tag:blogger.com,1999:blog-42973013212478680532024-02-19T21:54:25.902+08:00InfomidwifeInfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.comBlogger250125tag:blogger.com,1999:blog-4297301321247868053.post-24182310220238589972014-05-06T23:07:00.002+08:002014-05-06T23:07:41.065+08:00Back to blogging.... Missed you all!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_VB2e17cxHZ0jrmkrhlBIu1tZSPzTUaPGPY_6b8KzXPCGgfU7Vj52EJiUQIqXCreNKmHFWoa4m2TSVzhbb2MzLwc_LSdu7vmd5J1Arls-DBdWs4YESyhHh3_HWYlLVGDy219kEmgtqdQ/s1600/back-to-blogging.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_VB2e17cxHZ0jrmkrhlBIu1tZSPzTUaPGPY_6b8KzXPCGgfU7Vj52EJiUQIqXCreNKmHFWoa4m2TSVzhbb2MzLwc_LSdu7vmd5J1Arls-DBdWs4YESyhHh3_HWYlLVGDy219kEmgtqdQ/s1600/back-to-blogging.png" height="135" width="320" /></a></div>
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Well at long last I have come back to blogging - I have thought of blogging often, however something had to give in my life and at the time blogging was it. Just looking at the date I last blogged and it has been well over a year.......how time flies when you are having fun.<br />
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It was not a deliberate decision it was one made out of necessity an unconscious decision and now I have time again I will start again to blog.<br />
I have some decisions to make about how my blog is to go forward - but for now I will just write a couple of blogs - a few catch up blogs before I decide what will come of '<i>infomidwife</i>' - I would like to tie up a few loose ends and then move forward.<br />
I am mostly looking forward to a long earned holiday - 6 weeks in Europe which will incorporate the<a href="http://www.midwives2014.org/" target="_blank"> ICM Prague Conference.</a> - I almost have to remember how to navigate the blog again, its a bit like riding a bike - it all comes flooding back.<br />
Hope to catch you soon.InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-3008392923715291762013-02-26T21:28:00.001+08:002013-02-26T21:30:53.838+08:00The politics of birth for the private midwife: A minefield from all directions<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU7sSKrf2dftabRIxImP1Fi3d12nL_zGilgsNhoRFSQtIWDSpqVIw1rzZmJ2oOUYK-BZrAqpg7RegVTt0mJrYNHS_hkCUXd1flpb9cUXMOBRV0oMefYRP7hLKmk7iDs7XdFhhKEvEmy4M/s1600/LT-minefield-art-620x349.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU7sSKrf2dftabRIxImP1Fi3d12nL_zGilgsNhoRFSQtIWDSpqVIw1rzZmJ2oOUYK-BZrAqpg7RegVTt0mJrYNHS_hkCUXd1flpb9cUXMOBRV0oMefYRP7hLKmk7iDs7XdFhhKEvEmy4M/s320/LT-minefield-art-620x349.jpg" width="320" /></a></div>
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Being a private midwife can be a minefield, you never know
what action will set of an explosion. We all know minefields are designed to
destroy or disable. This means you can
have a varying degree of damage from slight, mediocre or catastrophic. Clearing
minefields is a long, slow, time-consuming process, and there is no room for
error, a bit like the life of a private midwife. There is no clear pathway
every woman (case) presents another set of issues often a new battle or the
same one revisited but it is the same minefield, you just pray that you don’t
step on one and get damaged. You have to select your path carefully.<o:p></o:p></div>
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What is so infuriating; the level of bureaucracy that is
required…. let me share a story or two…..you have a so called ‘low risk’ woman
who wants a homebirth, she needs to be booked into hospital as a backup – this
is required by several governing bodies, however the hospitals play ping pong
with you – Hospital ‘A’ says ‘No’ this woman is ‘low risk’ she needs to birth
in hospital ‘B’. Hospital ‘B’ tells you No ‘we don’t have the infrastructure’
to support a homebirth go to hospital ‘A’ and whilst this toing and froing is
going on….. The woman is progressing through her pregnancy…..God help you if
you have a problem…because everyone wants to pass the buck.... And in the meantime
the Director General has resigned; there is a State election so the Minister of
Health does nothing to assist you and no one in the dept. responds to your
urgent requests for help……What is the private midwife to do? However if the
private midwife is found to be lacking in some capacity the hammer falls very
