Saturday, November 19, 2011

No Collaborative Agreements: No equality or justice:


12 months on and I still do not have access or a collaborative agreement:

As a private practice midwife I have not been able to secure a written collaborative agreement or access to hospitals to facilitate the care of my private clients; Unfortunately for the women of WA, there is only one Tertiary hospital and to date this hospital has not supported the role of the 'eligible midwife' or women's choice to be cared for by a private midwife within the tertiary hospital setting. This is totally unacceptable and goes against the governments National Maternity Plan initiative.

There have been many obstacles to try and implement midwifery reform within Australia: To date as far as I am aware there are a handful of collaborative agreements and no credential pathways for access to hospitals for private midwives:

If you remember the National Health Collaborative Determination July 2010 outlines the requirements for private midwives to work within the community; This Determination is clearly not working; for whatever reasons, personal or professional 95% of Obstetricians / GP Obstetricians are not choosing to enter into a formal collaborate agreement with midwives; There has to be a better system in place that does not require midwives to be reliant on Obstetricians who clearly do not want to collaborate -this effectively puts a midwife out of business, and gives women little or no choice. This will not stop women, they will just birth without a midwife.

I have written to over 50 Obstetricians, receiving only 3 responses (negative): the latest response being:
"I do not intend to enter into one of these agreements...... Planned birth at home is clearly associated with higher rates of both perinatal morbidity and mortality and I cannot support it"
.... he went on to wish me well in my venture..... Just how well does he think I am going to do with no hope of getting a collaborative agreement? Maybe that is the plan! This appears to be the general attitude of Obstetricians in WA. The evidence clearly supports homebirth for low risk women, however my request was for continuity of midwifery care not homebirth.

The Determination has to be changed or rescinded to stop the monopoly and control of doctors over midwives, this system is clearly not working;

Just taking a step backwards;

From November 1 2010, women receiving midwifery care could claim a Medicare rebate for services rendered from an eligible midwife:

On 12 November 2010, the National Maternity Services Plan (the Plan) was endorsed by the Australian Health Ministers’ Conference.
The Plan recognises the importance of maternity services within the health system and provides a strategic national framework, as endorsed by state, territory and Commonwealth Governments for the five year period 2010-2015

Within the first 12 months the plan's priority 1 was to:

1.2.1 Australian governments facilitate increased access to midwifery-managed models of care for normal risk women, e.g. midwifery group practice or birthing centres, while maintaining support for choice of, and access to, medically managed
models of care. Australian governments facilitate increased access for public patients to midwifery and medical practitioner continuity of carer programs

1.2.2 Jurisdictions develop consistent approaches to the provision of clinical
privileges within public maternity services, to enable admitting and practice rights for eligible midwives and medical practitioners
NOT ACHIEVED - the first year has passed and we are no closer to achieving these outcomes;
It is apparent that women are not being offered true choice within maternity services and Health Services are required to be more flexible. The evidence is clear that midwifery continuity of carer affords better outcomes for women; it reduces intervention and provides for improved parenting. This includes homebirth as an option for uncomplicated pregnancies. Therefore it is imperative, to achieve the strict intention of the National Maternity Services Plan, to protect mothers, babies and achieve best outcomes in maternity care, the Australian Health Ministers need to provide PII insurance for Intrapartum care at home for uncomplicated pregnancies, rescind the current Determination requiring written collaborative arrangements with an obstetrician and compel local Health Districts / Services to provide clinical privileges for eligible midwives, as a matter of urgency.


Ref: picture: http://www.ontheissuesmagazine.com/2010summer/2010summer_Ross.phpA Feminist Vision: No Justice-No Equity by Loretta Ross - My mother always asked the question, "Why would I want to be equal to men, when I've been superior to them all my life?"

Tuesday, October 25, 2011

Head on the chopping block – HOMEBIRTH:



Homebirth the hot topic: combine that with autonomy, women’s choice of place of birth no matter what the risk factor and you have an explosive cocktail and a subject that will divide a nation. There has been much written on this subject and sadly what is bringing it to the forefront again is term foetuses (babies) dying at home, with or without a health professional.

In 2009 there were 30,760 women giving birth in WA and the average age was 29.5yrs, the majority of women (98.8%) gave birth in hospital. Non Hospital births 1.2% including Born Before Arrival (BBA) (0.4%) and babies born at home (0.8%). The caesarean section rate was 33.3% (10,241) of the women recorded as having had a previous caesarean section 87.1% had a repeat section. What we need to be doing is reducing the caesarean section rate and concentrating on is promoting normal birth.

In 2010 WA had 245 homebirths, 203 occurred with the Community Midwifery Program and 42 homebirths with private practice midwives. We have 19 private practice midwives registered with the Health Dept and 5 eligible midwives.

This debate about homebirth revolves around less than 1% of women, not that I am suggesting that their views are not important; however there are 99% of women that need midwifery input to improve their birth experiences. It seems that a disproportionate amount of time is spent on homebirth in relation to the work that needs to be done to improve maternity services for all women.

I will start with my position as a midwife on the subject in the current Australian context;

Do I believe that women have the right to choose where and how to give birth? YES.

Do all women need a midwife throughout the continuum of pregnancy, birth and postnatal period? YES.

Should homebirth be an option for all women? The evidence shows that homebirth is safe for uncomplicated pregnancies.

Should all women have a midwife? YES

Should high risk women birth at home supported by a midwife? This is the six million dollar question; professionally and personally I would answer NO, based on the lack of protection for the midwife to facilitate this choice. However it is not that simple; usually women who are choosing homebirth for high risk pregnancies have experienced some sort of birth trauma, are extremely fearful of hospital and usually have knowledge of the associated risks, each case needs to be evaluated individually. It is unfair to label all these women as zealots or radical. What needs to happen is to listen to what the issues are and find more flexible ways to support these women providing continuity of midwifery care, collaboration with an obstetrician within a safe health system.

What is a problem is if midwives / or de-registered midwives keep supporting high risk homebirth without collaboration and health service support. Recently there have been several high risk homebirth deaths. If the term fetus (babies) keeps dying in the homebirth setting we will be endangering homebirth for uncomplicated pregnancies. Worse still women will lose their autonomy because the term foetus will be afforded more rights similar to what has happened in the USA. Currently in Australia a foetus has no rights under law until born alive, but this concept is being challenged.

What needs to happen is that health services need to be more flexible, by having visiting rights for private practice midwives allowing them to bring their women into hospital and continue to caring for them. When fearful women present they should be facilitated to birth in a low risk setting such as a secondary hospital or birth centre supported by the tertiary hospital. Specialist obstetricians could travel to see the women and support the secondary hospital – it is about being flexible – considering the psycho-social issues of the women. Having all high risk women being herded into a hospital like cattle is giving them no choice or options therefore creating more fear. Remembering there is established legal principle that a mentally competent woman can refuse treatment. It is no wonder that these women choose to birth at home or freebirth. Freebirth is an unsafe and unacceptable practice and Health Services are failing women if this is the only option they feel they have.

We as midwives need some sort of supervision or mentoring system to support us in difficult clinical situations therefore allowing us to support these women. We need legislative changes to protect the midwife to stay with women no matter what the risk and where she chooses to birth, we need health services to be more flexible and supportive. We need women to be demanding that Health Services and Doctors be flexible, it’s about open communication and negotiation.

Three questions:

What do you think about the homebirth debate?
Would you have a high risk birth at home?
Would you freebirth?



