This week I have been invited to speak briefly at an Australian Nursing Federation (ANF) Victorian Branch midwifery conference. My topic is THE LEGAL AND PROFESSIONAL RESPONSIBILITIES OF A HOME BIRTH MIDWIFE – the buck stops with you!
I plan to make my presentation a tribute to homebirth and private midwifery practice as we know it. I will be using a brief slide presentation about the home-water-birth of a baby girl named Lila, about a year ago. The BMid student who was undertaking one of her follow-through journeys took the photos. Lila’s mother has kindly given me permission to share these intimate images with fellow midwives.
A focus on homebirth, rather than focusing on the woman, sets an unhelpful basis for this discussion. The place of birth, either home or hospital, is a choice that a well woman has if her midwife is competent in attending a physiologically normal birth in any setting. The picture of partnership between a woman and her midwife, who is primary care provider throughout the episode of care, is the key. The midwife is committed to the woman, not to the place of birth.
Monday, August 31, 2009
Saturday, August 22, 2009
indemnity insurance, smoke and mirrors
Australia's private midwives provide a professional service that has stood the test of time, and survived in spite of professional, social, and financial restrictions and disincentives.
The service we have provided to the women and families who employ us is demonstrably effective and highly valued in our communities.
The current media focus on private midwifery and homebirth - the main practice area of private midwives - is disproportionate to the number of midwives or the number of births we attend. Our future is now threatened in an unprecedented way.
Every day or so independent midwives are receiving messages from those who are representing us at federal and state political levels. Messages are also circulating in consumer advocacy circles. The situation is volatile. Our inboxes are clogged, and our minds are too. It is difficult in the multiple conversations that are happening to see the picture clearly. It is difficult when under serious threat to know who to trust, who to avoid, and who to fight.
Differences of opinion are bound to exist, and to become more polarised as time passes. One key issue is professional indemnity insurance.
Organisations that seek to represent the interests of the maternity consumer have come out clearly supporting the mandating of professional indemnity insurance for all registered health professionals. This requirement has been written into the new health practitioner legislation, to come into effect 1 July next year, and appears to have strong political support. Midwives' organisations have also joined the band wagon with idealistic statements about every consumer needing to be able to sue if they suffer harm at the hand of their health care provider.
I don't know how smoke and mirrors work in magic shows, but they do the trick. Every time I see someone put on a self righteous face and talk about the importance of professional indemnity insurance in health care, I wonder if they really believe what they are saying. Are they in effect the children in the front row, believing everything they see and hear as the magician wows the crowd?
The only consistent winners in the professional indemnity insurance scene are the insurance companies - businesses which collect huge premiums, with government support for bigger claims, and the lawyers. The people who suffer as a result of professional misconduct, negligence, incompetence, or a potentially avoidable mistake face a huge complex legal process in making claims. They might do better buying a lottery ticket.
There is much in maternity care that is unknowable and unpredictable. The midwife who works in harmony with natural physiological processes in birth embraces the unpredictability of birth, and is ready to act to protect wellness at any time. This midwife promotes health in the leadup to the climax of birth. It is no secret that the safest way to proceed through the complex terrain of birth is to do so without drugs or surgery. And the person with the professional expertise to facilitate physiological birthing is the known midwife, working in partnership with each woman.
These words have been repeated over and over again in midwifery literature. I doubt there will be anyone reading this blog who does not know this fact.
Indemnity insurance for private midwifery practice has not been available since 2002. Will Nicola Roxon find an indemnity product that can be afforded by midwives, passing on the costs to our clients, and working within the constraints that inevitably come with the product?
The service we have provided to the women and families who employ us is demonstrably effective and highly valued in our communities.
The current media focus on private midwifery and homebirth - the main practice area of private midwives - is disproportionate to the number of midwives or the number of births we attend. Our future is now threatened in an unprecedented way.
Every day or so independent midwives are receiving messages from those who are representing us at federal and state political levels. Messages are also circulating in consumer advocacy circles. The situation is volatile. Our inboxes are clogged, and our minds are too. It is difficult in the multiple conversations that are happening to see the picture clearly. It is difficult when under serious threat to know who to trust, who to avoid, and who to fight.
Differences of opinion are bound to exist, and to become more polarised as time passes. One key issue is professional indemnity insurance.
Organisations that seek to represent the interests of the maternity consumer have come out clearly supporting the mandating of professional indemnity insurance for all registered health professionals. This requirement has been written into the new health practitioner legislation, to come into effect 1 July next year, and appears to have strong political support. Midwives' organisations have also joined the band wagon with idealistic statements about every consumer needing to be able to sue if they suffer harm at the hand of their health care provider.