quickly and very hard…... There is just no equity in this at all…it seems that
progress is ever so slow: however I am grateful for the help I do get from some
corners and without that this journey
would not be worth it…. I am also thankful
for the women for without them we would not be midwives and the breaking of new
ground would not be possible.<o:p></o:p></div>
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On the other hand the minefield is the choice some women
make: they choose for whatever reason to go outside any boundary the midwife
has…outside of the scope of practice the midwife has, and each midwife has their
own limits….. now the midwife can choose to accept that woman’s sole choice at
her own personal risk… as there is nothing to protect that midwife when she
works outside the boundary of the so called ‘low risk’, accept her
documentation and sometimes that is not even enough – the woman is only wanting
what she considers is in her best interest. However the midwife ends up having
to defend themselves and this means $$$$$ in legal fees, even if the midwife
did everything within her power. Who looks after the midwives best interest? Not
the regulatory body, not the government and certainly not the AMA - The Midwife
has too….because no one else will…. This is sad reflection of Midwifery
practice in Australia – I for one am not prepared to risk my registration and
pay out $$$$ in legal fees…. until the midwife is afforded protection as her
counterparts in the UK and NZ the Australian private midwife is becoming are
rare commodity and will become extinct. <o:p></o:p></div>
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I will end by saying I have had some wonderful experiences
with women along this journey and every single one has taught me something
about myself and pushed a boundary – I reflect on every experience and say ‘how
can I make the next one better’. The major drawback is the political battle
that each case brings in access to hospital, collaboration and the support
required…. The burden of collaboration is tremendous….it is a one sided affair….every
now and then you step on a landmine and you get damaged….. And you contemplate
when will the damage be catastrophic and you pray it won’t be you and it won’t be
today.<o:p></o:p></div>
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picture ref:<a href="http://www.smh.com.au/it-pro/innovation/blogs/smoke--mirrors/patent-battles-are-a-worry-for-developers-20120831-254fo.html" target="_blank"> http://www.smh.com.au/it-pro/innovation/blogs/smoke--mirrors/patent-battles-are-a-worry-for-developers-20120831-254fo.html</a></div>
InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-49649749446782539532013-02-11T00:34:00.000+08:002013-02-11T00:35:06.966+08:00Where to find some Evidence - pregnancy<b>This is a great Blog</b> - have a look at the video regarding Evidence Based Birth Tutorial - very informative, shows you how to find the best evidence - you can then discuss this with your health professional - see what they say - to have knowledge is to be forearmed....for all those pregnant mums...check it out: <a href="http://evidencebasedbirth.com/evidence-based-birth-tutorial/" target="_blank">Evidenced Based Birth Tutorial:</a><br />
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<br />InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-40637911735512230142013-02-11T00:17:00.000+08:002013-02-11T00:17:54.763+08:00Communication, pregnancy & labour - women<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNormal">
The way we communicate with women:</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVN4JlnVYgnglFzIAJQgqqartr0feNX8TCtavmitjk2_IVSwag0GbMOXFiXHQJMwmW7sze1ld74a8Fl83ryuSgHdl_8-G-mGnZA64ayZAEwParHsNvq0Oo7Vd3k1hwC_2hgmO3Jk26sOg/s1600/communication.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVN4JlnVYgnglFzIAJQgqqartr0feNX8TCtavmitjk2_IVSwag0GbMOXFiXHQJMwmW7sze1ld74a8Fl83ryuSgHdl_8-G-mGnZA64ayZAEwParHsNvq0Oo7Vd3k1hwC_2hgmO3Jk26sOg/s1600/communication.gif" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was saddened today by again listening to a woman retell
her traumatic first birth from two years ago: it is really disheartening that
our health system is letting these women down by not providing the right care.
