Friday, January 28, 2011

The question is do you use a partograph or not?

The partograph or partogram graphically represents key events in labor and provides an early warning system for the health professional caring for the woman. Until recently I had not given this much thought, I just accepted as part of my practice. I would use a partograph as part of my normal care in labour. I do notice when I go to different hospitals how they all vary slightly. Some are just cumbersome, some not practical and some just down right difficult to use......... and as for that action line....that is a different question all together... I would happily use a partograph without the action line...because part of my normal practice is to know that if the woman is at 4cm and contracting well (3-4:10) then her cervix is dilating and I would make a mental note that in 6 hours I would expect to being seeing signs of being fully dilated.

I understand possibly the need for a partogram in the hospital setting when you have several people looking at the notes; therefore there needs to be a quick review process. However in a home setting you are the only person as well as your partner midwife looking at the I question the value of using a partogram:

As I was doing a search on the web looking for a partograph template, I found lots of literature supporting the use of the partograph and the action line in preventing or recognising obstructed labour. In fact The World Health Organization partographs are the best known partographs in low resource settings. Some people argue the partograph is essential for good decision making.....and therefore is considered best practice...

A midwife is legally bound to document to clearly / comprehensively all our care, recognise / interpret /act / inform on abnormalities found in a timely fashion however does this mean she/he has to use a partogram to do this?

I am thinking that it is not necessary to use a partogram in the home setting if your documentation clearly tells the story.

What do you think?

can you write your notes in a fashion that does not need a visual expression of what is occurring? and does it make a difference using a partogram?

please leave me a comment on what you think?

Sunday, January 23, 2011

Insurance for Midwives:

Now that I have a Medicare Provider number & eligibility it's time to consider my insurance; the options that midwives have are:
A government supported insurance through MIGA (The Medical Insurance Group) or Mediprotect insurance;

The question you have to ask is which insurance do you choose? here is all the information: an important factor to consider is which company offers run-off-cover:

Read MIGA information Booklet:
Frequently asked questions:
Payment options:
Risk Managment workshops:
Maternity Care Plans & Collaboration
Product disclosure Statement:Application form:

Mediprotect - Vero - wording of policy document:
Application form:

As you can see from the summary of information available.. there is more information provided by MIGA than Mediprotect:

The most important factor for me is, I need intrapartum cover when birthing in a hospital as a private practice midwife and run off cover; therefore my choice of insurance will be governed by this; I have therefore applied with MIGA and will see how much my costs will be, although I have a good idea of what it will be.......

I have also sort guidance from my accountant and that I am fully aware of my is exciting times....

Friday, January 21, 2011

Writing My Memoir Journey:

Ian and I have come down to Margaret River for a well earned break just for a few days; as usual we spent some time in the Margaret River bookshop...and I spotted this book “write your memoir – the soul work for telling your story” by Dr Allan G Hunter....what attracted me to this particular book is that it refers to your writing as your soul work, that resonated with me, because I think that when you write your life story you have to also be thinking at a deeper level and this may also bring about I had to have wonderful husband Ian bought it for me.

Ian is such a patient man, he supports all that I do, he must think there she goes again...another project started. In his wisdom, he said ok, this is a great place for you to start writing, and he is correct it is tranquil, nature surrounds, the birds, butterflies and flies for company and the occasional truck or car that flies along the road, just to remind you that life goes on. I start to type away on my computer under the grand Oak tree that has its own stories to tell, I can at least say the memoir has begun.

I have wanted to write my story for many years it is something I want to do for myself and I did begin several years ago compiling a timeline of events to keep me on track, I will have to put it together with this work and keep writing. This off course is a long term goal, so I will chip away at it slowly. We have decided that it would be good to book a regular yearly holiday to Basildene Manor to keep the project going.... and Ian well he is sitting beside me listening to his ipod story..... enjoying the same wonderful peace and quiet.....

Busselton Jetty:

Medicare Provider Number:

At last I have my Medicare Provider Number.... yeah...First eligibility,(see blog how to apply for eligibility) then Medicare Number and Insurance... all set to go.... website, business cards, flyers, something is missing.... yes the "women" wanting continuity of midwifery care.... I have booked my first woman.... and so life goes on... poor Ian is wondering how we are going to pay for the insurance......???

Applying for a Medicare Provider Number is relatively easy, however I have to say for WA applications are not processed here they are sent to Canberra so might take a few extra days for this reason..... interestingly you have to provide a signed form for every address that you will be working from and you will receive a provider number for each location.... for example if I was to work out of two officers, I would give each address and for a home visit I will use my home address as the office... therefore potentially you could have several address and provider numbers...