I don't know how smoke and mirrors work in magic shows, but they do the trick. Every time I see someone put on a self righteous face and talk about the importance of professional indemnity insurance in health care, I wonder if they really believe what they are saying. Are they in effect the children in the front row, believing everything they see and hear as the magician wows the crowd?
The only consistent winners in the professional indemnity insurance scene are the insurance companies - businesses which collect huge premiums, with government support for bigger claims, and the lawyers. The people who suffer as a result of professional misconduct, negligence, incompetence, or a potentially avoidable mistake face a huge complex legal process in making claims. They might do better buying a lottery ticket.
There is much in maternity care that is unknowable and unpredictable. The midwife who works in harmony with natural physiological processes in birth embraces the unpredictability of birth, and is ready to act to protect wellness at any time. This midwife promotes health in the leadup to the climax of birth. It is no secret that the safest way to proceed through the complex terrain of birth is to do so without drugs or surgery. And the person with the professional expertise to facilitate physiological birthing is the known midwife, working in partnership with each woman.
These words have been repeated over and over again in midwifery literature. I doubt there will be anyone reading this blog who does not know this fact.
Indemnity insurance for private midwifery practice has not been available since 2002. Will Nicola Roxon find an indemnity product that can be afforded by midwives, passing on the costs to our clients, and working within the constraints that inevitably come with the product?
Monday, August 17, 2009
APMA Media Release: Senate due to report - homebirth in or out?
Monday August 17, 2009.
Today’s Senate report into proposed legislation which effectively makes attending a homebirth outside of conditions of midwifery registration is being watched closely by the Australian Private Midwives Association. The Senate Community Affairs committee was asked to examine legislation which excludes homebirth from a government subsidised indemnity package – forcing midwives to cease homebirth practice and women to birth at home alone or with unregistered care providers. The legislation, the Health Legislation Amendment (Midwife and Nurse Practitioner) Bill 2009 and two other related bills is in response to the government's Budget measures enabling midwives to access the MBS and PBS and to receive high claims subsidies for professional indemnity insurance.
“We know that this Senate inquiry received over 2000 submissions indicating the depth of support for this issue as a fundamental women’s rights issue” said president of the Australian Private Midwives Association Liz Wilkes “We cannot believe that women will be denied the right to choose where they have their baby in a democratic society.”
The Senate committee heard from many major organisations in a hearing on August 6 and is due to report today.
“We have not seen any evidence that this legislation will make homebirth care safer, in fact it is just the opposite” Ms Wilkes added “The Federal Department of Health have indicated that women will be able to have a health care provider to attend a homebirth, they just won’t be able to be registered or to call themselves a midwife. This seems to be particularly ludicrous given that this is Australia and we are in 2009, not 1909.”
Whilst no clear reason for the exclusion of homebirth has been indicated there has been reference to the cost of indemnity by several sources.
“The Federal Health Minister has indicated that she may examine costing a package of indemnity including homebirth. We would welcome figures on this being bought into the public domain and for the process which determined costing to be examined” said Ms Wilkes. “We expect a supportive outcome of this Senate inquiry. There is a lack of anything to substantiate the governments exclusion of homebirth.”
Media – Liz Wilkes President APMA 0423 580585
in the press
From ethicist Leslie Cannold
Today’s Senate report into proposed legislation which effectively makes attending a homebirth outside of conditions of midwifery registration is being watched closely by the Australian Private Midwives Association. The Senate Community Affairs committee was asked to examine legislation which excludes homebirth from a government subsidised indemnity package – forcing midwives to cease homebirth practice and women to birth at home alone or with unregistered care providers. The legislation, the Health Legislation Amendment (Midwife and Nurse Practitioner) Bill 2009 and two other related bills is in response to the government's Budget measures enabling midwives to access the MBS and PBS and to receive high claims subsidies for professional indemnity insurance.
“We know that this Senate inquiry received over 2000 submissions indicating the depth of support for this issue as a fundamental women’s rights issue” said president of the Australian Private Midwives Association Liz Wilkes “We cannot believe that women will be denied the right to choose where they have their baby in a democratic society.”
The Senate committee heard from many major organisations in a hearing on August 6 and is due to report today.