Something really needs to change about the culture and language used within maternity
services and the paternalistic attitudes of our midwives and obstetricians; It
really is all in the way that messages are communicated to the women: </div>
<div class="MsoNormal">
I am sure we all have a story to share, I recently
experienced this first hand as an observer: the woman attends hospital and is
6cm dilated on arrival, she requests an epidural. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Doctor “<i>I want to do a vaginal examination first</i>”</div>
<div class="MsoNormal">
Woman “<i>I really want the epidural first, then you can do an
internal examinatio</i>n”</div>
<div class="MsoNormal">
Doctor “<i>I must do a vaginal examination first, now, you
might be fully dilated</i>”</div>
<div class="MsoNormal">
Woman “<i>I don’t care I want an epidural now please</i>”</div>
<div class="MsoNormal">
Doctor “<i>but don’t you understand it is important for me to
do one now</i>”</div>
<div class="MsoNormal">
Woman’s husband in a cross tone “<i>did you not hear my wife
she wants an epidural first then you can do your examination”</i></div>
<div class="MsoNormal">
Doctor “<i>alright then I will call the anesthetist but he may
not come for an hour or so”</i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This process had already taken an hour; this woman did not
get her epidural for an hour and a half.</div>
<div class="MsoNormal">
After a long labour, now fully dilated and a failed vacuum it
was determined by the doctor that a caesarean section was required. There was
no fetal distress – he had called another more senior obstetrician for trial forceps
in theatre.<span style="mso-spacerun: yes;"> </span>When the senior obstetrician
arrived the woman was upset, she had worked damn hard, she was tired now crying
and when the obstetrician introduced himself to her, she looked at him and pleaded..she said ....</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“<i>Please try everything before having to do a caesarean section;
it really is the last thing I want’. </i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The doctors response was “<i>I will do whatever I need to do,
that will be best for the baby, and if that means a caesarean section, well, so
be it”</i>. He then went on to say “ <i>a friend of mine did a small research study on
women who are fully dilated after failed vacuum and the outcome is much better
for the baby if you go straight to c/section’. ‘Now let’s get on with this to
theatre now’.</i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The woman and husband were shattered on so many levels; they
surrendered to what was to come:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My point is not whether the woman required a caesarean
section or not, it was the manner in which the obstetrician had spoken to her. <span style="mso-spacerun: yes;"> </span>There was no explanation, no informed choice,
there was no empathy, and there was no consideration for what she was feeling,
it was pure unadulterated power pure and simple. </div>
<div class="MsoNormal">
The obstetrician could have
said <i>“I am so sorry that this has been such a long hard journey; I will do my
best to assist you, however I must let you know that a caesarean section is
quite possibly on the cards, but I will assess the situation in theatre and
keep you fully informed, explaining the situation to you and we can make the
decision when I know the full picture”</i>.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
More consideration is needed when communicating with women
that enables informed decision making – clear explanations as to the clinical
picture therefore empowering women and their partners: More often than not when
the clinical picture is spelt out in clear simple language, women will do what
is necessary because they understand the situation and they are making the
decision.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As health professionals we need to constantly think about
the way we communicate with women.... think about the language you use, don’t
be paternalistic be empowering – give an accurate explanation of the clinical
picture and accept the decision that is given, not the one you want:</div>
<div class="MsoNormal">
