Midwives in Australia as well as other countries face varying degrees of regulation and restriction. Some of this control is enshrined in law, some by monopoly of funding and access to services, while much is the accepted status quo. People don't challenge what they don't recognise as having potential to change.
Historically doctors have taken the leading and thereby controlling hand in health care. This is especially so in maternity care, and midwives around the world have in recent decades strongly resisted medical supervision of midwifery. Most Australian midwives don't recognise this fact, as they work in hospitals and their scope of practice is defined by hospital protocols. Midwives who practise privately, and autonomously, develop a midwife identity that is informed by the partnerships we develop with individual women, and that is consistent with the contemporary international definition of the midwife. Midwives who practise privately know that we are responsible for all decisions, advice, actions, and lack of action in our interactions with women who employ us as their midwives. We consult, refer, and occasionally transfer care to medical colleagues when the situation a woman in our care faces is outside our scope of practice.
The question of 'who is responsible?' with reference to the relationship between doctors and nurses is explored in a paper from the Royal College of Nursing, Australia. The arguments posed in this paper can be applied to midwifery.
Ultimate doctor liability: A myth of ignorance or myth of control?
Author: Andrew Cashin and others
Reference: Collegian Volume 16 • Number 3 • July/September 2009, Royal College of Nursing, Australia
Summary
Ultimate medical doctor responsibility for the care delivered to patients by all professionals is a myth. Legally Lord Denning dismissed the myth in the mid-20th century in England. The assumption that a medical doctor is responsible for the care delivered by nurses has not existed in English and Australian law since that time, and it has been actively refuted. Yet it is a myth that continues to circulate influencing health service, state and federal health policy. For some it is a myth of ignorance and for others it is a means of control. This paper outlines the relevant case law to debunk the myth of ultimate medical doctor control.
________________________________________
The current government's effort to reform maternity service provision in Australia has brought to light the reality that the myth of ultimate doctor responsibility in maternity care is alive and well in this country.
Saturday, September 26, 2009
Friday, September 18, 2009
Birth Plan for twins
Readers may have seen recent posts on my villagemidwife blog about complex negotiations that have gone into planning for birth of twins, and a summary from the birth.
My purpose in telling this story publicly, with the support of the mother, is to highlight basic midwifery knowledge, that even in complex situations, the physiologically normal processes in birth can be, and often is, the best. The only way to reach physiological birthing in today's world is for the mother to have the confidence to refuse all offers to actively manage the birth. When a midwife and a woman have established a partnership based on trust, respect, and reciprocity, the midwife is able to support the woman as she negotiates complex and unpredictable decision-making.
In this particular case the mother had initially planned homebirth, but on my recommendation, after the twin pregnancy was diagnosed, agreed to change that plan to hospital birth. The mother was pressured and coerced in an attempt by the hospital to achieve compliance and agree to elective caesarean. She listened and discussed what was on offer, yet she believed that the safest way for her to proceed was to wait for spontaneous onset of labour, and to proceed without surgery or anaesthesia. This is what she did.
In this blog we are sharing the framework of a birth plan. This birth plan was prepared at about 36 weeks' gestation. Ultrasound scanning gave no indication of any specific reason which may have swayed the balance towards surgically managed birth, other than the fact that the first twin (A) was presenting as Breech. Size of babies and amniotic fluid around the babies were unremarkable.
BIRTH PLAN
Include statements such as:
• “I plan to give birth to my babies spontaneously unless there is a reason for me to change this plan.”
• “I understand that I have the right to refuse any intervention.”
• “I believe that my birth plan is the best way for me to ensure the safety of my babies and to protect my own health”.
• "I ask that all care providers respect my need for privacy in labour and birth. Please do not interrupt me without good reason. Please minimise the number of people who come into my room, and keep equipment brought into my room to a minimum."
• "If an intervention is recommended, please explain to me the reason and I will consider it, and discuss it with my husband and my midwife so that I can make an informed decision."
DECISION POINTS IN SPONTANEOUS BIRTH FOR BREECH AND TWIN BABIES
Include:
• Onset of labour – may be regular contractions, or breaking of water or both. [Contact midwife]
• Going to hospital – as labour becomes established. Usually labour for the first twin proceeds in a similar way to previous labours. [Discuss with midwife]
• Established labour – check babies are coping well with labour. [midwives will be watching for normal progress over time.]
• Birth of Twin A:
• Urge to push – find upright position
• If membranes have not ruptured when visible at the vaginal opening, midwife will break the sac
• As baby’s body emerges, allow it to hang, assisted by gravity
• No forceful manipulation of the body
• No touching unless absolutely necessary until neck is visible
• Gentle support as face is born
• Clamp and cut cord soon after birth to prevent the possibility of twin-twin transfusion
• Baby to mother, skin to skin, as soon as baby’s condition is good
• Mother rest and enjoy Baby A, while midwife checks condition of Twin B.
• Baby A to breast if mother wishes
• Mother may need to stand and walk, to bring Twin B into to the birth canal
• When contractions return, and mother needs to focus on the birth of Twin B, pass Baby A to father, who stays close by. As long as Twin B's condition is good, there is no reason to speed up the birth by breaking the baby's waters.
• Birth of Twin B:
• Second labour will usually progress quickly once baby is presenting well, as the cervix has been dilated.
• Third Stage: After pulsation of the cord for Baby B has ceased, proceed with administration of oxytocic and controlled cord traction.
[Thanks to English midwife Mary Cronk, for sharing her guidelines for the care of a woman expecting twins. These guidelines have informed me in advising several twin mothers over the past few years.]
My purpose in telling this story publicly, with the support of the mother, is to highlight basic midwifery knowledge, that even in complex situations, the physiologically normal processes in birth can be, and often is, the best. The only way to reach physiological birthing in today's world is for the mother to have the confidence to refuse all offers to actively manage the birth. When a midwife and a woman have established a partnership based on trust, respect, and reciprocity, the midwife is able to support the woman as she negotiates complex and unpredictable decision-making.
In this particular case the mother had initially planned homebirth, but on my recommendation, after the twin pregnancy was diagnosed, agreed to change that plan to hospital birth. The mother was pressured and coerced in an attempt by the hospital to achieve compliance and agree to elective caesarean. She listened and discussed what was on offer, yet she believed that the safest way for her to proceed was to wait for spontaneous onset of labour, and to proceed without surgery or anaesthesia. This is what she did.
In this blog we are sharing the framework of a birth plan. This birth plan was prepared at about 36 weeks' gestation. Ultrasound scanning gave no indication of any specific reason which may have swayed the balance towards surgically managed birth, other than the fact that the first twin (A) was presenting as Breech. Size of babies and amniotic fluid around the babies were unremarkable.
BIRTH PLAN
Include statements such as:
• “I plan to give birth to my babies spontaneously unless there is a reason for me to change this plan.”
• “I understand that I have the right to refuse any intervention.”
• “I believe that my birth plan is the best way for me to ensure the safety of my babies and to protect my own health”.
• "I ask that all care providers respect my need for privacy in labour and birth. Please do not interrupt me without good reason. Please minimise the number of people who come into my room, and keep equipment brought into my room to a minimum."
• "If an intervention is recommended, please explain to me the reason and I will consider it, and discuss it with my husband and my midwife so that I can make an informed decision."
DECISION POINTS IN SPONTANEOUS BIRTH FOR BREECH AND TWIN BABIES
Include:
• Onset of labour – may be regular contractions, or breaking of water or both. [Contact midwife]
• Going to hospital – as labour becomes established. Usually labour for the first twin proceeds in a similar way to previous labours. [Discuss with midwife]
• Established labour – check babies are coping well with labour. [midwives will be watching for normal progress over time.]
• Birth of Twin A:
• Urge to push – find upright position
• If membranes have not ruptured when visible at the vaginal opening, midwife will break the sac
• As baby’s body emerges, allow it to hang, assisted by gravity
• No forceful manipulation of the body
• No touching unless absolutely necessary until neck is visible
• Gentle support as face is born
• Clamp and cut cord soon after birth to prevent the possibility of twin-twin transfusion
• Baby to mother, skin to skin, as soon as baby’s condition is good
• Mother rest and enjoy Baby A, while midwife checks condition of Twin B.
• Baby A to breast if mother wishes
• Mother may need to stand and walk, to bring Twin B into to the birth canal
• When contractions return, and mother needs to focus on the birth of Twin B, pass Baby A to father, who stays close by. As long as Twin B's condition is good, there is no reason to speed up the birth by breaking the baby's waters.
• Birth of Twin B:
• Second labour will usually progress quickly once baby is presenting well, as the cervix has been dilated.
• Third Stage: After pulsation of the cord for Baby B has ceased, proceed with administration of oxytocic and controlled cord traction.
[Thanks to English midwife Mary Cronk, for sharing her guidelines for the care of a woman expecting twins. These guidelines have informed me in advising several twin mothers over the past few years.]
Monday, September 14, 2009
Monthly review
Last month I began a countdown to 1 July 2010. I hope to summarise and review progress over the past month, for my own sake as well as for others who are following events as they unfold. If you don't understand something I have written, or think I have got it wrong, please let me know.
We can be confident that a baby who is conceived this week will be born before 1 July.
A woman whose menstrual period starts this week and conceives when she becomes fertile a couple of weeks from now will attain 42 weeks' gestation in the first week of July.
If you are that woman, and are planning homebirth with a privately practising midwife, you will need to work closely with your midwife, keep a clear mind, and remember your personal rights and responsibilities in giving birth to your child.
In summary
# Health Ministers have agreed to a transitional clause in the current draft National Registration and Accreditation Scheme legislation which provides a two year exemption until June 2012 from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth. (AHMC Communique 4 September 2009)
Although this sounds like a useful reprieve at face value, I see it as a meaningless political gesture to get the pressure off the Health Minister and the government that is presiding over reform that is a dog's breakfast before it's even enacted. Curiously the two-year exemption was announced at 4pm on the last business day before the big rally!
# The Department of Health and Ageing is seeking tenders from insurance companies to provide indemnity for eligible privately practising midwives.
This could potentially make private midwifery technically lawful, while making it so expensive that it becomes more marginal and unaffordable than it is now.
# The Maternity Service Advisory Group, with hugely disproportionate obstetric and medical representation, has been set up by the (federal) Health Minister.
# Key players have been invited to send a representative to three technical working groups to be convened 24 September and 12 October, as a component of the national maternity reform process. The working groups will consider PBS (pharmaceuticals), MBS (Medicare), and eligibility (credentialing).
Australian Private Midwives Assn (APMA) and ACM have been invited to send one representative each. Maternity Coalition have been invited to send two representatives. I don't know who else is to be represented.
My comment:
I will be satisfied that we are moving in the right direction if there can be agreement on broad principles underpinning midwifery practice and primary maternity care.
These principles are well articulated in the ICM Definition of the midwife.
As long as the advisors to the Health Minister are ignorant of the principles underpinning midwifery, and are able to be swayed by interest groups who advocate for midwifery to be a support service to obstetrics, these principles including partnership between a woman and her midwife, promotion of normal birth, and professional competence will not be respected in any of the outputs from working groups and advisory committees.
We can be confident that a baby who is conceived this week will be born before 1 July.
A woman whose menstrual period starts this week and conceives when she becomes fertile a couple of weeks from now will attain 42 weeks' gestation in the first week of July.
If you are that woman, and are planning homebirth with a privately practising midwife, you will need to work closely with your midwife, keep a clear mind, and remember your personal rights and responsibilities in giving birth to your child.
In summary
# Health Ministers have agreed to a transitional clause in the current draft National Registration and Accreditation Scheme legislation which provides a two year exemption until June 2012 from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth. (AHMC Communique 4 September 2009)
Although this sounds like a useful reprieve at face value, I see it as a meaningless political gesture to get the pressure off the Health Minister and the government that is presiding over reform that is a dog's breakfast before it's even enacted. Curiously the two-year exemption was announced at 4pm on the last business day before the big rally!
# The Department of Health and Ageing is seeking tenders from insurance companies to provide indemnity for eligible privately practising midwives.
