Countdown - 3 months

A midwife's life follows the progression of time as babies in their mothers' wombs develop. I have a calendar on the wall of my office with the names of women in my care written at the time their babies are due. These names are ticked after the baby has been born.

The other gestation that we are watching carefully is the progression towards broad reforms of midwifery regulation in this country, that will remake the face of maternity care.

The big milestones will be:


#1 1 July 2010, when legislation mandates indemnity insurance for all registered health practitioners, with a 2-year exemption for certain midwives attending home birth.
#2 1 November 2010, when eligible midwives will be able to provide services that attract public funding via Medicare rebates. Prescribing medications and ordering pathology tests will also be part of this reform.
#3 1 July 2012, when the 2-year indemnity exemption for homebirth expires.


I am confident that private midwifery practice will continue past #1, 1 July.  We expect to be able to buy private indemnity insurance products that 'cover' all aspects of our practices, except homebirth, and to meet the other requirements that are yet to be finalised.
I am also becoming more confident that a means will be found whereby some established independent midwives will be able to incorporate #2, the Medicare and related reforms into their practices.

Some midwives will seek to continue private practice without public funding.  The reasons they will give for taking this approach include

• too many bureaucratic hoops to jump through
• professional decision making being constrained by impersonal guidelines
• excessive paperwork anticipated
• fear of ... 

The requirement for 'collaboration' by midwives has been written into various levels of the new regulation.  The picture that has been erroneously painted is that independent midwives set ourselves up as a 'one-stop shop', avoiding collaboration with the medical profession.  This is untrue.  This is fear-mongering by those who do not want midwives recognised in Australia as professionals with a discreet body of knowledge and scope of practice.


Under the legislative reforms, midwives will be REQUIRED to have collaborative arrangements with doctors. 
Doctors will not be required to return the favour.

I have concluded that the most obvious meaning of the verb 'collaborate' - to co-labour or to work together - is not understood.

Last week I attended a meeting hosted by the National Health and Medical Research Council (NHMRC), in which stakeholders were given an opportunity to comment on a draft document 'National Guidance on Collaborative Maternity Care'.  This is an extensive document that has a lot of good midwifery stuff in it.   A great deal of government funded work has gone into fixing a problem that doesn't exist.


When we move the focus of maternity care from the providers (midwives/doctors/hospitals/health services) to the individual pregnant/birthing woman (+child), the needs of the recipient(s) of care direct the service, rather than the service directing the recipients.

This is woman-centred care.

A woman who is well, and progressing without complication through pregnancy and birth, in the care of a midwife does not need to be seen by an obstetrician, a GP, a neurosurgeon or any other doctor.  Collaborative arrangements are in place, without being enacted for that episode of care.  But a woman who develops severe headaches in pregnancy may access specialist care (not necessarily healing or wellness, unfortunately) when the midwife coordinating her care advises her to consult with an obstetrician, who may refer her on to a brain specialist. 


Enough from me for now!
Joy