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
(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

For me this is easier than getting a signed 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 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.....


Joy Johnston said...

Hello Pauline.
I have just discovered your blog. I will add you to my list of midwives who are recording midwifery as we experience it.

The hospitals in Melbourne are baulking at identifying any (individual) specified medical practitioner for a collaborative arrangement.

I believe we need an amendment to the Determination, to recognise and validate the collaborative arrangement between the midwife and a hospital that has the capacity to receive women who need transfer from planned home birth at any time in the episode of care.

Your readers may be interested in and and other blogs linked to them.

InfoMidwife said...

thanks Joy for your comments, nice to hear from you... we certainly need something different than the current determination.... happy to help where ever possible... cheers Pauline

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