Wednesday, June 29, 2011
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.
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
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.....
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: