Tuesday, October 9, 2012

Journal: collaboration

Activity: Establish a working relationship with a doctor 
There is currently much grief and anger surrounding the term “collaboration” when used in the maternity care setting in Australia at present. ... discuss the following issues –
• What actually is collaboration?
• What would the best model of how women and their babies can have their needs met in pregnancy, birth and the postnatal period, including midwives AND doctors, look like?
• Discuss your own individual situations where you presently work, or intend to work.
• What ways are you currently able to work with local doctors?
• What works well?
• What doesn’t work well? Why? Is there scope to change this? ...

I have reflected a great deal on collaboration, especially in the past few years, with the rules demanding a formal and pedantic process that is called a collaborative arrangement, for each woman in my care, in order for that woman to access Medicare rebate.

Collaboration is, in my mind, simply working together 'co'+'labor'.  One person can't collaborate.  It takes two.  In maternity care, the woman+baby unit is at the centre of the care, and a midwife+/- others work together to provide the maternity care. 


This is the point at which disagreement arises.

For maternity care at its most basic level, the midwife is able to provide the entire episode of care, on her/his own responsibility, provided the woman and her baby are well and progress through pregnancy, labour, birth and the puerperium without complication.

Collaboration is added to the care mix if the woman or her baby need care that is outside the scope of the midwife's practice: whether it's collaboration with a dentist, obstetrician, physiotherapist, or paediatrician.

When I read the heading for this activity, "Establish a working relationship with a doctor", I asked myself, "which doctor?"

I have initiated collaborative arrangements with about 30 doctors in the past 18 months.  Most are GPs; a couple are obstetricians.  On a couple of occasions the same doctor has provided collaboration for more than one woman.  Most of these doctors I have never met or spoken to.  One of these doctors has given birth at home in my care.  Another doctor knows a woman for whom I have been midwife.

My understanding of good collaboration in maternity care is summarised in the letter that I send to a doctor when a woman asks me to be her midwife. (If the doctor is an obstetrician, and the woman is planning birth in a private hospital, the wording is slightly different.  Most of my work is with women planning birth at home, or in a public hospital)

"The plan is basically to proceed under normal physiological conditions, working in harmony with the natural processes, unless complications arise. We plan to go to the [X] hospital without delay for urgent obstetric concerns, or [the woman] would be referred to you for non-urgent medical indications."

Collaboration for midwives who are participating in Medicare has been set out in the National heath (collaborative arrangements for midwives) determination 2010
In the real world these rules present midwives with a difficult, though not impossible, situation.  I don't have energy to waste on resisting.  I hope that when my turn comes to be audited, my processes and records will be acceptable.
Thankyou for your comments

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