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.

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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.

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