Ref: WA Mothers and Babies 27th Annual Report – Midwives Notification System
photo credit: http://offthebroiler.wordpress.com/2006/11/21/death-of-a-turkey/

Sunday, August 28, 2011

Inspired.....


It's been a difficult week and I am sure next week the news will be all about Homebirth and midwives... so brace yourselves: Today I rekindled my passion, after a hard week.
“Courage is going from failure to failure without losing enthusiasm.” – Winston Churchill

I was delighted when I was asked to talk to a group of midwives who wanted more information about becoming a eligible midwife, we certainly need more: I was greeted by approximately 10 wonderful midwives and a consumer, all keen to learn more about setting up their own business and eligibility: we spent the next two hours discussing the current issues for midwives and some of the difficulties that we are facing as a profession. Whilst I acknowledged that we have some difficulties, I do think that we need to continue to put pressure on the government to follow through on the Maternity reforms; issues such as visiting rights for eligible midwives, so that continuity of midwifery care is an option for all women.
What I found fantastic about today was the interest and that it was younger midwives who traditionally have worked in a hospital who are embracing these new challenges and thinking about working in a different model of care, being more autonomous and wanting to work in the community...which is best for women, and what we all strive for...they were looking for ways of making it work within their current settings....it was really exciting to work with them to suggest the best ways forward for change... it is very important to have change agents spread out to inspire and encourage these changes; change is about knowing people, its about being passionate.... change sticks when people embrace it..and that is what we have to do... I see such potential in midwives being able to set up antenatal clinics....working side by side with Obstetricians, shared care - and six weeks postnatal care that we can provide in the woman's home, how brilliant is that? once a few people start doing it...the knock on effect will be phenomenal.... the issue is that the doctors are fearful of losing control ...and we all know when people are fearful they do things they would not normally do:

Yes we are currently experiencing some issues and that's because this whole concept is new, there is much change and not just small changes they are all huge... National Registration, new Act, insurance, Medicare provider numbers: no wonder we are all reeling with fear.... these are catastrophic changes - independent midwifery has never been so regulated... and this all creates an atmosphere of mistrust: we have to work together...

I found it refreshing today to meet so many midwives that were keen to begin to think about working within a different model of care and this gave me great hope for the future...we need to embrace the changes and work together to implement different models of care...and challenge the medical model, with this comes a word of caution.... the consumer demand has to be present; women need to want 'continuity of midwifery care'.

We still have some major hurdles to overcome with the maternity reforms: collaboration, indemnity insurance, visiting rights and more midwives to take up eligibility.

“The greatest barrier to success is the fear of failure.” – Sven Goran Eriksson

Wednesday, August 24, 2011

Confusion reigns.......


A sad state of affairs: it seems that continuity of midwifery care is the last thing on anyone’s political mind:

To say I am confused would be an understatement; two urgent issues: Insurance and the practice role of a midwife: for months I have been asking the question can a Midwife be a support person or advertise as a doula? to me a Midwife is a Midwife is a Midwife, not a doula or support person.....these are all roles within the scope of a midwife...I remember as a registered nurse you could not work as a career I would think the same would apply to midwifery; however due to the recent kerfuffle surrounding private insurance for midwives and the requirements of the regulatory agency... midwives have been looking at different ways of presenting themselves to elevate some of these problems and still support the woman and her choice. I have written twice to NMBA asking for clarification on this issue... Today a colleague highlighted to me that on the AHPRA website under frequently asked questions; ‘Regency of Practice’ gives a definition of what is meant by ‘Practice’ http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ.aspx
Q2. What is meant by ‘Practice’?
A. Practice means any role, whether remunerated or not, in which the individual uses their skills and knowledge as a nurse or midwife. For the purposes of this registration standard, practice is not restricted to the provision of direct clinical care. It also includes working in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on safe, effective delivery

In effect this means if you are a registered midwife you cannot act as a support person or a doula, because we have the knowledge and skills of a midwife.....this has far reaching repercussions and when you add the recent problem with the MIGA insurance into the picture it gets worse.

The MIGA cover clearly states you are not covered for
“midwifery services which are provided by you to a public patient (even if the public patient is in a private hospital).
This then leads me to the question when you are working in a hospital and you finish your shift and you stay back to support the woman because you choose too...because of the bond you have with your woman...this may be seen as interference as the woman may look to you for a clinical decision... in effect this will not be permitted as you will not be covered by the hospitals vicarious liability insurance because your role is a midwife not a support person.....I may have got the wrong end of the stick, but what’s good for one is good for all....

We as midwives are now backed into a corner... One would think with the Medicare provider number and the maternity reforms midwives would be rejoicing ...however the long arduous road to credentialing / visiting rights to hospitals have created many problems; the process is taking too long; the inability of obstetricians to agree to collaborative arrangements have left the maternity reforms in tatters....and the personal cost to many midwives trying to make this work is enormous; I am paying MIGA for the privilege to be insured only to find that I am not and its good money going out the window, I don’t have money to waist, however it seems that MIGA is profiting very well from this venture. At the end of the day both women and midwives are suffering here and the process are very unclear.... the only time you find out that something is wrong is when you have been reported... this is all unacceptable.

I have had good support from the Minister of Health WA, Office of the Chief Nurse/Midwife and the Chief Medical Officer, however this is not enough, no one can make collaboration happen:
As for collaborative arrangements, I have written over 40 letters to GP Obstetricians and Obstetricians asking for a collaborative agreement and have had one response, politely saying ‘no’. Where does this leave me...absolutely no where?
The other day I went with my client to meet her obstetrician, you know build bridges, be nice etc and he could barley look at me...he never addressed me once, there was no professional courtesy. How are we to move forward when we are met with such resistance.... it is a sad state of affairs. My client employed an independent midwife so that she could have continuity of care with a midwife, she choose a midwife for her knowledge and experience to enable her to facilitate the birth she wants knowing that the midwife would support her through this process.... this now is even a problem.

I also pay premium insurance through MIGA and it seems for nothing: I have no hospital access, no collaborative arrangement; yes I do have women booked, now I am in a quandary what to do; that I cannot be a support person because this may be a reportable offence this leaves us nowhere to move......my only saving grace is that I have access to a hospital as a casual midwife but this is only a temporary solution so one client is safe...as for the others I will have to bare the consequence as I have committed to being a support person... something has to give soon. I may have to look at not booking anyone further until the processes are in place and who knows when that will be...

Please if anyone has any further news on this issue let me know...
Very frustrated and disillusioned eligible midwife:

Monday, August 8, 2011

ACM Interim Homebirth Position Statement and Guidance for Private Practice Midwives


It is long overdue, a position statement on Homebirth for Australia from the ACM, well done: since 1987 RANZCOG has had an endorsed position statement that opposes homebirth: Since 2007 there has been a joint statement from the RCM & RCOG supporting homebirth for low risk women:

Now the ACM has an interim position statement that supports homebirth for the woman who has a 'low risk'; which is in line with the current Australian Legislation: The ACM cannot contradict the regulatory authority which created the Quality and Safety Framework.

This brings me to the Introduction of the Statement; yes 'women have the right to choose where and how they wish to give birth'..... as I have discussed before in previous blogs...women always have this choice...what they don't have is the right to a midwife to support that choice...because of how the legislation is set-up here.... for women that are in a 'risk category' a midwife needs to consult and collaborate with an obstetrician and this does not happen.... certainly not in WA....this is not from a lack of trying from private practice midwives / independent midwives to collaborate with doctors; As a privately practising midwife I have tried to no avail to get doctors to collaborate; they do not answer emails, letters phone calls. I have had some success with one doctor however the doctor is reluctant to put anything in writing.
A midwife owes the woman a duty of care to provide a safe environment and work within the defined scope of practice...very few obstetricians will support a homebirth for any risk category....and here we have a quandary; unlike the UK that supports midwives to support women in whatever choices they make.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
(RANZCOG) does not endorse Home Birth.

