Friday, February 28, 2014

the end of summer

A Japanese Maple bonsai tree in my garden
Readers may have read in previous posts that I am planning my retirement from attending births in the coming year, and eventually from the practice of midwifery.  I can't ignore the sadness that comes to my mind as I contemplate this huge step.  Midwifery has been my passion; to a great extent my identity, for many years now. 

Yet, just as I celebrate the changes of seasons, and tend my little garden, and look forward to the autumn colours on this little bonsai tree that I have tended for the past five years, since it was just a seedling, I am also choosing to celebrate the passing of time in my life.  I am also looking forward to the new freedoms and opportunities that will present when I am no longer 'on call'.  I am coming to the end of the 'summer' of my life: the time of productivity and strength.  I have the autumn and winter ahead.

I have, in the past couple of months, informed my colleagues and potential clients of my intention to retire.  I do not have any particular reason to retire, other than age.  I am in good health, and I think I am in possession of all my faculties.

In the past few years I have witnessed major changes in the midwifery profession in this country.  Many of these changes have been related to the legislation governing the practice of midwifery, and I have written at length on this and other sites.

In the past few years I have also witnessed a migration of midwives, from mainstream hospital employment, to private practice.  Of the twenty-or-so midwives practising privately in the Melbourne area, about ten have been part of the exodus from hospital jobs, since 2010.

This phenomenon, by which the number of midwives practising privately in Victoria has doubled in only three years, has translated into a decrease in the demand for my services as a midwife.  There are plenty of midwives looking for work.  New midwifery practices and businesses are working hard to promote their services, and to compete for clients.  I am content that the Melbourne (and surrounding areas) women who are seeking private midwifery services, either for planned home birth, or hospital support, will have midwives willing to work with them when I have called it a day.

Some of the garden produce this year: figs, peaches,tomatoes ...

A midwife’s scope of practice is not related to the business model under which she or he works.  This means that any midwife, except those who have specific restrictions imposed by the regulatory body on their registration, is able to practise midwifery without supervision, in the way that they choose. 
Mainstream maternity care is within hospitals and health services.  When a person applies for employment in a hospital or health service, the application will be reviewed by experienced peers, and processes will be followed to confirm that the skill and experience levels are suitable for the position.  This aspect of due diligence is expected of employers.

In private practice there may be no employer, other than the woman.  The onus falls on the individual midwife to ensure that they are competent for the work they undertake.  The main setting for private midwifery practice in Victoria today is planned homebirth.  Midwives who have practised in hospital maternity units in this country, whether for a graduate year, or for many years, may have had very little experience of caseload practice or homebirth.  They may have idealised notions about the women who employ midwives privately, and about what happens in homebirths.  

Midwives who have achieved Medicare eligibility and set up private practice have, in the past three years, quickly transitioned to homebirth practice.  This can be seen as a positive step: attending homebirth is, after all, basic midwifery practice.  Yet we need to proceed with caution: there is a body of knowledge and a set of skills that are specific to homebirth and caseload midwifery practice.  As some wise person said: “you can take the midwife out of the hospital, but can you take the hospital out of the midwife?” 

Until hospitals are willing to set up collaborative agreements, and support eligible midwives for the full scope of midwifery services, including attending births in the hospital, this will continue to be the case.  It cannot be assumed that the good outcomes that have been demonstrated in homebirth in Victoria for the past couple of decades will continue.  Midwives need support as they extend and develop their private practices.  This is not happening.

As I move into the autumn of my life, handing births over to younger midwives has to happen.  I hope these midwives are reflecting on their own practices, speaking honestly to colleagues, and reading widely in midwifery literature - even places like this.  And I hope many are writing their stories.  I don't see much evidence of that - it seems to be the exception rather than the rule, to have midwives who are not academics committing their practice to writing.

I know that this blog has only a few regular readers.  I don't know who you are.  I hope something I have written is meaningful and useful to you.

Many more visit the other midwifery blogs that I write: villagemidwife and midwivesVictoria.

Thankyou for your comments

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