This could potentially make private midwifery technically lawful, while making it so expensive that it becomes more marginal and unaffordable than it is now.
# The Maternity Service Advisory Group, with hugely disproportionate obstetric and medical representation, has been set up by the (federal) Health Minister.
# Key players have been invited to send a representative to three technical working groups to be convened 24 September and 12 October, as a component of the national maternity reform process. The working groups will consider PBS (pharmaceuticals), MBS (Medicare), and eligibility (credentialing).
Australian Private Midwives Assn (APMA) and ACM have been invited to send one representative each. Maternity Coalition have been invited to send two representatives. I don't know who else is to be represented.
My comment:
I will be satisfied that we are moving in the right direction if there can be agreement on broad principles underpinning midwifery practice and primary maternity care.
These principles are well articulated in the ICM Definition of the midwife.
As long as the advisors to the Health Minister are ignorant of the principles underpinning midwifery, and are able to be swayed by interest groups who advocate for midwifery to be a support service to obstetrics, these principles including partnership between a woman and her midwife, promotion of normal birth, and professional competence will not be respected in any of the outputs from working groups and advisory committees.
Sunday, September 13, 2009
Call for tenders to provide professional indemnity for midwives
From the Business section of The Australian newspaper yesterday:
"The Department of Health and Ageing is seeking tenders from capable and experienced individuals or organisations to provide insurance (in compliance with Australian insurnce legislation) to eligible privately practising midwives.
"The successful tenderer must offer professional indemnity insurance, in the form of a contract with each individual eligible privately practicing midwife who seeks such cover to provide cover for their midwifery services in a manner that is efficient, equitable and timely with effect from July 1 2010 for a total of three years. The successful tenderer must manage all claims during the contract period and certain run off claims after the expiry of the contract and must collect and provide data on incident notifications and claims to Medicare Australia. "
RFT 014/0910
REQUEST FOR TENDER
Professional Indemnity Insurance for eligible privately practising midwives
Tenders close October 8th 2009
If you have been talking to an insurer, please make sure they know about this call.
"The Department of Health and Ageing is seeking tenders from capable and experienced individuals or organisations to provide insurance (in compliance with Australian insurnce legislation) to eligible privately practising midwives.
"The successful tenderer must offer professional indemnity insurance, in the form of a contract with each individual eligible privately practicing midwife who seeks such cover to provide cover for their midwifery services in a manner that is efficient, equitable and timely with effect from July 1 2010 for a total of three years. The successful tenderer must manage all claims during the contract period and certain run off claims after the expiry of the contract and must collect and provide data on incident notifications and claims to Medicare Australia. "
RFT 014/0910
REQUEST FOR TENDER
Professional Indemnity Insurance for eligible privately practising midwives
Tenders close October 8th 2009
If you have been talking to an insurer, please make sure they know about this call.
Thursday, September 10, 2009
What will Medicare rebates mean?
A guest editorial 'Medicare rebates for midwives: An analysis of the 2009/2010 Federal Budget' appears in the September issue of the Journal of the Australian College of Midwives (ACM) (Women and Birth 2009, Volume 22 Issue 3). The authors are Liz Wilkes, Bruce Teakle, and Jenny Gamble - Queenslanders who are well known in maternity and midwifery activism. Liz is a privately practising midwife; Bruce is a homebirth dad and birth activist; and Jenny is a midwife academic.
This editorial explores some of the initial concerns that many midwives have expressed, both publicly and privately, about the wisdom and application of the government's 'reform' plans. The legislation sets conditions for midwife eligibility, including that the midwife be "appropriately qualified and experienced"; "working in collaboration with doctors"; under an "advanced midwifery credentialing framework".
The authors rightly note that the normal "full scope" of midwifery practice - which, incidentally, everyone who graduates with a midwifery qualification is supposed to be competent in - has been redefined as "advanced practice". They note that no other profession is required to be "working in collaboration" with another professional group as a separate requirement to their professional codes and competencies. And what does 'collaboration' mean? Watch this space - the definition has not been written yet. Likewise the meaning of "appropriately qualified and experienced", or the "advanced midwifery credentialing framework".