In Australia about 0.2% of women deliver their babies at home. However this may be an underestimate, as it is unlikely that all babies born at home are recorded in perinatal data collection statistics.
Whilst mindful of a women’s right to personal autonomy and decision making, RANZCOG
cannot support the practice of Home Birth due to its inherent risks and the ready availability of safer birthing practices. Where a woman chooses to pursue Home Birth, it is important that this is an informed choice, considering all the benefits and possible adverse outcomes.

RCOG and Royal College of Midwives joint statement
The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.


The ACM is the professional body for midwives and I urge midwives to comment on the Position statement: contact the college and express your point of view, do you agree with it? How would you change it? give a balanced view:
Send submissions by email to info@midwives.org.au or by post to PO Box 87, Deakin West ACT 2600. Only submissions with identified senders and a return address will be considered, you have until 23rd September 2011.

As for me I've read lots of comments on the Statement and the guidance document, one comment that keeps appearing is that a scarred uterus is a 'new concept' or 'new rule'.... this is nothing new.... a scarred uterus has always been considered 'high risk' I suppose what is new is the terminology of a scarred uterus...but the concept is old...

My objection with the Guidance Document is the fact that as a private practising midwife we are required to consult with an obstetrician prior to or at booking-in: this is an unrealistic expectation; I am usually booking a woman at anywhere from 8-12 weeks: I would prefer a booking visit with the obstetrician at 20 weeks to discuss the plan of care: The Woman is encouraged to attend this appointment with her midwife and create a plan of care...if the woman chooses a different pathway this also needs to be discussed and a plan made to facilitate this choice: this is clearly documented and all parties sign the document understanding all the risks associated with it: however I am not sure that this will be enough to protect the midwife in a court of law: What we need to be working towards is a continuity of care model...supporting high risk women to birth in hospital with her private midwife having visiting rights to all hospitals.

Remember please to send your comments to: info@midwives.org.au

Tuesday, July 26, 2011

Report concerns or risks......


Mandatory reporting is not only in Australia.... the UK is calling for more health professionals to blow the whistle...
NHS staff told to 'report concerns or risk investigation'
Health regulators should warn nurses, doctors and midwives they may be investigated if they fail to report concerns about colleagues, MPs say.

The General Medical Council (GMC), which regulates doctors, said it was committed to doing more in this area.

It is interesting that not many doctors report each other, the old school boy tie mentality is alive and well.... this is evident by the following statement;
The GMC is currently investigating doctors at Stafford Hospital whose own work was blameless, but who allegedly failed to report colleagues.

It seems though no one has a problem about reporting nurses and midwives.....
maybe the culture will change and there will be fairness about reporting all unsafe health practitioners or health practitioners that put the public at risk....

We have to remember it is about professional responsibility, being aware of professional codes and guidelines and aware of what is good and poor clinical practice. It is also about employers being open and transparent about what occurs within its institution and taking appropriate steps to rectify any untoward activities and not turning a blind eye. Clients have to be protected and advocated for by the health professional, not bullied or manipulated into receiving treatments they do not understand or want.

Fantastic new project: One World Birth

Sign up to One World Birth with Sheila Kitzinger, Michel Odent, Ina May Gaskin, Elizabeth Davis, Cathy Warick and more.......

One World Birth is also building a community of birth professionals to connect, inspire and to help deliver change, to make birth better and safer everywhere.

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One World Birth.com


Saturday, July 23, 2011

Homebirth: A reminder July 2012 is looming


Following on from my previous blog which generated much discussion; lets remember the figures we are talking about: In Australia less than 1% of women homebirth: In the UK 10% of women homebirth and there is a call by doctors to increase that figure and have more 'low risk' birth centres and homebirth: I wish the AMA would say that:

The role of the midwife is clearly defined; anything outside of 'normal' needs collaboration with an obstetrician in partnership with the woman. However we do have some serious issues within maternity services that force women to birth alone (freebirth) which is unacceptable: as I have alluded to before partly due to there being no support or protection for the midwife under the legislation.

The Determination (National Health arrangements for Midwives) of 2010 set out the rules for collaboration which to this date has been difficult to secure. As far as I am aware there are only a few collaborative arrangements in this country, one of them being Melissa Maimann (Eligible Midwife) and Dr Andrew Pecese.

As privately practising midwives in Australia we are in real threat to losing the ability to support women at home for a 'normal' homebirth, so where will that leave HBAC, (homebirth after Cesarean section): HBAC needs to be done in collaboration with an obstetrician; come July 2012 the exemption for private practice midwives / independent midwives (these terms are used interchangeably) will cease to exist. If we or the government cannot secure insurance for Homebirth we will lose this right: and only publicly funded homebirth programs will exist.

As I have said before the consumer must help to take this forward: we saw the result from the Homebirth Rally in Canberra. We all have to work in partnership with , professional bodies and consumers: Women need to be asking their obstetricians for midwifery care: Ask your GP surgery, what is their position regarding Midwives; will they facilitate shared care with a midwife outside a hospital system? we need to focus on the AMA - we need to get them to the table and debate these issues with the consumer groups such as Childbirth Australia.

My real fear is that we will go down the same path as the USA (Pregnant and Miscarry....Do not pass go; Go directly to Jail) and we will lose rights for women and gain more fetal rights; choices for women will be limited due to legislation, we need to act now by working together and find a solution: One solution is for 'continuity of midwifery care'.

There is no quick fix to these issues, this will be a long slow political journey of negotiation to get what we want: which means providing different models of care, such as 'continuity of midwifery care' access to hospitals for privately practising midwives: the right of the midwife to support the informed choice the woman has made: This has to be a united journey not fragmented into separate issues, Homebith v HBAC or 'low risk' v 'high risk'.
We need to move towards 'every woman needs a midwife' and 'continuity of care'.

Thursday, July 21, 2011

Challenging times for women and midwives (HBAC)



Sad and disturbing times for both women and midwives:

As a private practice midwife it is very important to understand the boundaries of my role as a midwife; some are outlined in my previous blog “government paying us lip service”. Many midwives are facing complex ethical dilemmas:
As a UK trained midwife I was used to being able to do a homebirth for a woman who has risk factors and has had collaboration and consultation with an obstetrician through the local Health Authority and has chosen a homebirth despite these risk factors. The difference being that in the UK there is a Supervision system of midwives (supervisor of midwives) that provides midwives with support and backup. Also within the UK system you are protected by legislation that states that only a midwife or a doctor can assist with the birth except for an emergency in which case anyone can help.

S16 (1) A person other than a registered midwife or a registered medical practitioner shall not attend a woman in childbirth: Nurses Midwives and Health Visitors Act 1997(UK)

In the UK a woman’s choice is respected in that she can birth at home and the local Health Authority has to provide a midwife for the homebirth if one is available (National Health Services Act). Also the Royal College of Obstetrics and Gynaecology (RCOG) and Royal College of Midwives have a Joint Statement No.2. -April 2007 supporting homebirth and work together to support this. However here in Australia a major problem is that the AMA categorically opposes Homebirth.

