Tuesday, March 27, 2012

Hitting a Brick Wall

The National Health (Collaborative arrangements for Midwives) Determination of 2010 (This instrument determines the collaborative arrangements with the kinds of medical practitioners that an eligible midwife must participate in when providing midwifery treatment in order to satisfy the definition of 'authorised midwife'.). This Determination is clearly not working and needs to be amended or rescinded.

Obstetricians benefit from Eligible Midwives not being able to practice. Is it fair and equitable that this group can monopolise the market? Should the role of a collaborator be given to a Health Service or an independent body rather than a ‘named obstetrician’?

I am an Eligible Midwife and have a Medicare provider number. The government introduced the Maternity Reforms in 2010. With these reforms came the Determination for Midwives 2010. At the time of the Determination the then Minister of Health Nicola Roxon acknowledged that there were issues with the AMA but encouraged us (Midwives) to try and make the determination work. We are almost at the 2 year mark and this determination is not working. There is a multitude of evidence to show that obstetricians do not want to collaborate with midwives.
Here are some comments from Obstetricians

‘ I will do the birth you can do the rest’
‘I will not collaborate, I am happy with the status quo’
‘we do not support homebirth regardless of the risk, therefore I will not collaborate’
’I am very comfortable with the situation as it stands and I am not interested in supporting your model of care’

It seems that there is a condition with an offer to collaborate, which means that as a midwife I cannot work to my full potential. On the other hand, there are some private midwives so frustrated with the current political system, they have rescinded their registration and are working as birth attendants. These birth attendants support and assist women’s birth choices and are not responsible to any regulatory authority and are not insured. I wonder is this the answer?

This piece of legislation is a bad law it needs to be changed urgently to allow the Eligible Midwife to work as they were intended. That is to give women more choice, more continuity of midwifery care and for women to claim a Medicare rebate for those services.
Call or email your local member of Parliament and have you say: Ask for your right to see a Midwife and claim your Medicare rebate:

Friday, March 2, 2012

Women need to debate if its time for fetal rights:

In doing so it must be remembered that women's autonomy is paramount. For too long men have bludgeoned and pillaged women's autonomy. A woman's autonomy and body is sacrosanct and for her alone to choose what to do with it.
Education, communication and choice about place of birth is the answer...not mandating through legislation what happens to the woman's body.

As Dame Elizabeth Butler-Sloss in Re MB (1977)
A mentally competent patient has an absolute right to refuse consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision might lead to his death. The only situation in which it is lawful for the doctors to intervene is if it was believed that the adult patient lacked the capacity to decide and the treatment was in the patient’s best interests.

Also Justice Cardozo on a Patient's "Rights"
"Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages,".

Consent in law is very clear, as is the current status of the fetus - it has no rights until born alive.

As I see it there seems to be two schools of thought - first when in domestic violence or violence against a woman and the fetus is killed at term (37 weeks usually able to survive outside the uterus)in this instance, women have been calling for greater accountability against the perpetrator...and calls for murder / manslaughter for killing the fetus (unborn child).
On the other hand, you have the woman who chooses an unconventional birth mode, in which her fetus (unborn child) dies at term (from 37 weeks) and there is no accountability for the death of the fetus.( This woman usually chooses this option due to the mismanagement of her care through conventional health services and she feels she has been left with no options).

There seems to be a disparity with this argument, there needs to be the same rule for all, we must come to a consensus as to whether the term fetus deserves some rights. The problem will be in affording the term fetus rights, that the woman's autonomy is not compromised.

Whilst discussing fetal rights it seems unfair that the AMA (WA) should be targeting pregnant women with drug and alcohol issues saying there needs to be some sanctions applied to these women. Where will we draw the line.... obesity, working, sport...this is a preposterous argument we will drive women away from health professionals -
Dr David Mountain stated "there should be penalties for some of the "wild extremes" of homebirth/freebirth advocates where misinformation is deliberately given to women about the risk to their unborn child. I was very clear that in this situation it is the purported expert who misleads a mother into endangering their unborn child that should be considered to have recklessly endangered the child"

I would like to know if this extends to the medical profession whose Caesarean section rate is rising at a rate of knots - are the purported experts misleading women into having a c-section (which will then affect the next pregnancy choice) when it is not required.....therefore endangering their unborn child....

Women who choose to homebirth are very well informed and often do most of the research themselves....they are well aware of the risks involved and think they are doing what is best for themselves and their baby.

No where else in health care do we see that a person's autonomy is compromised in such a way....no one makes you donate a part of your body to a dying relative if you did not want to do so..no one takes you to court to make you give a part of your body to that relative... so why are we so intent on undermining women's autonomy?

Yes it is time for society to debate these issues, as the born alive rule was made in the 17th century. I think women need to be debating this issue as it is their bodies that are in question.

Please write to the West Australian in response to Dr David Mountain's comments Friday 2nd March email: letters@wanews.com.au include full address and telephone number. These comments came as a response to this article.
Charge reckless mums: doctors' union

Questions to ponder:
- what do you think about fetal rights?
- Is a term fetus a human being? and does it deserve some rights?
- in what circumstances should a term fetus be awarded rights?
- should a health professional be accountable for the death of a fetus?
- what responsibilities does the mother have when making choices about her fetus?

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