I have sent my application for my MIGA insurance today... and hopefully that will take a week or so to sort out and then I am set to go.....this is an interesting journey.... a brave new world....

Monday, January 17, 2011

My Road to Meditation:

I dabbled in meditation back in the nineties and met the Dalai Lama when he came to Perth…. I subsequently read his autobiography and thought that if I was to have my time over again I would be a Buddhist. I continued to be a part time practicing Catholic and turned more to being spiritual rather than religious. I read books about quantum time (physics), Road less travelled, You Can Heal Your Life, My Mother Myself, A Course in Miracles and many more…..trying to find a sense of spirituality… life got busier and busier and both religion and spirituality took a back seat…. Never leaving… always at the back of my mind but never that priority.

My recent trip to Tanzania I was touched by the strength of the ordinary Tanzanian, the courage in the face of adversity…. The pain that people suffered and accepted as part of their life….what was unbearable for me was to see children suffering in hospital… from the baby that was crying and needed comforting and no staff to do this, his nappy changing and there was no nappy…. Or the toddler that was screaming because he was being bathed in Potassium permanganate dissolved in warm water to come up with a nice pink colored solution, having his burns debrided with no pain relief, it brought tears to my eyes…… I was both humbled and frustrated…. The disparity between rich and poor was at times palpable. The health issues seemed so insurmountable, that I need a way to stop my mind from churning…… I realized that my spirituality was missing… it was not even dormant it had gone……

Last year was very busy and stressful particularly then end of the year was even more so, after I came back from Canberra, I was at breaking point and realized I needed to stop….. I had decided to either go back to church on Sundays or start meditating….I usually go to midnight mass, have for the last 30 yrs… there was a new Parish priest at the church I usually go to… and it was the worst service I have been to for a very long time….no inspiration…… there was nothing….I was like a stranger, I came away knowing I was not going back….

I did an Internet search for a Buddhist retreat starting in January…and would you believe it one was starting on the 2nd January…. I booked in for the week and I have not looked back since then….. I felt like I had found my way home……very strange…. Time will tell how I go….. I feel calmer…. My mind is less chaotic and I now have strategies to slow it down…..I have set myself some boundaries as far as work is concerned…. And am working on my discipline to continue with my meditation on a daily basis with a quarterly retreat to keep me focused…I found a meditation centre here in Singapore and went this afternoon, which was a great end to my teaching weekend……watch this space...

Happy Chinese New Year "Rabbit" Happiness and Prosperity to all....

Saturday, January 15, 2011

Ethical /moral points of view:

I really enjoy teaching in Singapore the array of different cultures and ethical / moral points of view always make me reflect on life and consider another point of view: Ethics and morality are often interchanged…. Some people confuse ethics and think that it is ethical standards or a code of ethics even religion, which it is not…there is a subtle difference between ethics and morals….. Ethics is how society views social structure where as morals are a personal characteristic which often includes a religious flavor…. However generally people use the terms to mean one and the same…. Let’s face it morals are influenced by our religious, spiritual, cultural, scientific or learned experiences. Ethics goes one step further than morality in the sense that we have ethical theories (Utilitarian & Deontology)and principles, such as autonomy, beneficence, non-malefence, justice and veracity. Peter Singer states “Ethics has no necessary connection with any particular religion, nor with religion in general."

Interestingly I believe as we get older we generally change our point of view…. I think with maturity comes an understanding and wisdom and letting go of idealism. I think back to the days when I was a nursing student at 18… young and idealistic; I wanted to save the world from its self… I was given this knowledge as a student nurse and it was fantastic…. This particular day I was working in a rehabilitation ward looking after an elderly man recovering from major surgery, taking his blood pressure…and suddenly there was no blood pressure… I looked at the man and yes he was grey, pale, he had just passed away as I was talking to him….my first instinct was to resuscitate him… I did… when the team arrived someone read his chart and said….”he’s not for resus so maybe we shouldn't be doing this” I looked up and continued for a few more minutes then stopped. The man had died. The matron who was a nun asked me to see her in the office….. I had no idea what I had done wrong…. She asked me why did you resuscitate the patient. I am embarrassed now by my answer…. But I said… “God has given me the knowledge to resuscitate this man if he wants him to die he will die anyway”. The nun just looked and me and said nothing…..As I look back I can see I thought I knew best…. Ask me what I would do today…. I would respect the patients request not to be resuscitated…. I am not saying all young people are like this but I do think as we get older our morals, values and ethical views change due to our life experiences…. That is just part of life and getting older……

As a health practitioner I maintain that you have to have a good sense of “self” in order to care for your clients. That is understanding your own moral and ethical grounding, this sense of self awareness allows you to understand why you react in the way you do and allows you to step back and not be judgmental in the care you are providing to the client. I must say I did not become self aware until I was in my 30’s.