The Nursing and Midwifery Council (NMC) works in the same way as AHPRA in its role to protect the public to ensure that midwives work within their scope of practice which is low risk ‘normal’ and provide a safe environment for birthing women. Independent Midwifery is also under threat in the UK as there is no insurance for private practicing midwives: see Homebirth and the Law reference list: http://www.homebirth.org.uk/law.htm

The Health System is different in Australia; therefore we cannot really compare with the UK except to say that both regulatory authorities work in the same way, in protecting the public and ensuring that midwives provide safe and competent care for the woman.

Legal Advice: I am not a lawyer and not giving legal advice; this is my interpretation of the legal advice given to me)

I have to state that my position as a midwife is that yes I believe in “women having choice in place of birth” and I believe that every woman should have midwifery care. I also have to state that I believe my role as a midwife is dealing with the “normal” and anything that falls outside of the parameters of “normal” I will collaborate with an Obstetrician, working in partnership with the woman to achieve a mutual arrangement and provide midwifery care throughout. I would like to see more liberal / flexibility surrounding place of birth for high risk women instead of always sending women to tertiary centres where they often feel alienated and fearful this would be a step in the right direction.

In light of the recent debate surrounding HBAC, I have sort some legal advice regarding the issue of VBAC (vaginal birth after caesarean) and having a homebirth. I wanted to know where I stood legally when a woman approaches me as a midwife asking for this service, should I decide to book a planned homebirth for H/VBAC – in terms of my responsibilities and my registration/licence: You have to remember that a good lawyer can argue a defence for anything and there is always a defence to be had.

The first question you have to ask is - What does the professional bodies say about HBAC / VBAC?
The professional bodies are the AMA and ACM – (the AMA has 90% membership, do not support homebirth, and is very powerful & political) does this give you an idea of what the answer will be to the first question.

Second question: What does the regulatory body stipulate about HBAC/ VBAC? Here you have to look at the current codes and guidelines that govern midwifery practice; you could compare with the UK, NZ and USA;

Thirdly : Have you provided unbiased informed choice, have you got collaboration (Dr; support) for the H/VBAC is it clearly documented, have you clearly documented the risks associated with HBAC/ VBAC , are you providing a safe environment for the woman; and have you an emergency care plan, are you working within your scope of practice?

There may be a possible defence, how successful this would be is the unknown quantity as it has not been tested yet and I can assure you I am not going to be the first to do this.

Women do have a choice of place of birth; however the choice to have a midwife present in the home environment for a risk associated birth is a limited option due to the legislation and the regulatory authority. However if the midwife chooses to accept the HBAC he/she maybe risking disciplinary action which could mean losing his/her registration and or having restrictions on his/her practice together with a lengthy legal case that will be distressing and costly.

How to move forward:
The answer is to work on changing legislation, to something similar to the UK and gaining support from the AMA to collaborate with midwives in listening to what women want. Helping and facilitating women achieve the kind of birth they want in a safe environment with a health professional to support them, whether that is in hospital or the home. Providing different models of care which include continuity of care no matter what the risk factor is.

It is very clear that the consumer/woman has to lead the impetus for change, the demand must come from them otherwise nothing will change; it is the power of the voter to change legislation.

Wednesday, June 29, 2011

The government is paying us lip service:


There are three burning issues for me currently: Mandatory reporting, women’s choice to birth where and how they want and ‘continuity of midwifery care’; each deserves a separate blog.

I have refrained from blogging recently because things have been politically difficult and I have been trying to keep a low profile, but it hasn’t worked, so I might as well just carry on and express my opinions.

I am in a real quandary as with many midwives, there is a fine line we walk and I have erred on the side of caution and to no avail. What keeps me on the straight and narrow is the fact that I value my registration. That is not to say I don’t value the woman’s choice, but if that choice compromises my registration I will think very carefully about the consequences before making a decision.

Up until recent times this has not presented a problem, however since the introduction of the new legislation namely the Health Practitioner Regulation National Law (WA) 2010. With this legislation came mandatory reporting, if I had known the implications of this piece of legislation I would have fought harder to see it changed. I had no idea until it started happening, that is the reporting of midwives. This is not about pitting midwife against midwife; this legislation is about ‘mandatory reporting’ the same as ‘mandatory reporting’ for child abuse...... it is the law and if you don’t there are consequences for not doing so ( it is noted that there are no penalties prescribed under the National Law for practitioners who fail to notify, but you may be subject to conduct or performance action)....Most reports have been made by Health Services or Medical Practitioners, however it is interesting to note that it seems that only midwives are being reported using this clause: s140(d)
s.140 of the National Law defines ‘notable conduct’ as where a practitioner has; (a).., (b).., (c)..., (d) placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards.’
The explanation given in the AHPRA document Guidelines for mandatory notifications (p4)
The term ‘accepted professional standards’ requires knowledge of the professional standards that are accepted within the health profession and a judgement about whether there has been a significant departure from them.
The notifiable conduct of the practitioner must have placed the public at risk of harm as well as being a significant departure from accepted professional standards before a notification is required. However, the risk of harm just needs to be present - it does not need to be a substantial risk, as long as the practitioner’s practice involved a significant departure from accepted professional standards. For example, a clear breach of the health profession’s code of conduct which placed the public at risk of harm would be enough.

Maybe we should start reporting doctors for placing the public at risk by overzealous reasons for caesarean sections, or rupturing membranes when it’s not required, or induction of labour for social reasons. I am sure there are many reasons doctors give that are unfounded and put the public at risk. Why are health services or midwives not reporting doctors for unsafe practice or out of scope practice as readily as they are reporting midwives, there seems to be a real disparity in the reporting mechanism.
If hospitals are going to use this piece of legislation then use it fairly on all health practitioners not just midwives, this is paramount to a witch-hunt we have moved back 20yrs, why not just burn us at the stake.

Our problem lies with the legislation, it is the law and this is what needs to be addressed to resolve some of these issues. Australia currently has no protection for midwives who choose to support the woman's choice of care which falls outside of the recommended standard of care - a midwives role is "normal" - I can hear all the rhetoric.

Choice:
It seems that women do not have choice; choice seems to be relative to the situation or dependent on certain conditions – if your BMI remains normal, if your glucose level stays low, if you don’t have a scar on your uterus etc etc,. Working within frameworks is not something new for midwives and balancing the woman’s autonomy against these frameworks can be difficult and often puts the midwife in a stressful position which may lead to an inquiry and threats of negligence.

Informed choice is a fundamental issue, autonomy the right to self determination – not when it comes to health and perceived risk. Mavis Kirkham states that ‘in our own culture, obstetric ideology is particularly coercive. The medical definition of safety and risk means that while minor choices exist, conceptual choices cannot.’
“.......You can have your baby any way you like as long as you understand that I must step in when the safety of you and the baby is involved’ (Shelley Romalis 1985 p 190). How many times have you heard this?

The women the consumer must stand up and demand what is rightfully theirs, the right to birth where and how they want and protection for the midwife who cares for that woman’s choice.

The gloves are off, because I think the government is paying us as midwives lip service. Since November 1 2010, we have seen many changes, Medicare rebates, eligibility and insurance for midwives; however the maternity reforms certainly in WA are lacking in substance and commitment from the State government.



ref:Informed Choice in maternity care: Edited by Mavis Kirkham (2004)

Thursday, June 9, 2011

It’s been a while since I blogged.... life in the fast lane


Canberra - Autumn

I have really missed blogging even felt guilty about not writing and sorry to my faithful readers for the lack of updates, but as usual the build up towards the end of semester (marking, studying, and meetings) takes its toll on my time to blog....