Remember the old saying ‘you get more flies with honey than
vinegar’ – so true</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Ref pic:<a href="http://www.abc.net.au/talkitup/chalkitup/communication.htm" target="_blank"> http://www.abc.net.au/talkitup/chalkitup/communication.htm</a></div>
InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com1tag:blogger.com,1999:blog-4297301321247868053.post-73103015156787026802013-01-06T00:00:00.001+08:002013-01-06T00:00:36.228+08:00An action packed 2012<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUuEDRSN4PHtxwHQ091bt7CT_iHj-4ZVj4sF5MJJ5jvZQB33pG9t7f5tmrNU1hjR1pF65aft-xt266-adODG_ELbyPpX_1S0MUJd68ehX0MyE_2dqOrqbKUd3rvmoJXAkBWcZ7LkIE9Zo/s1600/P1050094.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUuEDRSN4PHtxwHQ091bt7CT_iHj-4ZVj4sF5MJJ5jvZQB33pG9t7f5tmrNU1hjR1pF65aft-xt266-adODG_ELbyPpX_1S0MUJd68ehX0MyE_2dqOrqbKUd3rvmoJXAkBWcZ7LkIE9Zo/s320/P1050094.JPG" width="240" /></a></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<span style="font-family: Calibri;">It always amazes me when I get to the end of a year and look
back, so much has been achieved. My intention each year is clear, I make a list
and by the middle of the year it has doubled and by then end of the year much
more than I planned is achieved… how does that happen? One thing was for
certain my work load was vast…. From 300 plus students, my private practice and
my study not including family and friends…..<o:p></o:p></span></div>
<span style="font-family: Calibri;">2012 started with various College activities and takes me through the whole year as this is an important part of my professional life as a midwife. Then comes my usual
trip to Singapore and my 140 students, my usual local students another 150
plus, as well as whatever extra your workload includes. Our private practice was
steady… and my usual two units of my personal study and whatever extra
summer/winter intensive units I could include. Most importantly there was the
family, 6 children and 8 grandchildren to fit into my life….. You might well
ask how it all happen…. It just does.</span><br />
<span style="font-family: Calibri;"><o:p></o:p></span><br />
<span style="font-family: Calibri;">Highlights for the year included: Major decision about
changing my work place – I was asked to review my study plan and consider
switching to a PhD – this was a major turning point in my academic work life
and chose not to commence a PhD at this time in my life as I was already committed….half
way through my Law degree and did not want to change at this stage. This gave me
the opportunity to re-evaluate where I was in terms of my study and my working
life and made a decision to reduce my work hours therefore my workload….by far
the hardest part of my work was the marking component, it always coincided with
my own study and made this time of the year extremely stressful for me…and
therefor my husband and made me unbearable to live with. So began the process
of changing my job.</span><br />
<span style="font-family: Calibri;"><o:p></o:p></span><br />
<span style="font-family: Calibri;">Our holiday to Thailand was a brief respite, it gave Ian and
I time together just sitting on the beach, reading I read all three 50 shades
books and found them brilliant…. Good light-hearted reading. We did some sightseeing;
dining, walking and just general fun… the only problem was it was so brief….<o:p></o:p></span><br />
<span style="font-family: Calibri;">The midwifery private practice is steadily growing however
the political struggles continue; we still do not have visiting or credentialing
rights to government hospitals….each woman brings with her a new challenge…. And
we have been rejected from more hospitals than I care to think about…. But we
continue to serve the women who employ us and continue to take the issues up
with both the Health Minister and the Hospital directors….. Interestingly the
Director General Kim Snowball resigned due to pressure of the job…now there was
a surprise… NOT.</span><br />
<span style="font-family: Calibri;"><o:p></o:p></span><br />
<span style="font-family: Calibri;">My study, I usually take two units a semester, and a winter
and summer intensive… I really enjoyed Bioethical and Medical law… a brilliant
unit as well as Occupational Safety and Health Law… they were my highlights. I
