I have recently reflected on the experience of transfer of a labouring woman from her home to the local public hospital. It's a regional city hospital, with contemporary obstetric, paediatric and anaesthetic services, and the machines that go 'ping'.
As usually happens in a transfer, a midwife takes away complex and multi-layered issues to reflect upon. In this brief record I want to highlight three points:
* the importance of seamless transfer from planned homebirth to an appropriately capable hospital
* the importance of careful decision making at each decision point
* the importance of respect by the hospital for the midwives attending the woman
1: TRANSFER
The ability to transfer from planned homebirth to hospital in a timely manner, without any sense of shame or failure by either the woman or her midwife, is an essential part of professional midwifery in the community. Much has been written in recent months about the Australian private midwife's need to *collaborate* appropriately.
2: DECISION MAKING
The process of decision making is constant and vital as labour progresses. As each observation is made a decision point is reached: the decision will be either to continue in 'Plan A', or to consider 'Plan B'. 'Plan A' is that the mother is able and willing to continue in the spontaneous natural process, with the expectation that this will lead to the best outcomes for her baby and herself, continuing in the care of her midwife(ves). Alternately, moving to 'Plan B' involves the decision that in this particular situation, intervention will be sought from specialist service providers.
3: RESPECT
The woman who transfers from planned home birth to hospital does so in a belief that she needs what the hospital is able to provide.
The woman has a right to expect a range of services within the capacity of that hospital. She also deserves respect for her choice of her private professional midwives, and the model of care.
My experience when entering some Victorian hospitals is an uneasy, awkward response from the midwives and doctors with whom I seek to collaborate. It's as though they would like to pretend that I (and midwives like me) don't have any place in the care of the woman I am attending. There is often a lack of respect for my scope of practice, and for the woman's choice of me as her care provider.
Private midwifery in Victoria, and in most of Australia, faces many challenges. Inter-professional jealousy, with the effect of excluding or threating the private midwife's right to practice, is common. Here are a couple of examples:
* A midwife attached to the regional hospital referred to above told me that the staff have been instructed to refuse to leave the room of the labouring woman when the hospital's advice is being discussed between the private midwife, the labouring woman and her partner. In an effort to ensure compliance, the woman's right to private conversation with whoever she chooses is being threatened.
* Midwives in private practice have experienced complaints to the statutory authority, complaining about their professional conduct during transfer from home to hospital. In material collected in the investigations, there appears to be a targeted trawling through records of previous cases involving the midwife under investigation and even other midwives associated with the midwife under investigation.
* Women who ask a GP doctor to order prenatal blood screening, and inform the doctor that they are planning homebirth in the care of a private midwife are increasingly being told by the doctor that he/she is unwilling/unable to provide that service; that their insurance would be jeopardised if they were seen to support homebirth.
The lack of acceptance and respect for midwives in private practice, and for the women who employ us, is a potential threat to the safety and wellbeing of the mothers and babies in our care. Midwives who fear reprisal and retribution when they need to arrange a transfer of a mother or baby to hospital may delay when the best course of action is the transfer of care.
Friday, May 28, 2010
Saturday, May 15, 2010
continuing the countdown - May
We midwives have now received the draft (13 May) 'Safety and Quality Framework for Privately Practising Midwives attending homebirths' (SQF).
Readers of this and linked blogs (such as midwivesvictoria) will be aware of concerns that the government's reform of maternity services would in fact put extreme limitations on the ability of midwives to provide primary care in the community, and particularly homebirth.
The first draft of the SQF confirmed our fears. A set of 'mandatory requirements' would effectively double-regulate midwives in private practice, as if private midwifery were a different profession from midwifery in mainstream hospital employment. In the MiPP response to the first draft, I wrote:
". ... MiPP recommends that broad inclusion factors be applied to midwives' eligibility for the exemption, rather than the fairly narrow approach that is outlined in the draft. We recommend that all midwives who are currently in private practice should be eligible for the exemption ... The only mandatory requirement should be that the midwife is registered by the National Nursing and Midwifery Board to practise midwifery without restriction."
It appears from the new draft that this recommendation has been accepted:
"This framework will be provided to the NMBA (Nursing and Midwifery Board) with the intent that it is placed in a code or guideline. ... The exemption applies [for all midwives] even without a NMBA approved code or guideline providing guidance for a quality and safety framework."
Readers of this and linked blogs (such as midwivesvictoria) will be aware of concerns that the government's reform of maternity services would in fact put extreme limitations on the ability of midwives to provide primary care in the community, and particularly homebirth.
The first draft of the SQF confirmed our fears. A set of 'mandatory requirements' would effectively double-regulate midwives in private practice, as if private midwifery were a different profession from midwifery in mainstream hospital employment. In the MiPP response to the first draft, I wrote:
". ... MiPP recommends that broad inclusion factors be applied to midwives' eligibility for the exemption, rather than the fairly narrow approach that is outlined in the draft. We recommend that all midwives who are currently in private practice should be eligible for the exemption ... The only mandatory requirement should be that the midwife is registered by the National Nursing and Midwifery Board to practise midwifery without restriction."