Let’s see where I got up to.... sorting out collaborative agreements... progressing with CeMGP “the practice”.... writing copious letters and getting limited responses....working three days a week at Uni.....my commitments to the College continue...picking up three units in my study this semester was not a wise move...note to self “don’t do that again”, no more than 1 or 2 units or drop something else... almost forgot I was sick....feeling better now... the mediation continues.... it really keeps me sane I do notice my anxiety levels rise when I don’t meditate... Thank God on Saturday I get an injection of super duper all day retreat... that should centre me again.


Jasmine - I think mummy ate all that chocolate

On the grandchildren front the birthday season for this year has begun, as they get older they are harder to buy for.... Jasmine is now 7, Dylan (June) 6yrs & Jessica (Aug) 6 yrs, Talia (June) 4, Sam (July), Isabella (July) and Logan (Oct) will be 3yrs old and off course our newest one Tayla is 7weeks old.... by far the greatest pleasure I get is from the grandies...they are truly delightful and the light of my life.....


Talia's party:

As the semester comes to a close and the marking is complete, its time to read a book or novel.... today as I was buying birthday pressies for family and friends I spied a couple of books that leapt off the shelf into my bag via the cashier.... I wanted them all...but alas some are for gifts, however I will keep and read “The Wish” it did appeal to me.... so will give some feedback once I’ve read it.... I think I am back in the swing for my blog... will update on the political agenda for midwifery in my next entry:
Ciao!

Thursday, May 12, 2011

Understanding Collaborative arrangements for midwives


Well as usual life has been extremely busy and I have quite a few blogs to catch up on... like our Good Friday grandchild Tayla.... birth experience coming soon...but first what has been consuming my time is trying to secure collaborative arrangements.

Collaboration was always going to be problematic as it was never a sure thing, it was doomed from the beginning because it was the medical profession trying to control midwives and midwifery.

The question is now how to make it work without having to have a signed agreement. This is how I see it... first it is about closely reading the National Health Collaborative arrangements for midwives Determination 2010 carefully... scrutinising every word.

Part 2 of the Collaborative arrangements; sets out the general requirements of the collaborative arrangements; (what is required or our core choices. It is interesting when you examine our choices as midwives, the only one that I find palatable is 7(1)a,b,c,d).

(1) For the definition of authorised midwife in subsection 84 (1) of the Act, each of the following is a kind of collaborative arrangement for an eligible midwife:

(a) the midwife is employed or engaged by 1 or more obstetric specified medical practitioners, or by an entity that employs or engages 1 or more obstetric specified medical practitioners;

(b) a patient is referred, in writing, to the midwife for midwifery treatment by a specified medical practitioner;

(c) an agreement mentioned in section 6 for the midwife;

(d) an arrangement mentioned in section 7 for the midwife
.
This means we can choose one of these options....what will work for me is 1(d)which I will explore fully here...the other options are not going to be discussed at this time. Please check the full document if you want to find out more.

6 Agreement between eligible midwife and 1 or more specified medical practitioners
(1) An agreement may be made between:
(a) an eligible midwife; and
(b) 1 or more specified medical practitioners.
(2) The agreement must be in writing and signed by the eligible midwife and
the other parties mentioned in paragraph (1) (b).


(d) section 7
7 Arrangement — midwife’s written records (this means we do all the writing and do not need a signed arrangement).

(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;

(d) plans for the circumstances in which the midwife will do any of the
following:
(i) consult with an obstetric specified medical practitioner;
(ii) refer the patient to a specified medical practitioner;
(iii) transfer the patient’s care to an obstetric specified medical
practitioner.


For me this is easier than getting a signed agreement...my experience is that obstetricians are reluctant to sign a collaborative agreement.
I email or write to the obstetrican refering my client when I book them into the hospital of the client's choice. The obstetrician replies thanking you for the referral (acknowledgement by named medical practitioner)you also make a plan of action should transfer or obstetric care be necessary and you consult with them when the situation requires, sounds all very reasonable.

I always inform my clients that I will be collaborating with an obstetrician... it is a shame this is not a reciprocal arrangement...in that obstetricians inform their clients of midwives and midwifery care. It all seems to be a one way street......

The determination then outlines the requirements for documentation of the midwife's written records.....
(
2) The midwife must also record the following in the midwife’s written records....
(a) any consultation or other communication between the midwife and an obstetric specified medical practitioner about the patient’s care;
(b) any referral of the patient by the midwife to a specified medical practitioner;
(c) any transfer by the midwife of the patient’s care to an obstetric specified medical practitioner;
(d) when the midwife gives a copy of the hospital booking letter (however described) for the patient to a named medical practitioner — acknowledgement that the named medical practitioner has received the copy;
(e) when the midwife gives a copy of the patient’s maternity care plan
prepared by the midwife to a named medical practitioner — acknowledgement that the named medical practitioner has received the copy;
(f) if the midwife requests diagnostic imaging or pathology services for the patient — when the midwife gives the results of the services to a named medical practitioner;
(g) that the midwife has given a discharge summary (however described) at the end of the midwife’s care for the patient to:
(i) a named medical practitioner; and
(ii) the patient’s usual general practitioner.


Something I have found very interesting on this journey; is with all my corospondence to GP surgeries, doctors, and hospitals no one has written a response to me... not even a common courtesy of saying thank you for your letter we will respond in due course.....

So I find it amusing as I read the determination and it states "when the midwife gives a copy of the patients' maternity care plan etc etc etc or copy of results to the named medical practitioner - acknowledgement that the named medical practitioner has recived a copy... when no one has responded to any of my letters... and I have sent many.. now whose responsibility is it to ensure acknowledgement is given? surely it is the person receiving the information and it is not my responsibility to ensure a response?????

The next step is Credentialing and or visiting rights... this currently seems like Mt Everest.....and I am not a climber of mountains... so heaven help me.....

Wednesday, April 20, 2011

Waiting patiently for grandchild no 8.....


The art of patience I think is disappearing, we are always in a rush for things to happen or to be done, we want everything yesterday...sadly this is a reflection of the times.

Pregnancy traditionally is anywhere from 37 - 42 weeks, which is nine months and one week. More than 90% of babies do not arrive by the predicted date. So it is not unusual for a mother not to go into spontaneous labour just because its her due date. Technically you are not overdue until 42 weeks, but alas you see women are being offered inductions of labour (IOL) from 37 weeks.

Some mums battle with health professionals consistently about this issue..why is it that once you get to about 38/39 weeks you are offered and IOL, it seems like we are trying to change the boundaries of normal gestation times: Fair enough if there is a medical reason for an induction: as in the fetus (baby) is at risk or the mother, but not because you look uncomfortable or because we can.... IOL can lead to a cascade of intervention and we all know where that ends up. We need to let nature take its course, it stands to reason if you have reached 40-42 weeks and you have not gone into labour your body is clearly not ready....and you have to wonder have we got the dates right? This can already be disheartening for the mother who is eagerly awaiting her new arrival and can sometimes be annoying after so much of anticipation and excitement and pressure from family and friends.

Sadly it is not just health professionals that put pressure on mums, it is society that is friends, family, acquaintances, all saying when is this baby coming.... why don't you just get induced and have it over and done with....it seems everyone is in a hurry....sometimes too this is born out of fear, fear that something may go wrong and we as midwives need to be constantly reassuring about the normal processes of birth.

