meant by a *framework*?
Google took me straight to Wikipedia,
A framework is a basic conceptual structure used to solve or address complex issues. This very broad definition has allowed the term to be used as a buzzword, especially in a software context.
Framework can also refer to mechanical structures, such as scaffolding.

[and if you are unsure of what a *buzzword* is, Wikipedia can help out there too!]

As time passes I am becoming increasingly more confused as to what is actually meant by our Federal Health Minister, and all who are collaborating with her in bringing about maternity reforms, when they refer to a *framework*.

The challenge in my mind has been to prepare a statement which is a "basic conceptual structure used to solve or address complex issues", that is, midwifery practice.

I found the answer to my quest - the conceptual structure ... in the Definition of the Midwife (2005), a Core Document [ie no buzzwords here] of the International Confederation of Midwives (ICM).

The ICM Definition is foundational to all midwifery practice, including homebirth. Education and Codes of Practice and other guiding documentation of all member organisations, including the Australian College of Midwives, are expected to be consistent with this definition.

The ICM Definition of the Midwife establishes the following principles:
.1 The principle of ‘partnership’: “The midwife … works in partnership with women …”
.2 The principle of professional responsibility: “The midwife is recognised as a responsible and accountable professional …”
.3 The principle of continuity of carer (‘caseload’) – primary care: “The midwife … works … to give the necessary support, care and advice during pregnancy, labour and the postpartum period, …”
.4 The principle of primary care – on the midwife’s own responsibility: “… to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.”
.5 The principle of health promotion: “This care includes preventative measures, the promotion of normal birth,…”
.6 The principle of detection of complications, consultation, referral, and carrying out emergency measures: “This care includes … the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.”
.7 The principle that midwifery care has broad community health implications: “The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.”
.8 The principle of ‘any setting’: “A midwife may practise in any setting including the home, community, hospitals, clinics or health units.”

Simple logic tells me from the principles of midwifery, that basic midwifery includes, by definition, consultation with and referral to a doctor when appropriate. And, for that matter, referral to a dentist when appropriate. Doctors and dentists don't do midwifery, and vice versa.

So when midwives are told that we are going to be required to undertake "advanced midwifery credentialing framework" in order to be 'eligible' midwives, who will also be "appropriately qualified and experienced"; "working in collaboration with doctors", we are confused.

The only way this makes any sense is to accept the Wikipedia broad definition of *framework*, as a no more than buzzword. Until any framework applied to midwifery practice or credentialling or teaching actually confirms the principles that undergird midwifery, any attempt to describe midwifery's position will flounder.

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