Sunday, October 3, 2010

Pondering the profession of Midwifery:

I have spent the weekend away from the email and work to try and recuperate from a really bad dose of the flu..... I must be run down, I have taken the opportunity to ponder my future..........The recent months have created much, discussion, passion, excitement, lobbying, stress, anguish, disillusionment, tension and more recently a more pronounced division within the profession of midwifery; even to the point of a midwife reporting the Australian College of Midwives to the ICM (International Confederation of Midwives) which I find extraordinary, I would of thought this would be saved for something so terrible; not here a modern, young progressive country such as ours with excellent maternal and infant outcomes however not so good midwifery services.... I am lost for words at this dissatisfaction within the ranks.....from what I can determine there is a strain of midwives that believe that no matter what the risk factor a midwife can provide the primary care without the necessary collaboration: I am particularly thinking of the twins, footling breach, high blood pressure, more than 1 caesarean at home type births; the homebirth that is not recommend at home. Any high risk category requires an obstetrician, this does not mean that you cannot have midwifery care but you have to collaborate with an obstetrician and birth in hospital.

Tawny Frog Mouth Owl (Male)

This has caused me to reflect on what my own vision is for midwifery within Australia as we are on the cusp of change or no change as it may be. Before I can discuss this it is important to say that I have only practiced midwifery in Australia for 7 years now after completing my midwifery in the United Kingdom and working there for several years, so my basic ideology of midwifery comes from my experiences in the UK. When I first arrived back to Australia as a Midwife it was extremely different and difficult to work as an autonomous midwife to the same level as in the UK, in fact impossible: I even tried the Birth Centre where I was told “no we do not do water births, you have to pull the plug out”, tried independent practice but the thought of no insurance and no support system was too much of a risk, I nearly gave up the profession several times as I felt it was a losing battle.

Nevertheless what kept me strong was the idea of being a change agent and influencing the public perception (namely women and not just the minority of women) of midwifery in Australia so I continued the journey for change and the freedom of midwifery from the medical model which is so prevalent in Australia. So how does one go about change in such a huge way, it seemed only right that you should join the peak professional body for midwives, which is the Australian College of Midwives; whose philosophy is.... “Our vision is to be the leading organisation shaping Australian maternity care for the benefit of women and their families”. The college’s work is to provide a unified voice for the midwifery profession, supporting midwives to reach their full potential and ensuring all childberaring women have access to continuity of care by a known midwife”....The College has grown significantly recently as the profession has gained recognition and respect. The numbers of midwives within Australia has been difficult to quantify.... and so too are the numbers of independent midwives; with nursing and midwifery being lumped together; However due to the new National Registration and separate registers for nurses and midwives, we will finally be able to separate nurses and midwives and determine the numbers of midwives etc;

Tawny Frog Mouth Owl (Female with baby)

Traditionally in Australia midwifery has been seen as a tack on postgraduate course to recent years we have seen the introduction of the Bachelor of Midwifery course which will also improve the profile of midwifery as being separate from nursing; ....... ever since I can remember (20yrs ago) the reputation of midwives is that “they are outspoken/bossy women” “consider themselves better than the rest” “ a bunch of dykes or lesbians” “difficult women” ‘feminists” and I am sure you know more than me, you have to wonder who put these labels upon us? And as I ponder my future.... all these anecdotal comments about midwives are no different now to 20yrs ago..... I have to say I aspire to being a “feminists in the truest sense of the word” I have always valued and wanted equality for women and I firmly believe to be a high-quality midwife one of the qualities is to be a feminist or have feminist ideology.
There are three main facts that I think are imperative to where we currently stand politically: What is a midwife: Medical dominance in obstetrics; Private Health Insurance:

The leaning tree

The role of the Midwife: I was amazed on my return to Australia how very little was known about who a midwife is? What is the role of the midwife? Coming from a system where every woman sees the midwife at 6/8 weeks at the GP surgery to women not seeing a midwife until 19/20wks...... unforgiveable for a woman & midwife. Therefore the first trimester is left to the GP/ wonder they don’t want to give this up now as it is money lost to them......I realise that funding is different here in Australia as compared to the UK, but this just illustrates that there are huge changes required for women and the medical profession in Australia; interestingly if you examine midwifery history you will see that the UK and NZ have gone through several battles similar to the ones we are going through on two fronts, that from outside midwifery (political/medical) and internally from the difference of opinion from the independent sector of midwifery.

The second main point is the medicalisation of childbirth; it seems to me that in Australia generally women take on face value what a doctor says and takes very little responsibility for their own health care or pregnancy.... they seem to have the notion that “Doctor knows best” “just do what you think is right” you are the doctor, however I think this is slowly changing, I am hoping women are changing and taking more control of their bodies and their pregnancy;

Thirdly is private health insurance; here in Australia the uptake of private health is far greater than in the UK, and women seem to think that private health equals better, higher quality health care, which is not the case. Most importantly women think that obstetrician means best possible care whilst pregnant, and this is definitely not the case; private obstetric care means higher caesarean section rates and longer stays in hospital. Yes you need an obstetrician when things go wrong or you have a high risk factor.... but there is no reason why a woman should not be seeing a midwife alongside the obstetrician....but this rarely happens.....

As far as childbirth goes, Australia has a history of being medically led, midwives and midwifery is starting to gain some recognition, up until this point there has been no funding to support the profession of midwifery; the AMA is very strong and with its blanket rule of no support for homebirth this clearly indicates there is no support from that front. The independent midwives feel that the ACM is not supportive enough because they choose to take the safe route which will benefit many women & midwives rather than a few...and this is not to say that the few are unimportant, absolutely not, but small steps of change need to occur in order for greater change to follow; therefore working towards changing a medically dominated system that cannot be changed overnight and made to accept midwifery led care when this is a whole new way of thinking, in this country....... I have always thought it is best to take small careful considered steps to success rather than giant steps trampling on people to get the same result.

My vision is similar to that of the College in that I think that every childbearing woman should have access to continuity of care by a known midwife and that
I would like to see the ACM have its own industrial arm and legal support for its membership
(separated from the ANF)...... however in saying that.....I do despair for the future of midwifery in this country with such fragmentation within the profession........ As for me I am still pondering..... Shall I stay or shall I go? Is there a point to all this?

Isabella 2yrs old, her expression says it all!


Carolyn Hastie said...

Great post Pauline. Thanks for outlining your thinking. And yes, stay. Midwifery is worth it, women are worth it, babies are worth it, the future health of society is worth it. We need all the voices, all the struggle, both ends of the spectrum because that is the way we end up with something that's rich, ripe and juicy! Also with something that has longevity. There is no doubt that the move to 'collaboration' has given some doctors the idea that they are firmly in charge. We need to ensure that maternity care is woman led, not midwife led, not doctor led, not institution led. Now we need a midwives Act. We need to keep the vision in sight. 'Without vision, the people perish'

InfoMidwife said...

Thanks Carolyn for your support

Save Homebirth

Home Birth Australia