Then off course comes the advice about how to be induced naturally...and believe me everyone has a story about this one.... (some women have tried it all and none of it worked, like wise some women have tried one or two and it has worked....you never know your luck until you try)
Some of the traditional ways are:
Walking, housework, spicy food (curry) raspberry leaf tea, nipple stimulation and if you are really game clitoral stimulation; intercourse (love making) which releases the hormone Oxytocin which is called the love hormone... this then gets the contractions started; essential oils such as lavender and clary sage; membrane sweep; acupressure and most importantly be calm and think positively..... but like anything it is practice that makes perfect.... doing it just once or twice is not going to make it happen... it is something that you are going to consistently do over a few days or so...ensuring that everyone is safe and you can feel the fetus moving...

Formal Induction of labour: starts with prostin gel or Foley Catheter; artificial rupture of membranes, Syntocinon drip.....epidural? however this needs to be a blog all on its own....

We are waiting for contractions to begin....passing of a mucous plug, waters breaking.... all signs of the beginning.....the deadline is looming...

Thursday, April 7, 2011

Lamenting about the lost art of nursing care:


This is a plastic slipper-pan....mine was papermache...even more lightweight...

I have recently been in hospital, nothing serious but none the less needing/requiring some nursing care: There is nothing like a bit of firsthand experience to relay to nursing and midwifery students the importance of a caring attitude..... I also say that people generally complain about staff that are rude and give the impression of not caring ...that is a distinct difference to the nurse who just doesn’t give a shit.

I do have to say that I find being a patient extremely difficult because I do not want to relinquish any sort of control of my life.....to someone else particularly someone who really doesn’t care. On the whole my care was good..... However it is always the little things that make life all the more difficult..... like your tray being placed out of reach and you can’t move....emmm a little difficult.... and ringing the call bell to use...yes the dreaded bedpan... and it takes 20mins for the nurse to appear....then a further 15mins before you get the slipper pan.... oh no..... you can just feel your bladder is about to burst...and then you have this ridiculous looking slipper pan and you know it’s just not going to happen....at this point I wished I had a penis...it would be so much easier....but alas no we take a deep breath and ask to be left alone to contemplate emptying your bladder lying flat on your back and trying not to be in any pain.... it seems a fate worse than death...trying to pee in these conditions.... remembering you have done this all about 4hours ago and wet the bed in the process...then you have to go through the embarrassment and the changing of the bottom sheet.......anyway about half an hour later I think yes... I’m done.... ring the bell... by now the slipper pan is well and truly stuck to my buttocks... the nurse comes in “are you finished” yes thank you... Ok let’s get it out then.... lift up.... tummy muscles work frantically and lift.... as the nurse manoeuvres the pan out .... oops yes you guessed it.... a spillage...but of course... how can this flimsy product hold several litres of fluid without having a mishap......oh did I mention it is the middle of the night....the nurse says “oh that’s good....it didn’t spill did it?” emm... I lament and say...” I think that the bed is wet”....no says the nurse it’s your perspiration... it will dry very quickly....and slips out the room very quickly carrying her overladen slipper pan.... and me... well she doesn’t know that I am a nurse / midwife educator and am totally blown away by this blatant lack of insight into poor care....now here I am the patient....at this stage a not well patient who has pain, now lying in a wet bed and wondering is it worth the trouble to ring the bell wait another 20mins and complain about my care , have the sheet changed creating more pain or shall I just lay here and hope that I fall asleep as I am still affected from the anaesthetic... to which I do just that (I have to say this only happened once, not all the staff were like this).

I should think it is equally as difficult for a man to pee lying down.....

In the next bed was an elderly frail lady whom I had not met but could hear through the curtains that she had some sort of facial surgery and could only swallow. I came to this conclusion because I could hear her trying to swallow her drinks and her meals came in a bowl, she had hardly any visitors and was very quiet. It is interesting trying to assess someone you have not seen by the care she received from the nursing staff. Some nurses would come in very chirpy “Good morning, I have some pills for you, oh your poor darling, that looks uncomfortable let me crush your pills”....to, hello here are you pills.... Patient “oh I find it hard to swallow can you crush them” nurse – just try; patient; ok..... Cough; splutter; splutter; tears........oh Ok I will be back...... surprisingly it was the younger nurses that showed less caring....this occurred at least 4 times a day all with differing responses.... On the second day when the nurse came in and said “here are your pills and asked her to swallow them after the patient had asked for them to be crushed...... I could not bear to hear the patient again try to swallow....that I yelled through the curtains..if I could have got up without causing myself pain I would off.... why don’t you just crush or give her dissolvable paracetamol......the nurse scurried out the room and came back with dissolvable pills.... I know there is nothing worse than a busy body not minding their own business..... but it just had to be done...later when I got up ...the elderly lady said thank you to me for asking the nurse to crush her pills...and explained she had two sons lived away and it was difficult for them to visit...but they would say something if they knew.... and said I don’t know why some of the nurses won’t crush my pills.....she became teary and wondered whether it was all worthwhile.... I sat with her talking about life and I was saddened that none of the nurses found time to spend any time with this frail lonely woman who has had some remarkable facial surgery and how any nurse could possibly ask someone to attempt to swallow when visibly it was obvious that this was an onerous task for the elderly woman....

I know we all use the excuse that we as nurses and midwives are overworked, but please, caring and compassion is what we are about... it is a basic human need.....everyone is so busy with the task that there was absolutely no caring or compassion ......

My dilemma as an academic is how we teach our students to be caring and compassionate in a world that demands tasks to be completed in unrealistic timeframes.... and why are we producing young nurses that do not have a caring philosophy.....

Tip to nurses.... you never really know who the person you are looking after.... therefore be kind, caring and professional to all.... treat your patients like you would like to be treated yourself... and if you are having a bad day stay home..... don't inflict it on your patients.....

Wednesday, March 30, 2011

Privacy Act: patient consent to collect and disclose information:


This is a gentle reminder for all privately practicing midwives to get patient / client consent to collect and disclose information, especially now that there are eligible midwives: something else we have to set up for the practice........

All organisations that provide a health service are covered by the Privacy Act (whether or not they are small businesses). Organisations providing a health service include:
traditional health service providers such as private hospitals and day surgeries, doctors and specialists
• pharmacists
• allied health professionals such as psychologists
• complementary therapists like naturopaths and chiropractors and
• in some cases other services like gyms, fitness services and weight loss clinics, child care and schools (if they provide a health service and hold health information).


The National Privacy Principles set out how organisations should collect, use, keep, secure and disclose personal information. They cover collection, use and disclosure date quality
Further information on the new privacy legislation can be obtained from the Australian Privacy Commissioner’s web site http://www.privacy.gov.au/

Don’t leave Privacy to chance:

10 steps to protecting other people’s Personal Information:

1. Collect only the information your require
2. Don’t gather personal information just because you can and just in case you require it
3. Tell people what you are doing with the personal information you are collecting
4. Consider whether you should be using personal information for a particular reason
5. Think about whether you need to divulge the information
6. If people ask, give them access to the personal information you hold about them
7. Keep personal information secure
8. Don’t keep information longer than you need to
9. Keep information accurate and up to date
10. Consider making someone in your organisation or agency responsible for privacy

Use and Disclose example: with my consent, the practice staff will use and disclose your information for purposes such as:
- account keeping and billing purposes
- referral to another medical practitioner or health care provider
- sending of specimens for analysis
- referral to a hospital for treatment and or advice
- advice on treatment options
- the management of our practice

Ensure that you gain the clients consent (best to have written consent) for the practice or midwife to collect, use and disclose personal information as outlined and I understand that I may withdraw my consent as to use and disclosure of my personal information......

ref pic:http://health-link.com.au/PrivacyPolicy.aspx

Wednesday, March 23, 2011

What’s in a name? Independent; Private Practice Midwife; Eligible Midwife


As I ponder how to advertise myself on the Internet I look at the possible variables and it comes down to “independent midwife” or “private practice midwife”, so let’s have a look at what difference a name makes:

What's in a name? That which we call a rose
By any other name would smell as sweet.
Shakespeare

By definition: dictionary.com “independent” –an independent person or thing.... not influenced or controlled by others in matters of opinion.... thinking or acting for oneself..... not subject to another’s authority or jurisdiction. – A free thinker.... not influenced by the thought or actions of others....