As we know there is no right or wrong when it comes to discussing ethics; however when you focus on the hard issues such as capital punishment, abortion, organ transplant, euthanasia, genetic testing, and allocation of health resources the students came up with some pretty black and white answers, they are rather pragmatic about the whole issue. Singapore’s Medical Council is currently reviewing its code of ethics to keep in line with the advancing technological age (biotechnology) and the demand for organ transplants and genetic issues. This is an attempt to hold the health profession more accountable for decisions made within these areas.

Recently President Obama called on Americans to “expand our moral imaginations, to listen to each other more carefully, to sharpen our instincts for empathy, and remind ourselves of all the ways our hopes and dreams are bound together”. This was an attempt to defuse the abortion debate in America which often reverts to violence due to such opposing views. But the reality is we all worlds apart in finding solutions – everyone has their own idea about polices and justice. Often our moral imaginations are so divergent that never the twain shall meet.

When I asked the students how valuable do they consider human life within today’s society? Everyone said it is valued, and yes it is wrong to kill another human being; except if they have killed another person…..(Singapore has the death penalty) I then asked what about drug traffickers? They haven’t directly killed anyone. Again most agreed that yes they deserved to die because they contribute to someone else’s death or changed circumstances; even though they are really only the carrier or victim because the real culprit is rich and to clever to be caught….this was food for thought. So in essence the wrong person is being killed: In order to question the rules of society I then asked what about the woman who is stoned for committing adultery….(not in Singapore). In this instance the person that is being killed is the woman; the man did not get the same punishment. This did generate some discussion and most agreed that this was wrong……however most agreed with the philosophy that if some takes a life theirs should be taken.

Abortion always creates a debate…. No one can agree on this topic, I wonder if the world will ever reach a consensus on this; Pro Choice v Pro Life; with a multi-cultural, multi-religious class it was an interesting discussion at least there was a discussion and an expression of opinions however the divide still remains; does life begin at conception? Or when the fetus moves @ 16 weeks or when the fetus can live independently from its mother? Is abortion under 12 weeks acceptable? What about late term abortion for abnormality or not? All these questions need to be explored by the people and policy makers in a peaceful and respectful way.

The ethical debate will continue on many subjects, should the alcoholic or drug addict have a liver transplant, the smoker have a triple bypass, what if a prisoner for murder needs a kidney transplant.....Should the pregnant woman who is a drug/alcoholic be in prision?(as they do in America), I hope this never happens in
Australia, the list is endless... what is the individuals responsibility towards health v poor.... if you can't help yourself in improving your health care.... should the government support your treatment....? we are spending billions of dollars on health care.... what is the solution? the debate about health care resources continues.

Saturday, January 1, 2011

My plans for 2011

It would not be a New Year without setting some goals, writing them on your blog makes it harder to break and you are more accountable.... I find it very useful each year to reflect on the year gone by and plan for the following year... some of my goals are as a result of reflecting the year gone bye..... one decision I have come to as a result of my trip to Tanzania is to spend more time on my spirituality. Equally importantly I need to reduce my stress levels.

Spirituality: - Dharmapala Buddhist Centre – starting January 2nd with a week guided meditations – I am committing to the first week four sessions a day for the first two days.... and then two evening session for the rest of the week... then I will do the evening sessions... My aim is to meditate each day and go at least once or twice a week to a group mediation to keep me focused.

Study – Must complete my assignments on time.... devote more time to my study and learn to say “No” to anything that interferes with it......

CeMGP – Centred Midwifery Group Practice – much is required this year, I am so excited about the success of this practice...continuity of care is the focus... advertising, clientele, staff..... I am really excited about this business and its growth.... the website and blog is coming by the end of January.

Work – I have reduced my teaching hours.... starting a new curriculum therefore much work is required for my units.... Singapore is exciting and challenging...and I am not ready to give this up... I am looking forward to meditating in the temples when I next visit.

Clinical Practice – I will be signing up for casual midwifery work...the decision is which hospital and probably a shift or two a week...

It is an exciting year and I am really focused this year on getting my spirituality & study on track then every else will fall into place.

6 Key points to keep in mind this year;
Spend less, watch my weight, be less wasteful, exercise 5 out of 7 days, meditate everyday, keep a work life balance.

I am determined and dedicated as always to put women and midwifery first for greater choices for childbirth.

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