While initially midwives expressed delight at the bravery of the Health Minister to open a pathway for publicly funded private midwifery practice, the draft legislation does not look good on closer scrutiny. It lacks attention to detail, and lacks understanding of the foundations of midwifery. In a bumbling effort to prevent "polarising the professions", the legislation has managed to discard all private midwifery practice as it currently exists, considering it 'controversial'.
I consider the best option at present would be to send it all back to the drawing board.
I have been involved in the call for reform of maternity services since the mid-1990s. 'Medicare for Midwives' has been a catchy slogan that many have taken up eagerly.
I have not supported 'Medicare for Midwives'. My argument has been that the Medicare system as we know it is NOT a suitable funding system for primary maternity care. Medicare fragments care into 'items' - fragments a woman into prenatal, intrapartum, and postnatal care, as most Australian women today experience. Medicare causes buck-passing between federal and state health departments. The federal health funding covers prenatal care through Medicare rebates to doctors, and the Medicare Safety Net. State and Territory health funding covers acute care for birth and the early postnatal days. This is the domain of the hospitals. The recipient of materntiy care is pushed from pillar to post - "that's not my problem, it's theirs'"!
Holistic primary maternity care by comparison is woman-centred, meaning that the pregnant woman/mother-baby dyad are central throughout the continuum of care. Midwives providing woman-centred care work with caseloads, or at the very least in small group practices. Notions of partnership between a woman and her known midwife, promotion of normal birth, and preventative measures - all of which are fundamental elements in the international definition of the midwife (ICM 2005), are nigh impossible in fragmented models of MEDI-care.
My objections to Medicare for basic maternity have not been allayed in any way since the draft legislation has been available. It is nonsensical to imagine that midwives will be able to set up private practices that are modeled on medical practice. Noone has even attempted to describe how a midwife will practice within this Medicare-funded fragmented scheme.
Reform, like any structure, cannot work without reliable foundations. The structural framework required for reform of midwifery is to agree firstly on the principles that define midwifery. This is not a matter for a committee of interest groups, dominated by medicine, under the direction of the Health Minister. Midwifery has been defined, and the definition has been refined and updated regularly by the International Confederation of Midwives.
I do not want to see the group of reform bills pass in their current form. They fail at the very foundational level. Australian women deserve a funded maternity system that works for them and their babies.
This editorial explores some of the initial concerns that many midwives have expressed, both publicly and privately, about the wisdom and application of the government's 'reform' plans. The legislation sets conditions for midwife eligibility, including that the midwife be "appropriately qualified and experienced"; "working in collaboration with doctors"; under an "advanced midwifery credentialing framework".
The authors rightly note that the normal "full scope" of midwifery practice - which, incidentally, everyone who graduates with a midwifery qualification is supposed to be competent in - has been redefined as "advanced practice". They note that no other profession is required to be "working in collaboration" with another professional group as a separate requirement to their professional codes and competencies. And what does 'collaboration' mean? Watch this space - the definition has not been written yet. Likewise the meaning of "appropriately qualified and experienced", or the "advanced midwifery credentialing framework".
While initially midwives expressed delight at the bravery of the Health Minister to open a pathway for publicly funded private midwifery practice, the draft legislation does not look good on closer scrutiny. It lacks attention to detail, and lacks understanding of the foundations of midwifery. In a bumbling effort to prevent "polarising the professions", the legislation has managed to discard all private midwifery practice as it currently exists, considering it 'controversial'.
I consider the best option at present would be to send it all back to the drawing board.
I have been involved in the call for reform of maternity services since the mid-1990s. 'Medicare for Midwives' has been a catchy slogan that many have taken up eagerly.
I have not supported 'Medicare for Midwives'. My argument has been that the Medicare system as we know it is NOT a suitable funding system for primary maternity care. Medicare fragments care into 'items' - fragments a woman into prenatal, intrapartum, and postnatal care, as most Australian women today experience. Medicare causes buck-passing between federal and state health departments. The federal health funding covers prenatal care through Medicare rebates to doctors, and the Medicare Safety Net. State and Territory health funding covers acute care for birth and the early postnatal days. This is the domain of the hospitals. The recipient of materntiy care is pushed from pillar to post - "that's not my problem, it's theirs'"!
