The challenge of collaboration:

http://www.nhmrc.gov.au/guidelines/publications/cp124

I have written about collaboration in the past and it still seems elusive, however a few of my esteemed colleagues have managed to gain some sort of formal collaboration. The word ‘collaborate’ means ‘to work with another, cooperate’. However so far, the collaboration has been limited to antenatal and postnatal care, and intrapartum care being only provided by the doctor. When it comes to continuity of midwifery care, through all phases of pregnancy the problem arises when the woman goes into labour - the birth is still in the realm of the doctor. The woman goes to hospital and is cared for by the doctor, they still hold onto this part. However I have noted that times and attitudes are changing and maybe given a little more time the doctors will not be so territorial regarding ‘normal low risk’ births.

I would dearly love to see women with the opportunity to have a midwife in their home for the early part of labour, to support, encourage, nurture and be with woman. Keeping the woman in their own environment with a midwife until they are ready to go to hospital in established labour, this could prevent the cascade of intervention and we would have more normal births.

I do wonder whether the threat of things going wrong and not in the doctors control; in other words the threat of litigation is the motivator, together with no real benefit for the doctor to collaborate with the midwife. What is the incentive for the doctor to collaborate? Maybe if we a sign a Medicare no to "collaboration" doctors might do so... Most doctors I have written too are happy to continue as they have for the past years; however the issue is, that women are requesting midwives and continuity of midwifery care, it is time for change.

NHMRC was commissioned by the Dept of Health to develop national guidance on collaborative maternity care as part of the national maternity reforms they produced a whole document about the process of “Collaborative Maternity Care”. This was to encapsulate maternity care collaboration placing the woman at the centre of her own care, whilst supporting the health professionals who care for her. Thus ensuring her cultural, psychological and clinical needs were met. The NHMRC produced a pamphlet for women to help explain collaboration; I have yet to see this document widely distributed.

The pamphlet explains to women that

“Midwives provide care to women during pregnancy – from conception until early parenting in collaboration with other health care providers. Midwives can provide most aspects of ‘low risk’ pregnancy, labour and birth, and postnatal care to women. They may need to refer you to, or talk with, a doctor or other services if you or your baby have or develop problems”

Obstetricians & GP “Provide specialised care for mothers and babies in collaboration with other health care providers. They can look after women with “routine” and “complicated” pregnancies and births, and provide labour and birth care in hospitals.

Pregnancy is a very special time for women and families, it is very important to ensure you are getting quality safe care including informed choice from your service provider, whether it is an obstetrician, midwife or GP Obstetrician. That your choices are being heard and respected, you also have the right to say ‘no’ to treatments you do not want, don’t ever be afraid to ask for a second opinion.

Collaboration is about working in partnerships with each other in order to facilitate the wishes of the woman and her family. Recently I experienced true collaboration with a hospital in facilitating a woman’s birth, what we need is the Determination of July 2010 overturned or amended for midwives to collaborate with a Health Service, rather than an individual doctor.

Here’s to ‘continuity of midwifery care’, every woman having the opportunity to have a midwife and doctors and midwives working in partnership.