Thursday, July 22, 2010

Collaborative arrangements for Midwives:

Well; after a long awaited time we finally know what the collaborative arrangements are.....I must say I am disappointed...after lots of negotiation I feel let down and that the machinery of money, politics and power have yet again trampled on the profession of midwifery.

The other issue is the upcoming election; we are in a crucial stage....Labour stays so does the current status quo...Liberal in and we lose it all....I do think that NICOLA ROXON Minister for Health and Ageing has tried to do the best for Midwives and also trying to accommodate the AMA.....without losing any ground and yes she too has to protect her position so that Labour remains in power.

This document is hard to read, you need to read it several times to work out exactly what it is saying.
For example if you read this section:
Specified medical practitioners
For the definition of authorised midwife in subsection 84 (1) of the Act, the
following kinds of medical practitioner are specified:
(a) an obstetrician;
(b) a medical practitioner who provides obstetric services;
(c) a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative

First impression is that an independent midwife or private practice midwife cannot practice without having an obstetrician sign them off..... however (c) indicates that any hospital doctor can act as an collaborative partner...therefore the hospital will act as an collaborative partner....

Now if we look at section 7: this part is more hopeful in that if we get a hospital to support private practice this will work as collaborative arrangement: we could extend it to domino births.....the problem with all this collaborative how much is truly required.... if everything is normal then there needs to be no collaboration....and yes...there has to be a hospital booking which will mean collaboration with a least once..but thereafter you would not see the doctor again if everything is normal....and this is as it should be.....

Arrangement — midwife’s written records
(1) An eligible midwife must record the following for a patient in the midwife’s
written records:
(a) the name of at least 1 specified medical practitioner who is, or will be,
collaborating with the midwife in the patient’s care (a named medical
practitioner);(b) that the midwife has told the patient that the midwife will be providing midwifery services to the patient in collaboration with 1 or more
specified medical practitioners in accordance with this section;
(c) acknowledgement by a named medical practitioner that the practitioner
will be collaborating in the patient’s care;

If doctors truly were collaborative they would be referring more women to our current Birth Centers, but they do not because they want the control and money.... It is hard to even imagine that doctors will refer to the midwife....for normal care...because they do not even believe in Birth Centres.... how will they make this massive change when they do not even support homebirth.....?
I would like to see that they are made to refer women to midwives... instead of the old school boy tie club and kick backs to specialists.....

The bottom line is, it's the women's is about continuity of care and that every woman needs a midwife.

Keep focused on the dream, the passion and the right of women to choose where they want to birth their babies, the right to informed choice and the right to have a midwife.

Click on this link:
National Health (Collaborative arrangements for midwives) Determination 2010

Wednesday, July 21, 2010

Midwife struck off for failure to keep documenation

A UK midwife was found guilty of misconduct and struck off the Nursing and Midwifery Council register for failing to keep contemporaneous records, she also made similar mistakes with a second patient and failed to record observations and inform colleagues about two others.
"The panel's conclusion is that the registrant's continued registration would represent a serious continuing risk to the safety of patients," it added.

"The panel has decided it is necessary to make an interim suspension order for 18 months, in the public interest and for the protection of the public."

NEW SOUTH WALES, Australia: According to Health Care Complaints Commission dated 07/06/2010, a registered midwife, was found guilty of professional misconduct. The Nurses and Midwives Tribunal of New South Wales said that the midwife's conduct in a home delivery demonstrated a series of serious misjudgments and that she lacked insight into the standards of practice for midwives.

The Nurses and Midwives Tribunal of New South Wales ordered that the midwife should be deregistered for a period of 12 months. The midwife carried out a home delivery involving multiple births which was outside her scope. The midwife only recorded the mother’s vital signs twice during a 13 ½ hour labor and should have called an ambulance shortly after the birth of the baby.

Principles of good documentation: Remember if it is not written it is not done!
Your records need to reflect the care you have provided; it tells a time line account of the care provided to the woman;

NMC Record Keeping for Nurses and Midwives:

Handwriting should be legible.
All entries to records should be signed. In the case of written
records, the person’s name and job title should be printed
alongside the first entry.
In line with local policy, you should put the date and time on all
records. This should be in real time and chronological order,
and be as close to the actual time as possible.
Your records should be accurate and recorded in such a way
that the meaning is clear.
Records should be factual and not include unnecessary
abbreviations, jargon, meaningless phrases or irrelevant
You should use your professional judgement to decide what
is relevant and what should be recorded.
You should record details of any assessments and reviews
undertaken, and provide clear evidence of the arrangements
you have made for future and ongoing care. This should
also include details of information given about care
and treatment.
Records should identify any risks or problems that have arisen
and show the action taken to deal with them.
You have a duty to communicate fully and eff ectively with your
colleagues, ensuring that they have all the information they
need about the people in your care.
You must not alter or destroy any records without being
authorised to do so.
In the unlikely event that you need to alter your own or
another healthcare professional’s records, you must give
your name and job title, and sign and date the original
documentation. You should make sure that the alterations
you make, and the original record, are clear and auditable.
Where appropriate, the person in your care, or their carer,
should be involved in the record keeping process.
The language that you use should be easily understood
by the people in your care.
Records should be readable when photocopied or scanned.
You should not use coded expressions of sarcasm or
humorous abbreviations to describe the people in your care.
You should not falsify records.

Remember that your documentation will protect you in a court of law, as it is the only protection you have as often these cases come to court many years later.

Sunday, July 11, 2010

Homebirth hits the news again.

The other morning I woke to the news of "Danni Minogue is rushed to hospital for a Cesarean section, doctors save mother and baby in a Nick of time...Homebirth emergency",I was incensed. This was complete sensationalism by the media....Again today the headlines read: Minogue ditches home birth over safety fears's a way of grabbing headlines and selling newspapers again without having complete this current climate of Homebirth being the focus of news and the government not providing private practice midwives insurance cover. It almost seems like we will take any opportunity to bash Homebirth.
There was no mention of the good professional care that Danni received.... that the midwife is a professional who provides continuity of care and collaborates with other professionals, this includes knowing when to safely transfer care to a teritary unit...this is good midwifery care and excellent collaborative care.....ah but no, the media and some doctors decide to jump on the bandwagon and start to knock the woman's choice and demand that Homebirth is unsafe.....what was unsafe about what occurred....Danni would most likely have had the same outcome in a hospital birth.... women have the right to choose Homebirth and this case shows good collaborative care with the woman being the centre of care and focus.

The Australian today published a comment made by Dr Barry Walters WA who said "DANNII Minogue is better at judging performers than she is in making choices about childbirth".
Many studies show maternal complications and stillbirths are more common in women who deliver at home. The decision to try homebirth is based on ideology, not on concern for the baby. Most women will experience a wonderful and fulfilling event, assisted by caring midwives, when they deliver their baby in hospital. Don't play Russian roulette with a baby. Babies don't care where they are born.

This comment by the good doctor is arrogance at its best, negating women's right to choose and insulting their intelligence because it is not his choice. Danni Minogue has every right to make an informed choice and based on the evidence Homebirth is not playing Russian Roulette.
Clearly this Doctor has not read the recent studies on Homebirth: In the private and public sector the evidence has shown a strong safety for homebirth. Women want more control around the birth of their baby. Control provides greater satisfaction especially psychologically. Studies also show that 30% of women found that their hospital birth was traumatic. Women want continuity of care by a known midwife and this happens at home and can happen in a hospital.
Congratulations Danni & Kris and the birth of your son Ethan:the joys of parenthood begin enjoy the journey.

New Registration Fees for Midwives in Australia

National Registration came in effect 1st July 2010 except for WA.....check out the new National Fees and categories for registration: AHPRA Midwife Fees

Nursing & Midwifery Board of Australia
Schedule of fees $115.00 per year.