Holistic primary maternity care by comparison is woman-centred, meaning that the pregnant woman/mother-baby dyad are central throughout the continuum of care. Midwives providing woman-centred care work with caseloads, or at the very least in small group practices. Notions of partnership between a woman and her known midwife, promotion of normal birth, and preventative measures - all of which are fundamental elements in the international definition of the midwife (ICM 2005), are nigh impossible in fragmented models of MEDI-care.
My objections to Medicare for basic maternity have not been allayed in any way since the draft legislation has been available. It is nonsensical to imagine that midwives will be able to set up private practices that are modeled on medical practice. Noone has even attempted to describe how a midwife will practice within this Medicare-funded fragmented scheme.
Reform, like any structure, cannot work without reliable foundations. The structural framework required for reform of midwifery is to agree firstly on the principles that define midwifery. This is not a matter for a committee of interest groups, dominated by medicine, under the direction of the Health Minister. Midwifery has been defined, and the definition has been refined and updated regularly by the International Confederation of Midwives.
I do not want to see the group of reform bills pass in their current form. They fail at the very foundational level. Australian women deserve a funded maternity system that works for them and their babies.
Tuesday, September 8, 2009
What does the 2-year exemption mean?
What does it mean for privately practising midwives?
What does it mean for women who want to plan homebirth with a private midwife, as distinct from those who plan homebirth under a publicly funded scheme?
The general response by midwives to the announcement of the temporary reprieve is guarded. As I wrote last Friday, we have no reason to trust those who are advising the government, or the government itself. The woeful lack of consultation with midwives in this whole sorry saga, making us pawns that can easily be sacrificed by health ministers in their point-scoring and dodging of responsibility, has forced us to defend ourselves in a way that most midwives have never imagined we would need to do. We are not just talking about our livelihoods; which are in and of themselves legitimate and worth protecting. We are also talking about the safety and wellbeing of a group of mothers and babies whom midwives have served consistently since the beginning of human existence.
Midwives are waiting to see what hoops we will be required to jump through in order to "access the exemption".
One argument private midwives in Victoria have used in our submissions to government authorities and inquiries is the homebirth data that the Victorian government's Perinatal Data Collection Unit collects and analyses each year. It seems that no amount of evidence to the contrary can convince those at the helm of the ship of state that private midwifery practice, even with all the unreasonable restrictions that we face, is safe.
I have made an application to the Perinatal Data Collection Unit to make a Performance Indicator analysis of de-identified data for the past five years, from both homebirths and those who planned homebirth and transferred to hospital. [Here's a link to the 07-08 Performance Indicators You won't find 'Homebirth' in the publications, as our data is included in the Private Hospital aggregate data, because we provide private maternity services. There's a conundrum to consider!]
What does it mean for women who want to plan homebirth with a private midwife, as distinct from those who plan homebirth under a publicly funded scheme?
The general response by midwives to the announcement of the temporary reprieve is guarded. As I wrote last Friday, we have no reason to trust those who are advising the government, or the government itself. The woeful lack of consultation with midwives in this whole sorry saga, making us pawns that can easily be sacrificed by health ministers in their point-scoring and dodging of responsibility, has forced us to defend ourselves in a way that most midwives have never imagined we would need to do. We are not just talking about our livelihoods; which are in and of themselves legitimate and worth protecting. We are also talking about the safety and wellbeing of a group of mothers and babies whom midwives have served consistently since the beginning of human existence.
Midwives are waiting to see what hoops we will be required to jump through in order to "access the exemption".
One argument private midwives in Victoria have used in our submissions to government authorities and inquiries is the homebirth data that the Victorian government's Perinatal Data Collection Unit collects and analyses each year. It seems that no amount of evidence to the contrary can convince those at the helm of the ship of state that private midwifery practice, even with all the unreasonable restrictions that we face, is safe.