also committed to the Flinders Graduate Certificate of Midwifery, two units
pharmacology and diagnostics…..the two worst units ever… disorganised, time
consuming over assessed and inconsistent with the marking of assessments….. Thank
God I passed and will be an endorsed midwife able to prescribe……Worst law unit
was evidence…. It just about broke me…. but have a good handle on it.... I must learn not to show what I am thinking on my face....</span><br />
<span style="font-family: Calibri;"><o:p></o:p></span><br />
<span style="font-family: Calibri;">Change of job midyear as another major step…. Moved to half
time (.5) as a senior lecturer… this reduced my work load significantly… and
allowed me more time to complete the extra units for my midwifery prescribing …..this
job has been challenging in a different way…the private sector is always different..... new courses are always difficult
and have teething problems….but most of them have been overcome….watch this space.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<span style="font-family: Calibri;">With so much study and work, sadly my blogging has taken a
back step…. But I hope that I will have more time to do more of this in 2013…. As
I do enjoy blogging… I am always thinking of blogs...but finding the time to write and post them is difficult....</span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<span style="font-family: Calibri;">My diet has been fantastic....very hard work....I just did not realise I was as fat as I was.... sometimes I think I am mad deciding to diet when my life is so busy...there is never a good time.... you just have to do it..... it has been well worth it.... have lost now 18kgs.... would like to lose another 10kg.... I always think you never see a fat lawyer..... a shallow reason for losing weight...but it has worked for me....I feel really good for the weight loss.</span></div>
<span style="font-family: Calibri;">The family is all good…. I am so blessed.. I had some personal struggles with
a decision made… I guess this is normal, the challenge is to give your opinion
and then stand back and watch how it all plays out…when it doesn’t go your way….it
is about letting go… continuing to love & support and deal with how you feel in your
own way… and that is not always easy…. And sometimes you find you don’t even
like each other for the decisions made…time does heal…. the trick is to accept
and move on…and that was the biggest lesson I learned in 2012.</span><br />
<span style="font-family: Calibri;"><o:p></o:p></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge7gXvTonHJ4a6wXLAuN4OeQ2ZIQw6qT7LnSknqwNmxNmD5ZDLQvfWaphvMULCppVKMjUJsv_CVpb7ZXJYeQwgUTFhyphenhyphenbMvVFzhNuOD4khNgOn9FcUxpPApnn70utl2OFCFGIdLeHlcwaY/s1600/P1050113.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge7gXvTonHJ4a6wXLAuN4OeQ2ZIQw6qT7LnSknqwNmxNmD5ZDLQvfWaphvMULCppVKMjUJsv_CVpb7ZXJYeQwgUTFhyphenhyphenbMvVFzhNuOD4khNgOn9FcUxpPApnn70utl2OFCFGIdLeHlcwaY/s320/P1050113.JPG" width="320" /></a></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<span style="font-family: Calibri;">The grandchildren are the delight of my life… Christmas is
always my favourite time of the year…. I love watching them open their presents…..
and it is the time of year in which I can spend some quality time with them……watching
them all growing … wow… Jasmine is 8 now… Talia 6, Sam 4, Dylan 7, Isabella 4,
Jessica 7, Logan 4 and Tayla 18mths…. And a new one due in April……one of the grandchildren
has just been diagnosed with Dyslexia…. Which will bring us some new
challenges… the highlight for the year was the family portrait with nanna and
pops… I didn’t think it was going to be as hard as it was to get all 8 in<span style="mso-spacerun: yes;"> </span>a picture, between Sam having a sad, Talia
falling of the fence, Tayla teething and off course Isabella deciding not
enough attention is being paid to her…. But the photos were a great success… can’t
wait to receive them, they were overpriced and the copyright annoys me…but they
will be well worth it…<o:p></o:p></span></div>
<span style="font-family: Calibri;">2013 will bring many new changes for me…as I am going to
work towards my career change… not that I want to leave midwifery… but I really
want to see some changes from a political stance….our practice will be busier….