“We have not seen any evidence that this legislation will make homebirth care safer, in fact it is just the opposite” Ms Wilkes added “The Federal Department of Health have indicated that women will be able to have a health care provider to attend a homebirth, they just won’t be able to be registered or to call themselves a midwife. This seems to be particularly ludicrous given that this is Australia and we are in 2009, not 1909.”
Whilst no clear reason for the exclusion of homebirth has been indicated there has been reference to the cost of indemnity by several sources.
“The Federal Health Minister has indicated that she may examine costing a package of indemnity including homebirth. We would welcome figures on this being bought into the public domain and for the process which determined costing to be examined” said Ms Wilkes. “We expect a supportive outcome of this Senate inquiry. There is a lack of anything to substantiate the governments exclusion of homebirth.”
Media – Liz Wilkes President APMA 0423 580585
in the press
From ethicist Leslie Cannold
Sunday, August 16, 2009
Countdown to 1 July 2010
Any woman who is hoping to conceive in the near future, and give birth in Australia, who is interested in private midwifery services, please stay in touch with private midwives in your area. We care very much about supporting you through the transition that we face.
Click on the photo to enlarge it, and you will see that if the first day of your menstral period is today, and you conceive with your next ovulation, your baby is likely to be born between mid-May and early June.
If the first day of your last menstral period is 10 September, and you carry the baby to 42 weeks' gestation, your baby could be born 1 July.
Please do not assume that midwives will abandon women who intend to give birth at home, or who would prefer to have a privately contracted midwife to attend them for hospital birth after 30 June next year. Please speak to private midwives in your community.
Australian Private Midwives Association
In the past month independent midwives across Australia have banded together under a new organisation, Australian Private Midwives Association, APMA. A management committee and office bearers have been elected, and email lists set up.
APMA "represents midwives in private practice. The association is focused on the safety of women, the ability of women to access quality midwifery care across Australia and the partnerships between women and midwives. APMA supports women’s choice in maternity options within a framework of quality and safety and believes in women being able to access midwives in all settings. APMA unites all midwives seeking to provide continuity of care for women. APMA strives to provide midwives in private practice with information relevant to their practice and advocacy in the political process."
APMA president and spokeswoman, Liz Wilkes from Toowoomba, made a compelling presentation to the Senate Inquiry on behalf of the organisation.
APMA "represents midwives in private practice. The association is focused on the safety of women, the ability of women to access quality midwifery care across Australia and the partnerships between women and midwives. APMA supports women’s choice in maternity options within a framework of quality and safety and believes in women being able to access midwives in all settings. APMA unites all midwives seeking to provide continuity of care for women. APMA strives to provide midwives in private practice with information relevant to their practice and advocacy in the political process."
APMA president and spokeswoman, Liz Wilkes from Toowoomba, made a compelling presentation to the Senate Inquiry on behalf of the organisation.
midwives' blogs tell the story
Several blogs have been presenting the story. Here are a few examples:
The question that was not answered
Insurance measures could force homebirth underground, Opposition says
Homebirth Whisperer
Homebirth, the masters plan
What assumptions underlie the costing of the government's midwife indemnity scheme?
Streaming from the Senate Committee Hearing
The Rally outside Nicola Roxon's office
and
and video footage
I would like to make a list of midwives' blogs at this site, and invite midwives who are blog keepers to trade links. In this way anyone who is interested in following the unfolding events leading up to 1 July 2010 is able to find and follow the links. Please contact me by responding in the comments section, or by email.
Saturday, August 15, 2009
A new midwifery primary care option
Hello!
I am Joy Johnston, and I am an independent midwife in Melbourne, Victoria [Australia]. This new blog is an addition to my villagemidwife blog, and my website.
I am one of the estimated 200 experienced homebirth midwives in this country who will lose our right to practise midwifery privately from 1 July next year, as a result of new legislation that mandates professional indemnity insurance.
I have set up Aitex Private Midwifery Services (APMS), as a transition from the model I have managed since 1993, working as a solo midwife, to whatever private midwifery services I am able to provide and coordinate after July 2010.
APMS has a dual focus: the birthing woman, and the midwife. APMS is a professional service which exists to provide one-to-one private midwifery care for women in pregnancy and birth, and to mentor and guide midwives in caseload midwifery for births in the home or hospital.
If you wonder why the title uses the word 'Aitex', this is the name of the family company that my husband Noel and I have managed since 1989. Aitex allows us to coordinate and share the resources, such as printers, computers, phones, website, and email addresses. Noel is a Veterinary scientist. He understands and fully supports my efforts to promote and protect health through working in harmony with natural, physiological processes in birthing and care of the newborn.
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