I have made an application to the Perinatal Data Collection Unit to make a Performance Indicator analysis of de-identified data for the past five years, from both homebirths and those who planned homebirth and transferred to hospital. [Here's a link to the 07-08 Performance Indicators You won't find 'Homebirth' in the publications, as our data is included in the Private Hospital aggregate data, because we provide private maternity services. There's a conundrum to consider!]
Friday, September 4, 2009
Two-year exemption from indemnity insurance announced today
A reprieve has been announced, giving more time to resolve the impasse caused by the intersection of Bill B (which makes indemnity insurance mandatory) and other bills which are designed to reform maternity services in this country.
Australian Health Ministers’ Conference
JOINT COMMUNIQUE
4 September 2009
Australian Health Ministers met in Canberra today to discuss a range of issues affecting the national health system. The meeting was chaired by ACT Minister for Health, Katy Gallagher.
...
Homebirth
Health Ministers agreed to a transitional clause in the current draft National Registration and Accreditation Scheme legislation which provides a two year exemption until June 2012 from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth.
Additional requirements to access the exemption will include;
- A requirement to provide full disclosure and informed consent that they do not have professional indemnity insurance.
- Reporting each homebirth
- Participating in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process.
These provisions will only apply to midwives working in jurisdictions which do not prohibit such practice as at the date of the implementation of the scheme.
...
Other matters referred to in the communique include Health and Hospitals Reform, H1N1 Influenza, Fourth National Mental Health Plan, BreastScreen Australia Evaluation, and Health Workforce Australia.
Comments are welcome on this and other midwifery blogs.
My initial comment centres on the requirements:
A requirement to provide full disclosure and informed consent that they do not have professional indemnity insurance.
This is not a problem. It's not as though we have been pretending that we have had indemnity insurance all these years! I wonder what 'they' think we tell our clients now?
- Reporting each homebirth
Also, not an issue in Victoria, as it seems that the only homebirths that don't get 'reported' to the government's perinatal data collection unit are the intentionally unattended births.
- Participating in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process.
This is a totally unknown entity. We will have to look at it when it happens. Past experience has included a woeful absence of consultation by government entities with privately practising midwives, so the stated commitment to consultation is something we will be looking out for!
Joy Johnston
Australian Health Ministers’ Conference
JOINT COMMUNIQUE
4 September 2009
Australian Health Ministers met in Canberra today to discuss a range of issues affecting the national health system. The meeting was chaired by ACT Minister for Health, Katy Gallagher.
...
Homebirth
Health Ministers agreed to a transitional clause in the current draft National Registration and Accreditation Scheme legislation which provides a two year exemption until June 2012 from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth.
Additional requirements to access the exemption will include;
- A requirement to provide full disclosure and informed consent that they do not have professional indemnity insurance.
- Reporting each homebirth
- Participating in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process.
These provisions will only apply to midwives working in jurisdictions which do not prohibit such practice as at the date of the implementation of the scheme.
...
Other matters referred to in the communique include Health and Hospitals Reform, H1N1 Influenza, Fourth National Mental Health Plan, BreastScreen Australia Evaluation, and Health Workforce Australia.
Comments are welcome on this and other midwifery blogs.
My initial comment centres on the requirements:
A requirement to provide full disclosure and informed consent that they do not have professional indemnity insurance.
This is not a problem. It's not as though we have been pretending that we have had indemnity insurance all these years! I wonder what 'they' think we tell our clients now?
- Reporting each homebirth
Also, not an issue in Victoria, as it seems that the only homebirths that don't get 'reported' to the government's perinatal data collection unit are the intentionally unattended births.
- Participating in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process.
This is a totally unknown entity. We will have to look at it when it happens. Past experience has included a woeful absence of consultation by government entities with privately practising midwives, so the stated commitment to consultation is something we will be looking out for!
Joy Johnston
Wednesday, September 2, 2009
a message from the Victorian Health Minister
The Minister for Health, Hon Daniel Andrews, informed a large group of midwives at the ANF (Vic Branch) conference today that midwives in private practice "need to have dialogue with us [the Department] about what would need to be included in pilot schemes [for hospital auspiced homebirth] for MIPPs to be part of them." There were three or four MIPPs in the gathering of over 150.