Three of the grandchildren will be in kindy…and the rest will be in year
1,2,3,4. My study will continue and hopefully my plan is to be finished by the
end of this year…..Wow!</span><br />
<span style="font-family: Calibri;">Wishing everyone a happy, successful and healthy 2013.....go forth and reap the benefits of life you only live once.... and don't forget to play:</span><br />
InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-48923569485892773692012-12-12T21:04:00.002+08:002012-12-12T21:04:25.319+08:00Hospitals in WA not accepting Women who are choosing Homebirth with a private midwife:<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsR81TSnXLloihksESvMSiUHC2dXDOjOJlkhWgAD6HzZbsOoYv4TnWGEiXZNC9zy-DXSobTMOV5SnwuiDpHkuUQwXA0b7eLIHyTaMsLpGe63OYiMM2UIaWZUIZqVI5q5zcvlEo3CFqrC8/s1600/frustration20logo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsR81TSnXLloihksESvMSiUHC2dXDOjOJlkhWgAD6HzZbsOoYv4TnWGEiXZNC9zy-DXSobTMOV5SnwuiDpHkuUQwXA0b7eLIHyTaMsLpGe63OYiMM2UIaWZUIZqVI5q5zcvlEo3CFqrC8/s320/frustration20logo.jpg" width="320" /></a></div>
<br />
<br />
The 2010 Maternity reforms <b>are still not working</b>.....Access for Private
Midwives was to be achieved within the first year….Still <b><i>not achieved…</i></b>I wonder why
it takes Australia so long to instigate credentialled private midwives. Surely
it can't be that hard to set this up...after all Visiting Medical Officers
(VMO's) have a system already....why not just emulate that one? It seems that
procrastination is rife within the Health Dept.….2 and half years and where are
we? absolutely nowhere:<br />
<br />
As a private midwife I still cannot get access to hospitals…..here I am playing
by the rules and some hospitals refuse point blank to accept a woman who is
going to have a homebirth and being cared for by a Private Midwife…The Safety
and Quality framework to which I as a private midwife have to abide by as
dictated by the regulatory body (NMBA) states that the woman has to have the
closest hospital to her (within 30mins) as her back-up hospital…. The Director
General of WA Health has given a direct instruction to hospitals to allow
access for midwives conducting homebirths….are the hospitals abiding by this
directive? <b>NO</b>….what happens to these hospitals…..<b><i>nothing</i></b>…. What happens to
the Midwife when she/he does not follow directives….<b><i>we get the sack or reported to NMBA</i></b>…
where is the parity…where is the justice? Who is holding these hospitals to be accountable?<br />
<br />
So where does this woman and midwife go? Where does the woman give birth? Does
the midwife birth her at home with no back up hospital? Because the hospital
refuses access the woman is not booked there, if anything was to go wrong we
would then have to travel over 45 mins to get to the tertiary hospital. This is
a complete farce of a system that is nothing but prejudicial against women’s
choice of place of birth and midwives facilitating the woman’s choice. <br />
<br />
<div class="MsoNormal">
<b>Midwives and women need to stand up and be counted</b>…. There
is a multitude of evidence to show that low risk homebirth is safe….. The AMA is propagating fear and control by the
constant mantra “<i>We do not believe or support in homebirth</i>”….it is time to fight back……..Midwives
are not handmaidens to doctors…..Women have the right to choose and refuse
treatment.....and women do have a right
to homebirth with a skilled midwife.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Picture_ Ref: <a href="http://wisdomfrombooks.wordpress.com/2010/12/01/3-ways-to-handle-frustration/" target="_blank">http://wisdomfrombooks.wordpress.com/2010/12/01/3-ways-to-handle-frustration/</a></div>
InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-14857480170149337782012-12-09T23:52:00.001+08:002012-12-09T23:52:45.977+08:00<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6qr4lAaIO_ZabZDwpRgsHAO3QrsegG2lTVcdbONUliBUr1zFbvZMuZ3QL8qj6Ol-6sVQEEoVzw0zM1c9KmL2QDW3f3NZv1T3NFNLIZb24z5LA3SR295VOV35TJ6a6wxdIwNIB8ZtMjpo/s1600/safety+first.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="98" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6qr4lAaIO_ZabZDwpRgsHAO3QrsegG2lTVcdbONUliBUr1zFbvZMuZ3QL8qj6Ol-6sVQEEoVzw0zM1c9KmL2QDW3f3NZv1T3NFNLIZb24z5LA3SR295VOV35TJ6a6wxdIwNIB8ZtMjpo/s320/safety+first.jpg" width="320" /></a></div>
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<span style="font-family: "Tahoma","sans-serif";">Goodness me I have been so
busy with studies and work that I have not had time for my blog. Sorry to all
my readers.... for not keeping up with regular posts. I will try to make up for
it in the next few weeks. </span><br />
<br />
<span style="font-family: "Tahoma","sans-serif";">Interestingly I have just
finished a summer intensive in the Law of Occupational Health and Safety and
thought I would share some of the key points I learned. I have had my
head buried in books, study and work that I did not realize there was a big
