Tuesday, February 9, 2010

Continuing the countdown ... February

As we progress toward 1 July, just over 4 months away, independent midwives continue to have many questions, and no answers, as to what the regulation of our professional activity will look like after that date.  Many of these questions are linked to the 'exemption' from indemnity insurance for midwives attending homebirth.  I have written about that at the MiPP blog.  Only those midwives who have been granted the exemption will be able to attend homebirths lawfully.

Questions midwives are asking include:

Will all midwives who are currently attending homebirths be granted the exemption, and thereby be permitted to continue providing this service for the coming two years?

Will I be able to continue to earn my living lawfully as a midwife?  If not, what will I do?  [join the dole queue?]

What will the women who are planning homebirth do?

We have no answers yet to these questions.

Some midwives have already declared that they are not accepting bookings post 1 July.  Others (including me) are informing women who inquire that there is a degree of uncertainty, yet we are optimistic that a way will be found through the uncharted terrain.  Many midwives are distressed and angry.

The Victorian consultations around the national Quality and Safety Framework for the exemption from profession indemnity insurance for homebirth are booked for next Thursday 18 February.  The consultation team, appointed by the Victorian health minister, will listen to presentations in capital cities, and will come up with a set of rules that all midwives who are given the exemption will be expected to follow.  The process for governance, or policing of compliance will also be decided.

There is a pessimist in me that says it's likely those rules have already been written - that we are giving the health department the opportunity to tick the box that they have 'consulted' with stakeholders.

Yet I am holding on to enough optimism and belief in the value of authentic midwifery, that if enough people speak the truth, it might get through.

Private or independent midwifery should not, in my opinion, focus exclusively or even primarily on home birth.   The midwife's commitment is to the woman and her child, not to the setting in which the care is provided.  Home is a very wonderful and reasonable choice for most women, but is not the ultimate. 

Midwives provide primary maternity care that is tailored to each woman's personal needs and choices, as well as being based on best standards of contemporary midwifery practice. Studies have shown that women who receive care from the same midwife or small group of midwives throughout pregnancy and birth have improved outcomes and greater satisfaction than those who do not receive continuity of carer.

Midwives providing private midwifery services:

· seek to establish a one-to-one partnership with each woman

· limit the number of clients booked so that we can provide a personal, reliable service

· commit to being with each woman as her personal professional carer throughout the episode of care. This sort of midwifery practice is often referred to as ‘caseload’ midwifery

· commit to being with each woman in the setting she chooses for her birth, either home or hospital, and with the personal support team that she chooses

· If you give birth at home your midwife will give you the paperwork required for registering the birth, claiming the ‘Baby Bonus’, adding your baby’s name to your Medicare card, …

· If some unforseen circumstance prevents your midwife from attending you, a colleague will usually be able to stand in for her.

A midwife’s unique skill in providing primary maternity services is her ability to work in harmony with natural processes, to promote health, and to enhance wellness in both mother and baby. In situations where a mother or baby experience illness or complications the midwife continues to provide the personal midwifery care, while collaborating with medical services and specialists as we seek to provide appropriate care.

The main choice a woman has to make in primary maternity care is a very basic choice: to proceed without intervention/interference/interruption, or not. Provided there is no valid reason to interfere with the natural processes in birthing, midwives recommend, and support women to work in harmony with their own wonderful bodies, rather than relying on drugs and other medical or surgical processes, which all have side effects and a potential to cause harm.

Sometimes it’s not clear, and there are choices that a mother needs to make about a course of action. A midwife will seek to provide information, and answer questions, so that the client can make an informed decision.

We look forward to accompanying each woman on her wonderful, personal journey, as she brings a new life into her family and community.

Joy Johnston

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