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

journal of a new student

The text book: Pharmacology for Health Professionals 2011

This month I am beginning university studies at Flinders (SA), in order to undertake

"an accredited and approved program of study determined by the Board to develop midwives' skills and knowledge in prescribing"

This is a requirement for midwives who have notation on the Register as eligible for Medicare.  It is a new extension of practice for Australian midwives, as I noted in a previous post.

The topic is within a Graduate Certificate of Midwifery; will be by distance education, and is to be completed part time in one semester.  The text book, Pharmacology for Health Professionals, Bryant and Knights, 3rd edition 2011 (pictured) is a weighty tome that appears, on first glance, to be well presented and comprehensive.

I plan to make entries to this journal each week, for my own record as well as for readers who are interested. I would like to record an overview of this journey - not a step by step process. I hope to be honest and objective, not sugar-coating, and not bad-mouthing any aspect of the experience.  There will be times when I expect I will find it difficult to set aside time for focused study.  I won't be the only one experiencing this.  Any midwife who has a caseload has a high degree of unpredictability in life, when we must put the women and babies in our care first. 

I have not been enrolled in a university course since the late 1960s, and I have pretty well forgotten the details of that year! I completed hospital-based nursing studies (Royal Brisbane) in 1972, and hospital-based midwifery (Women's, Melbourne) in 1973.  I studied for, and passed exams for the International Board Certified Lactation Consultant certification on several occasions in more recent decades.  (Oh, I also studied Chinese painting, but that doesn't give me any prior learning credit!)  My other university experience is that I am a casual lecturer, tutor and marker in midwifery at Deakin University.

As I embark on this journey I wonder if my ageing mind will be a problem.  It's not that the knowledge is new learning - it will be good to review current evidence, and to check my 'knowledge' against what the course topic expects.

My style of learning is to take note of anything that varies from my current body of knowledge.  I think of it as a flashing red light, and I use this system in all areas of life.  When I listen to a lecture, or a sermon in Church, or a documentary, or read something, most is unremarkable, because it's what I expect.  But if something different comes up, I take note.  In a sense it's an editorial skill, but in stead of looking at the spelling and sentence construction, you look at the thought content and the conclusions.

When I go into my Flinders Learning Online site, and type in my password, I find topic information, and a forum to which all students of that topic are automatically connected (oh, the wonderful web and electronic databases!). There are 90 students enrolled at present.  Some have written introducing themselves; some have added a picture of themselves ...

There is an email site to which the course posts direct communication, and through which students can contact the faculty.  There are probably other aspects that I haven't found yet - you don't know what you don't know!

Enough for now.  As someone said, "Watch this space".




Thankyou for your comments

Prescribing

It was reported last week in the Australian that

Midwives still await PBS script training

by: Adam Cresswell, Health editor

From: The Australian April 20, 2012

MIDWIVES have not written a single prescription under the Pharmaceutical Benefits Scheme, nearly 18 months after they were supposed to begin, because no training courses exist to teach them safe prescribing.

Link


There are approximately 200 midwives nationally who have achieved eligibility for Medicare (MBS) and pharmaceutical benefits (PBS) - 'prescribing'.  Each of these midwives were required to sign an undertaking to the Nursing and Midwifery Board that we would
"undertake, and successfully complete, within 18 months of recognition as an eligible midwife:-

1. an accredited and approved program of study determined by the Board to develop midwives' skills and knowledge in prescribing; or
2. a program that is substantially equivalent ...  

A few midwives have completed university courses that have been accepted as 'substantially equivalent' to such an approved program of study as determined by the Board.  They have completed courses that have been accredited and approved for Nurse Practitioners, and submitted a comprehensive 'mapping' of the course against the standard set by the Board.

Many midwives, including yours truly, are waiting for (1) an 'accredited and approved program of study' before launching into this endeavour.  It is unlikely that midwives who have not commenced their course of study within 6 months of receiving notation as eligible for Medicare will be able to complete their courses within the required 18 months of recognition.