debate regarding changes to our Occupational Safety and Health (OSH) Laws in
Australia..... shame on me. This has made me think if I didn't know how many
other midwives did not know....WA's current legislation is Occupational Safety
and Health Act 1984 (WA) & OSH Regulations... remember regulations outline
how the Act is implemented. </span><br />
<br />
<span style="font-family: "Tahoma","sans-serif";">Currently each State and
Territory in Australia has their own safety and health laws. They impose broad
general duties on key stakeholders such as employers, controllers of workplaces
and designers, manufacturers and suppliers of plant to workplaces in relation
to ensuring the health, safety and welfare of people. </span><br />
<br />
<span style="font-family: "Tahoma","sans-serif";">As from the 1st January 2012
the Commonwealth, NSW, QLD, ACT and NT have actually passed the new
legislation, Victoria, WA, Tasmania and SA will be delayed until sometime in
the New Year.</span><br />
<br />
<span style="font-family: "Tahoma","sans-serif";">Harmonisation would mean
each State and Territory will still have their own safety laws, but they will
be based on an agreed model Work Health and Safety Act supported by model
Regulations and model Codes of Practice. The new law is called Work Health and
Safety (WHS) - WHS laws create obligations on employers to put systems in place
to prevent workplace injuries.</span><br />
<br />
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">Harmonisation
also involves a National Compliance and Enforcement Policy, designed to support
the consistent application of the laws across Australia by the different state
regulators. These laws will only come into play when each state/territory
passes them through their own Parliament.</span></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">There
are several key elements to WHS, they are: duty of care, meaning of worker,
cooperate with other business, consult with workers, upstream duties, union
right of entry and due diligence.</span></div>
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<br /></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">A
key element of the new National Law is the legal term ‘person conducting a
business or undertaking (PCBU)’. This term is not intended to mean individual
persons unless they are operating the business in their own name, for example
as a sole trader or a partner. A person who is a director of, or employed by, a
company is not a PCBU, the company is. The responsibilities of individuals who
are directors or senior managers of companies are covered under the new element
of ‘due diligence’. </span></div>
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<br /></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">Most
of the concepts in WHS are not new, they are just reworded and definitions have
been redefined; such as workers means more than employees, this is due to work
being completed by people who may not be employees. WHS defines worker very
broadly to include; employees; contractors; sub-contractors; outworkers;
employees of labour hire companies; and volunteers. </span></div>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">
</span></div>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">WHS
requires persons conducting business or undertaking therefore to as far as is <i>reasonably
practicable</i>, ensures the health and safety of workers it engages, or workers
whose work activities it influences or directs, while they are at work in that
business. Ensuring health and safety is imperative and this is defined as
eliminating risks, so far as is reasonably practicable, or if that is not
possible, minimising the risks.</span></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">“The
phrase “reasonably practicable” means something narrower than ‘physically
possible’ or ‘feasible’. What is ‘reasonably practicable’ is to be judged on
the bases of what was known at the relevant time and to determine what is
‘reasonably practicable it is necessary to balance the likelihood of the risk
occurring against the cost, time and trouble necessary to avert that risk
(Gaudron J at para 53.<i> Slivak v Lurgi (Australia) Pty Ltd </i>(2001) 205 CLR
304.). </span></div>
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<br /></div>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">Alright
let me put this in plain language and use water-birth for an example. Under the
new laws you are required to exercise due diligence....this means you are
required to have updated knowledge of health and safety matters...in this
instance we are relating it to water-birth - have you considered how you will
inflate and deflate the pool? access to power points? How is the woman going to
get into the pool? is there a step or stool, is it safe? can she slip? is there
a non-slip surface? get the woman out of the water if there was an emergency?