“private” – belonging to some particular person ( personal belonging)...pertaining to or affecting a particular person or a small group of persons; individual; personal; undertaken personally or individually without the presence of others; alone

“private practice” – independent and not as an employee; mainly pertaining to medicine;

Quote by George Bernard Shaw;
“He said that private practice in medicine ought to be put down by law. When I asked him why, he said that private doctors were ignorant licensed murders.”

Thesaurus.com: private practice by definition pertains to general medical care.... family practice and independent pertains to separate, liberated, free – alone, aloof, self governing

When I did a Google /Yahoo search of “independent midwife” the search generated pages of independent midwives Australia wide and internationally. The Google/Yahoo search with “Private Practice Midwives” generates equally a list of midwives however I have to say not as many as “independent” and more groups and associations....

It is interesting to note that the new Health Practitioner Regulation National Law Act 2010 refers to Private Practice Midwives and makes no mention of Independent Midwives: therefore I think there is a change in terminology .... moving towards private practice....

The upshot of this exercise highlighted that it doesn’t matter about the name women will find you whether you are called “independent or private midwife” so to throw the cat amongst the pigeons I am going to call myself “eligible private midwife”. My rationale for this is to focus on the legislative changes for midwives by highlighting the ‘eligible’ aspect therefore informing women of the ability to access Medicare rebates for midwifery care.

Remember; a midwife is a midwife is a midwife.... eligible, independent, private makes no real difference what matters is that you are a midwife.

The lost art of letter writing: Etiquette:


I come from an era of when someone sends you a letter, remembering that a letter is in place of the spoken word..... It is polite to respond particularly in business; it was accepted etiquette to respond and say thank you for your letter, we will respond shortly or whatever the reasons are.....this is not the case anymore. Not responding is tantamount to rudeness, being uncivil as if to ignore a person who is talking to you.

Question: Do we put emails into the same category as a letter?

The end of February I sent a letter to our Private Health Fund with a query of an overpayment, this was a substantial over payment and we were keen to find out whether our fortnightly payments were going to be reduced and a refund of the overpayment. Up until last week I had not heard anything, so I rang them to ask had they received my letter. The Health Fund, said, yes we are processing your claim. When I asked “why did you not respond in writing”, their response was “oh we don’t do that, it’s not our policy”...... I asked how am I to know you received the query then... “emm” she said... “I guess you have to wait or call to confirm it has been received” as you can imagine I was less than happy with that response... the outcome was that the young lady assured me she would ring back when the claim had been assessed and completed..... I find this disgraceful business etiquette..... the Health Fund rang today to confirm that they were going to credit our membership... they did not ask if we wanted a refund.... and they were not going to send a statement to show how they came to their conclusions, even when it was asked for they said ‘it is not the way we do business” WHAT!... again not how I thought business should be run.... where is the accountability? what I do know is that if we owed them money...we would be receiving an account on a weekly basis....

Over the last 6 months I have written many letters and emails, mainly business orientated; I have come to notice that I have not had any responses to my letters. I wonder why this is. I have written to politicians, hospitals, GP’s with very little response not even the common courtesy to say thank you for your letter and we wish you well.....or we are looking into your enquiry and will inform you of the outcome. But alas no responses..... There could be several reasons for this.... one they don’t want to know about what I am asking.... or is letter writing just an out dated exercise... maybe I should twitter, or Facebook.... only joking:
Writing letters is about keeping in touch, building relationships and politeness ...it’s about presenting your business and responding shows good etiquette even if you do not want the product.....or service:

I do think as a society we are losing the art of letter writing on a personal level because communication via the internet has exponentially grown and therefore letter writing is not really necessary. Although I do think it is an art worth keeping..... but very few people do it anymore, which is a sad reflection of the times.


picture ref:http://www.pubarticles.com/article-letter-writing-write-formal-informal-letters-notes-1244769964.html

Saturday, March 19, 2011

The art of being patient: Centred Midwifery Group Practice:


The Centred Midwifery Group Practice....it's interesting for me,in my mind the vision of the practice is a complete success, it flows smoothly and seems easy.... however the reality is somewhat different there are so many other variables involved to which I have no control. Yes that might be naive of me or it could be that the vision I have is so strong that it propels me to do the things I do... However the truth is that this is going to be a long slow process and I need to rethink the way forward in terms of my sustainability and how we are going to get collaboration working.... as my friends, colleagues and family keep telling me that “Rome was not built in a day” and it has taken us 20 years to get Medicare rebates for midwives.... a valued colleague said yesterday “ you are going to fall on your bottom and few times...the trick is to get back up and keep going,” “why are you surprised?” ......The answer is that I have a vision and the vision doesn’t have the stonewalls..........

The story thus far: The Group Practice has a brilliant dedicated team or midwives/consumers working to build the practice: We owe Berry Digital Design(Cass) an enormous Thank you she has done all our logo designing flyers, business cards / letterheads/invoices/receipts etc, printing and all pro bono...I highly recommend her so check out her website: if you want any designing or printing done. We have our email x6 is setup secretary@centredmgp.com and director@centredmgp.com the website and blog is coming as I type... so watch this space.....Our rooms are at the Conscious Conception and Birth Centre and we are now setting up the office with equipment: if anyone has a phone fax and photocopier/computer they would like to donate please let me know: Medicare provider number obtained, Insurance paid, pathology and diagnostic rights have all been secured and we are working on collaborative arrangements with the local Health Service..... this will take time: Most importantly we are starting to get clients and this is what keeps us going.... our practice is about offering women choice the choice to birth with a known midwife.... continuity of midwifery care....it’s about having time to talk to women, engage and build trusting relationships with women and their family throughout pregnancy birth and the postnatal period...


It is an exciting process setting up a new midwifery group practice in WA....
The next step is to go and visit the local hospitals, MP’s and GP surgeries to introduce the Practice and rally up support.... go to consumer meetings and get the word out there.....and last but not least advertising for clients....... it really is very exhilarating watching it all coming to fruition.
We need more midwives to pick up eligibility..... if you are an experienced midwife and want to work with women in the community, that is at home and hospital births please consider this option....contact me for more information about the process that is required for eligibility it’s not difficult you just need three years post registration working across the continuum of midwifery: or visit the AHPRA website and follow the links to eligibility:

As for me.... it is practising the art of patience’s....slowly, slowly, slowly..... Diplomacy and political lobbying; continue meditation... this has really proven helpful in slowing my mind chatter and keeping a calm demeanour...
Watch this space for our grand opening...... date coming soon......

Friday, March 18, 2011

Rules of engagement and Facebook:



Firstly I want you to think about why do you engage in Facebook (FB)? What is your primary focus?...this question is very important as you will read further into this blog. For me it is about connecting with people, friends, associates, overseas family, local family, it’s about linking, networking and disseminating information.... FB is one of the fastest growing social mediums in the world...it is changing the way we communicate.... I see it as a fantastic way to get information out to the cyber world..... and remember it stays there forever:

A recent study shows that 54% of Australians use FB.........