Friday, July 9, 2010

Alice Springs Review

Can you spot the Rock! Click the picture to see the album of photo's.

Our trip to Alice Springs started with a Bus trip (Emu Run Tours)0600 to 2330hrs....a long day, as we (6) were prepared for the day I had some papers to mark and my book (Tuscan Rose by Belinda Alexandra)to read along the way, plus my bottle of water and off course some chocolate. The bus picks you up from the hotel surprisingly there were approximately 12 midwives on the was a great way to see the rock if you have limited time and someone else does the driving.....lucky for us it was a fine day, cold but fine...some of us had Spencer's and long johns on to keep warm. We travelled south from Alice Springs, passing through the MacDonnell Ranges, breakfast was on the bus then our first stop was at Erldunda Roadhouse and Aboriginal art display. We arrived at Uluru around midday and stopped at the Visitors Centre. We have lunch and travel to the Olgas. Back to Ayers Rock and visit the Aboriginal Cultural Centre. Joan and I decided that we would do a mini walk of Uluru.... I got about a quarter of the way up.... it became to steep for me and I did not have hiking boots was to slippery for me and not being fit was also a draw back...Joan did very well she manged to get to the top and start walking along the flat surface....but we only had 40 mins... and it takes about 2.5hrs to do the whole walk. I was happy with just sitting and taking in the beauty and spirituality of the really was breath taking....I came down and walked around the base breathing in the clean air.... I was delirious with a sense of truly was special......

Our accomodation was the Palms Springs Resort....about a 10 min walk to the confernece centre and a 20 min walk to town. The Conference was a great success, it was good to see nurses, midwives, doctors all working together for the common goal..... a healthy nation, closing the gap in Indigenous health care. For me it was good to hear all the keynote speakers, the resounding message was....."collaboration" is the key to successful relationship between health professionals. Dr Paul Reuwer, said "I love midwives" "Midwives need to be the key provider, they should be in charge and they should be referring to the Obstetrician". The thing I like most about conferences is that you can network, catch up with old friends, make new friends and generally spend time with like minded people spreading the word about midwifery and learning from each other. There were two evening events... the Beanie and Ballgown Party followed by the Conference dinner... one of the best nights is when the girls all went into town to Bojangles and danced the night away.....oh and guess what I didn't take my camera that night....

The town of Alice Springs is interesting.... a population of 25,000 people of which 85% are indigenous....the town has approx 13 indigenous campsites, some do not have established infrastructure. Its the first place I have seen so many dry river beds... The Todd River was bone dry.... however in the wet season it can get flooded....The local shops cater for most of your needs, clearly no boutique shops as it is a small town, Coles, Woolworth's and Target...what more could you ask for... a good variety of restaurants and pubs...there is no shortage of bottle shops and the town has a good taxi service...the last taxi driver was chatting to me and took me on a tour of some of the town campsites... he has lived in the town for 20 years and was telling me about all the changes and also how he felt that things could be done differently and better....for the people of Alice Springs. Would I go back to Alice Springs?.... maybe on my way to see Kings Valley and with my husband, including it in a wider tour of the central area including Katherine and the gorges..... A tip...if you are short of time and only want to see Uluru...the bus tour is a good solution, well worth seeing the Rock......another tick on the bucket list.......

Tuesday, July 6, 2010

Integrity, democracy, bullying and respectful communication; a philosophical discussion:

This blog will examine the meaning of these words in relation to women, midwifery and the meaning of life. I consider integrity fundamental to my life and practice therefore it is essential to midwifery. Bullying has such wide ranging implications and forever present in many formats throughout life..... We are constantly reviewing bullying strategies to prevent the phenomenon. Democracy, the choice for one vote, one person....and lastly how do we attain respectful communication? These principles are all very dear to me and I get very upset whenever I see that they are being discarded for the sake of what is perceived to be “the greater good” by some people. The question is “whose greater good?”
Yes we all know that integrity means honest, trustworthy, one’s own beliefs, and values at all times..... Here is how Wiki defines......Integrity is a concept of consistency (lack of contradiction) of actions, values, methods, measures, principles, expectations and outcomes. In western ethics, integrity is regarded as the quality of having an intuitive sense of honesty and truthfulness in regard to the motivations for one's actions. The word "integrity" stems from the Latin adjective integer (whole, complete). In this context, integrity is the inner sense of "wholeness" deriving from qualities such as honesty and consistency of character. As such, one may judge that others "have integrity" to the extent that one judges whether they behave according to the values, beliefs and principles they claim to hold (From Wikipedia, the free encyclopedia).
Integrity acting on what you believe is right and wrong.... discovering the truth? Efforts to arrive at either the truth or a mutually equitable outcome, this leads to respectful communication:

Democracy means elected by the people....a majority rule.....equal rights....... well know what that terms of Australian Politics this doesn’t quite ring true with the recent events of the spill of Kevin Rudd and the current PM Julia Gillard..... However there are always exceptions to the rule... nevertheless integrity is required.... remember truth and honesty.... which is something not terribly renowned for politicians.

Bullying.... now this is the hot topic.....the definition of bullying is as follows...... Bullying is defined by the effect of the behaviour, even though there may not be a specific intent to bully. In my experience people don’t always mean to be a bully.... and often it is unintentional however unacceptable. For more information read this report....Dealing with bullying at work; a guide for workers.

There are bound to be occasional differences of opinion, conflicts and problems in working relationships, these are part of working life. But when treatment of another person is unreasonable or offensive, then workplace bullying exists and should not be tolerated. Interestingly all workers and other people at workplaces are potentially at risk of experiencing some form of bullying. Different researchers have found examples of victims who are younger, weaker, less important, less experienced and those with less social skills, as well as those who are highly skilled, competent and high achievers, who are trusting, creative, and politically inept and have a high degree of loyalty to the organisation.

It is a very difficult position to find yourself...being overtly know its happening yet you are still powerless and fearful... and often it can be from respected people...the question is how do you deal with it? there is no point being like a bull at a gate.... but careful consideration is required.... you can just walk away...then you may feel that your integrity is questioned...because this could happen to someone else... and really the culture has to change.... therefore careful consideration is my case it will result in a well constructed letter out lining the issues and hopefully this will not happen again...if all else fails... walk here for the cycle of bullying:

The answer is respectful communication; Dealing with difficult conversations and conflict is never easy but the sooner you start communicating effectively, the easier it will be to resolve your dispute. It always sounds so simple..... but in the vast majority of cases, most people want to continue their relationship with the party or parties they are currently having problems with, particularly if they are family members or work colleagues. To avoid damaging relationships in the process, so they can be maintained or even strengthened and improved once the issues are dealt with, it is helpful to learn more about effective communication. One way to communicate more effectively is to treat the person you are addressing respectfully.... even if you do not really respect him or her....Exhibiting disrespect is almost never helpful, as it immediately places the listener in an adversarial, and hostile frame of mind. You need to state your differences that do not belittle the other example would be... “that’s a stupid project to choose... I will resign if you do that” it would be more helpful for you could say.... “I see the situation differently ..... I can do the best project for xyz reasons” is a real tragedy when midwives bully....and even more of a tragedy when they do not even know they are doing women, peers, subordinates.... in fact to anyone is just unacceptable....unfortunately it seems to be an accepted culture.... and I for one will not stand by and watch it happen.... please be true to yourself and speak up....for the sake of others....

Its about, truth, honesty, choice, equity and respectful communication.....! treating each other with respect.

"Coming together is a beginning. Keeping together is progress. Working together is success." - Henry Ford

Ref: Towards Dignity and Respect: An exploration of Antecedents and Consequences of Bullying Behaviour in the Workplace, Maryam Omari, 2003, Curtin University, Western Australia


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