Minister Andrews was giving the opening address at the midwifery conference. Much of what he had to say was the same spin we had heard previously. He stressed the importance of his government's plan to introduce hospital-auspiced homebirth, and strongly reiterated his previous statements that he would not be providing any support for independent midwives to obtain indemnity insurance.
He stated that exemptions [from indemnity] would compromise the integrity of the scheme. He avoided the fact that the pilot homebirth programs are no more than a vague plan - not a reality. He said they will be up and running in 2010. [we will see!]
It was clear to me that the health minister is more interested in neat systems and schemes, putting people into boxes, than in respecting the individual woman's autonomy in primary care options, or the individual midwife's right to hang up a shingle and provide this very basic level of care in communities. This is socialist health policy on steroids - restrictions and bureaucratic systems taking precedence over the individual's right to choose who provides the most intimate care in bringing children into the world.
Andrews was dismissive of women who seek private midwifery care. He declared that homebirth is not an important option to most Victorian women. The numbers of women and midwives are too small to matter. His 'hospital in the home' style of homebirth will provide choice for "a lot of women" - tick the choice box! Too bad that most of the women in the State who will be seeking private midwifery services for births after i July next year will not be in the vacinity of the two hospital-auspiced homebirth programs. They will have to make the best choice from what's available to them. They can choose primary care from a private (specialist) obstetrician who may or may not be around if they labour spontaneously, and for that matter who has no skill in the midwife's terrain of physiological birth; or they can choose whatever fragmented model of maternity care is available via the local hospital and general practitioners, with a 'lucky dip' option of midwife allocation in the hospital when midwifery services are most needed. Or, of course, they can choose to DIY - stay at home without a midwife.
Women must stand strongly against the arrogance and rudeness of politicians who refuse to listen. Women who want a midwife to provide primary care - whether the birth is at home or hospital - actually want to avoid costly medicalisation of their births. They want the skill a known midwife brings to their birthing, enabling and protecting normal birth in most cases. Surely this is not too much to ask?
Minister Andrews was giving the opening address at the midwifery conference. Much of what he had to say was the same spin we had heard previously. He stressed the importance of his government's plan to introduce hospital-auspiced homebirth, and strongly reiterated his previous statements that he would not be providing any support for independent midwives to obtain indemnity insurance.
He stated that exemptions [from indemnity] would compromise the integrity of the scheme. He avoided the fact that the pilot homebirth programs are no more than a vague plan - not a reality. He said they will be up and running in 2010. [we will see!]
It was clear to me that the health minister is more interested in neat systems and schemes, putting people into boxes, than in respecting the individual woman's autonomy in primary care options, or the individual midwife's right to hang up a shingle and provide this very basic level of care in communities. This is socialist health policy on steroids - restrictions and bureaucratic systems taking precedence over the individual's right to choose who provides the most intimate care in bringing children into the world.
Andrews was dismissive of women who seek private midwifery care. He declared that homebirth is not an important option to most Victorian women. The numbers of women and midwives are too small to matter. His 'hospital in the home' style of homebirth will provide choice for "a lot of women" - tick the choice box! Too bad that most of the women in the State who will be seeking private midwifery services for births after i July next year will not be in the vacinity of the two hospital-auspiced homebirth programs. They will have to make the best choice from what's available to them. They can choose primary care from a private (specialist) obstetrician who may or may not be around if they labour spontaneously, and for that matter who has no skill in the midwife's terrain of physiological birth; or they can choose whatever fragmented model of maternity care is available via the local hospital and general practitioners, with a 'lucky dip' option of midwife allocation in the hospital when midwifery services are most needed. Or, of course, they can choose to DIY - stay at home without a midwife.
Women must stand strongly against the arrogance and rudeness of politicians who refuse to listen. Women who want a midwife to provide primary care - whether the birth is at home or hospital - actually want to avoid costly medicalisation of their births. They want the skill a known midwife brings to their birthing, enabling and protecting normal birth in most cases. Surely this is not too much to ask?
Subscribe to:
Posts (Atom)