Recently a friend described and instance where she was reprimanded in her work place over a Facebook (FB) comment, in fact she did not write the comment she ‘liked’ the comment; I thought that the reprimand was a rather excessive step, so I delved into the possible legal implications of such an activity and have decided that there are some specific rules that you need to consider when engaging on FB.... in fact we all know the rules I think that often people believe the comments they are making are so ambiguous, insipid or insidious that it won’t be connected to them or their work place..... Think again.

The term ‘friend’ on FB is a false term it lures you into a artificial sense of security; come on think about it.... how many of us really have 200-300 friends in real life?.... when I was growing up they use to say “if you are lucky, you will be able to count your true friends on one hand”..... In FB the people I allow in yes are called ‘friends’ and some truly are but the majority are valued colleagues, acquaintances, ex students, friends of friends...etc... not what I consider true ‘friends’, I have to say I like them otherwise I would not invite or accept them..... but in the true sense of the word friends.... most of them are not.... please don’t misunderstand this.... but it is a fact of life: Therefore I go back to the question Why do you engage in FB? You have to really consider who you let into your FB world and what you publish. Keep work and FB separate.

After doing a web search regarding some legal issues on FB... I have come up with a list of rules that might help you keep out of trouble in the work place or anywhere else relating to FB.

Rule 1: really consider carefully who you are letting into your FB as a ‘friend’, if you allow mangers, work colleagues/associates this means you let your work into your private life. Ensure you have a closed privacy setting.

Rule 2: Do not mention anything to do with your work place no matter how insignificant you think it is... if you can be connected to your work by your comment you probably break the golden rules of ‘confidentially’ and ‘Code of Conduct’.

Rule 3: Be mindful of the photos of yourself you allow on FB, these photos become the property of FB and if you are acting in an unbecoming manner this could come back to bite you later. Don’t allow people to take your photo without asking you and letting you know if it is going on FB.

Rule 4: Do not write on FB when you are angry or under the influence of alcohol once the information is in cyber space it stays there: Internet Defamation is the fastest growing litigation ....so don’t write anything derogatory about anyone.

Rule 5: People seem to believe what you do outside of work does not affect your work life....WRONG....this is dependent on what it is and if you have you bought your profession/company/school into disrepute? Just think of our footballers .....there is a prime example of unbecoming behavior.

Rule 6: Social responsibility: this is like a duty of care to society, a reciprocal duty: we owe society and society owes us a mutually beneficial obligation. Be kind to each other.

The bottom line FB is on your employers radar; remember be careful who you invite in your world, don’t talk about work, don’t say anything derogatory and be mindful of the photos you let FB have:

Have a read.. How to use FB without loosing your job over it.....
Happy Facebooking!!!!!!!

Saturday, March 12, 2011

Busy, Busy, Busy, but loving it:


Life is a wonderful journey with lots of lessons to learn... however I can't believe that I can still be so naive in terms of maternity reform. I have so many things to blog about its hard to know where to start:

Friendship: my friend returns to the UK this evening ...yes I am sad because we have so much in common and it is nice to share with someone who accepts you for who you are and knows your failings and understands your vulnerability: we may not see each other often these days but each time we do its like we've never been apart..... there is something so special about the kinship that women have with each other....

This now brings me to my spiritual journey.... Buddhism and mediation: there are many different categories within Buddhism... the one I am exploring is Kadampa Buddhism.. I am half way through the eight steps to happiness ( 8 week course)...which at times really has tested my way of being...the fundamental way of my thinking processes is being challenged: "May I take defeat upon myself and offer them the victory"..... I am having huge problems with this.... yes I can hear you say... that's because you have an ego problem...and maybe I do.... but it is really hard to do this...so I have been taking little steps.... I just don't say anything malevolent ... I just keep quiet... and I don't think it either...I try to work out why I am so angry or upset... and cherish them instead...and I have to say I think it is working slowly...I did say slowly... but it is making me rethink the way I say things....I don't think I have quite reached Abraham Lincoln's philosophy; The best way to destroy an enemy is to make him a friend; the journey continues.

Maternity reforms: this has been very frustrating these last few weeks... and I have had to cherish many times on the phone when I am getting blocked at every corner...requesting pathology and radiology access has been problematic...the reforms have been in place since November 1 2010; yet all pathology and radiology depts have not prepared for this process....I have had almost every excuse under the sun...such as databases need to be changed, it has to go through the billing committee... even staff education has not occurred.....so we cant give you access until all this has been achieved....FRUSTRATING.... I have noted on the Medicare webpage that they have PBS forms already but we can't use them as there are no approved courses yet.... strange this is available.... anyway after a few weeks of inconvenience the pathology process for two companies and one radiology dept has been approved... so this is good news it will be smooth sailing from here on in......

Good news....the process has began, my first pathology and radiology requests went through without a hitch....my woman at 13/40 has had all her first trimester screening completed.... should get the results next week....it is a fantastic feeling for both of us.... to have the complete package of care... just brilliant.....watch this space for more...


Singapore was dazzling, I just love the teaching, the students are keen, enthusiastic and in the workshops they never cease to amaze me with there wild imaginative stories there is never a dull moment....I spent most of my time teaching and in my spare time at Sim Lim Square the techno junkie's toy shop....visited my local Buddhist temple had a philosophical discussion about lying with a monk....ate chili crab and to die for satay sticks.... oh and I forgot I tried an ice cream sandwich... yes with coloured bread....

Saturday, February 19, 2011

A Festschrift to celebrate the careers of two remarkable women:


I was privileged today to find myself sitting amongst many wonderful people and some great academics, I heard many wonderful stories of two amazing women who have had diverse and awe-inspiring careers which has had tremendous impact on the midwifery profession and will do for many years to come, Pat Brodie & Nicky Leap.



Until today I did not know what a “Festchrift” was, I meant to look it up on the internet….but just did not get round to it…. So was relieved today when I heard lots of people had no idea what it was…..and that it actually means “a living book of your life” a celebration of your career by others on the occasion of retirement, what a fantastic idea, just brilliant….. Someone likened it to being at your own funeral, except you are there to enjoy it….. but then Pat said it would be a very long funeral” ….. to me it really is a bit like “this is your life”.



There was opportunity for great networking….. Too many wonderful people to name them all …. Besides you all know who you all are…great to see you and have a chat…. The energy and inspiration goes a long way to maintaining your enthusiasm for when you get home… and need to carry on the task of change and ensuring women have choice and midwifery care…….



For me it was an inspirational day, the room was filled with liveliness….. my soul was rejoicing at the many possibilities for midwifery…..if only we had this sort of leadership everywhere in Australia….some places are truly isolated and continue to have an uphill battle…..we need to spread the talent….

Key take home messages that resonated for me ……
“Square peg in around hole” - midwives
“The less you do the more you give” – care in labour
“Every woman needs a midwife and sometimes a doctor too” - collaboration
“Community based continuity of care for all risk categories of women” – private practice
“The key is good collaboration”
“Morbidity of women during childbirth is only going to increase due to repeat caesarean sections and the obesity crisis…..” – Obstetrician
“Midwives are essential for primary care”
“Address the equalities of women and birth”
"From little things big things grow - Group practice



A truely wonderful time in Sydney..... the only downside was that I didn't stay an extra day or two do some shopping.....not that I have money for shopping...lol

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