It appears from the new draft that this recommendation has been accepted:
"This framework will be provided to the NMBA (Nursing and Midwifery Board) with the intent that it is placed in a code or guideline. ... The exemption applies [for all midwives] even without a NMBA approved code or guideline providing guidance for a quality and safety framework."
Wednesday, May 12, 2010
Countdown - 6 weeks...
... til 1 July.
Today I was with a colleague in a cafe in Middle Camberwell when a doctor who is well known for his ongoing support of homebirth came up to our table to say hello. He asked us, "What should I tell these women who are wondering if they will be able to have a homebirth later this year?"
My colleague and I were happy to reassure him that independent midwives would be continuing to offer home birth privately after 1 July.
We had just come from a MiPP (Midwives in Private Practice) meeting. A colleague presented current information about the United Nations Convention on the Elimination of all forms of Discrimination Against Women CEDAW, and developments in the response of key women's groups to our government's maternity 'reforms'.
In recent years many midwives and birth activists have attempted, apparently in vain, to argue the midwife's right to carry out our professional business on a level playing field under Competition Policy. It now appears that the human rights aspects of home birth need to be investigated and promoted.
Is there a human rights argument in the choice of place of birth?
Is our government failing in its human rights commitments, as a signatory to conventions such as CEDAW, by maintaining the state-sanctioned discrimination against women who plan to give birth in their home?
Can you think of any other natural, physiological function of the human body for which we experience discrimination that seeks to force all to follow government-mandated management in hospital? What would our society do if similar discrimination was enacted for a uniquely MALE function?
In a previous post I reflected on the suggestion "that the Austrlian constitution has clauses that can be used in defence of women's rights to homebirth as a "natural law right".
The legislation denies a woman’s natural law right to give birth under natural physiological conditions, in the place of her choosing.
The only requirement for physiological birth is that the woman is able to proceed without medical or surgical assistance. Since pregnancy and birth are truly natural states, and are not, per se, reliant on outside management, it is reasonable to protect the woman’s natural law right to maintain personal control over such decisions, including if and when she goes to hospital.
I want to stress the distinction between physiological birth, and managed maternity care. I would not argue that there is any natural law right to induction of labour, or to medical analgesia or anaesthesia, or to surgical birth or any of the other items that are common in maternity services in this country and throughout the developed world. These are no more our 'right' than is dental care or surgery to remove an inflamed appendix. The only requirement for physiological birth is that the woman is intentional about doing the work of labour and birthing herself.
Today I was with a colleague in a cafe in Middle Camberwell when a doctor who is well known for his ongoing support of homebirth came up to our table to say hello. He asked us, "What should I tell these women who are wondering if they will be able to have a homebirth later this year?"
My colleague and I were happy to reassure him that independent midwives would be continuing to offer home birth privately after 1 July.
We had just come from a MiPP (Midwives in Private Practice) meeting. A colleague presented current information about the United Nations Convention on the Elimination of all forms of Discrimination Against Women CEDAW, and developments in the response of key women's groups to our government's maternity 'reforms'.
In recent years many midwives and birth activists have attempted, apparently in vain, to argue the midwife's right to carry out our professional business on a level playing field under Competition Policy. It now appears that the human rights aspects of home birth need to be investigated and promoted.
Is there a human rights argument in the choice of place of birth?
Is our government failing in its human rights commitments, as a signatory to conventions such as CEDAW, by maintaining the state-sanctioned discrimination against women who plan to give birth in their home?
Can you think of any other natural, physiological function of the human body for which we experience discrimination that seeks to force all to follow government-mandated management in hospital? What would our society do if similar discrimination was enacted for a uniquely MALE function?
In a previous post I reflected on the suggestion "that the Austrlian constitution has clauses that can be used in defence of women's rights to homebirth as a "natural law right".
The legislation denies a woman’s natural law right to give birth under natural physiological conditions, in the place of her choosing.
The only requirement for physiological birth is that the woman is able to proceed without medical or surgical assistance. Since pregnancy and birth are truly natural states, and are not, per se, reliant on outside management, it is reasonable to protect the woman’s natural law right to maintain personal control over such decisions, including if and when she goes to hospital.
I want to stress the distinction between physiological birth, and managed maternity care. I would not argue that there is any natural law right to induction of labour, or to medical analgesia or anaesthesia, or to surgical birth or any of the other items that are common in maternity services in this country and throughout the developed world. These are no more our 'right' than is dental care or surgery to remove an inflamed appendix. The only requirement for physiological birth is that the woman is intentional about doing the work of labour and birthing herself.
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