what will you do if your pool has a leak? what will happen if the woman faints,
hemorrhages etc</span></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">Is
there a safety culture present? an informed culture? a reporting culture? a
just culture (a no blame)? a flexible culture? and lastly a learning culture?</span></div>
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<br /></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">What
safety measures have you in place? do you practice safe evacuation? what
measures have you in place to protect your back, the clients partners
back? </span></div>
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<br /></div>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">What
is important to remember is that everyone owes everyone a duty of care, as to
what is reasonably practicable.</span></div>
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<br /></div>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">WA
has rejected the model WHS Bill, it has highlighted four areas that it did not
agree with and consequently would not be adopting as law in this State. However
none of the four issues relates directly to safety outcomes within the
workplace.</span></div>
<h4>
<span style="color: #0d0d0d; font-family: "Tahoma","sans-serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 115%; mso-bidi-font-style: italic;">The
four issues are penalty levels, union right of entry, Health and safety
representatives’ capacity to direct the cessation of work and Reverse onus of proof
in discrimination matters. WA agrees in principle that the penalty fees should
be increased; however feels that the proposed increase is too high. In terms of
workers’ rights to cease working if it is considered too dangerous WA feels
that this should remain with the worker and not be delegated to the Health and
Safety Representative. Union right of entry is already provided for in WA
legislation and to have it in this model would be a duplication of the rules.
Lastly WA considers that harmonisation will allow a company to be prosecuted
without the opportunity to prove that the company tried to fix the safety issue
and also considers this to be</span><span style="color: #0d0d0d; font-family: "Tahoma","sans-serif"; font-size: 12.0pt; font-weight: normal; line-height: 115%;"> </span><span style="color: #0d0d0d; font-family: "Tahoma","sans-serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 115%; mso-bidi-font-style: italic;">contrary
to one of the issues that initiated harmonisation.</span><span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;"></span></h4>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">WA
will probably accept the national Model Act with some minor
modifications. </span></div>
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<span style="font-family: "Tahoma","sans-serif"; font-size: 12.0pt; line-height: 115%;">Remember
to work safe and always consider is your work environment safe? what can I do
to make it safer? Watch out for when these laws come into place and make sure you are aware of the changes and how it will affect your work practice.</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Reference: <a href="http://www.safeworkaustralia.gov.au/sites/SWA" target="_blank">Safe Work Australia </a></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> <a href="http://www.aigroup.com.au/images/industry_full/whs_at_a_glance_insert_web.pdf" target="_blank"> WHS At a Glance: New National WHS Laws</a></span></div>
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Well it has been a while since I have written, and this is due to being very busy with four units of study, work and family life.<br />
I am looking forward to the semester finishing so that I can have some free time to blog, play and have some fun...... However I have taken some time out of my study plan today to write this blog, as I am very frustrated about this issue.<br />
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Firstly yes I think water is a fantastic source for women to use for pain relief, and if I had my time over again I would have a water-birth - so I am no opposed to this concept, in fact I am highly supportive of it. But equally so I think it is important to maintain a safe environment for both mother and fetus (baby).<br />
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Please have a look at this draft position statement on the <a href="http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccms.r" target="_blank">ACM Website:</a> <a href="http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccms.r?PageId=10084" target="_blank">Water immersion in labour and / or birth</a>:<br />
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Here are some excerpts:<br />
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Position Statement on use of water immersion for labour and birth<br />
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<i><b>"The ACM supports the choice of all women at term to have the opportunity to access water immersion for labour and/or birth.</b></i>"........</blockquote>
This opening creates a problem for me as not <b>'all' </b>women are suitable for water immersion - and I think that this statement is a potential problem because it could be seen as encouraging <b>'all'</b> women even those with a know high risk factor to use water immersion (in the bath/pool) - this in fact could work against the college if there was an adverse outcome.<br />
However equally the problem arises when such tight restrictions (the current policy for water immersion states only low risk women) are placed on women who don't necessarily fall into the 'high' or 'low' risk category......<br />
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The other major problem I have is in the achieving best practice......<i><b>.all maternity services to be encouraged to provide telemetry.</b></i>.. for water immersion ( that is CTG monitoring in the bath/pool)<br />
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<i><b>To achieve best practice use of water immersion for labour and birth, it is necessary for:<br /> all maternity services to be encouraged to provide women with access to water immersion in labour and/or birth including telemetry as required;</b></i></blockquote>
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My concern with this is two fold, one if a woman needs a CTG (fetal monitoring) then it is considered that she has a risk factor that should not necessarily be in the water - and are we putting her more at risk?<br />
Second issue is that but stating this point even the low risk women might end up having monitoring in the water...will we be opening Pandora's box?<br />
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What I really like about the position statement is the following excerpt....because this tells women that they can so <b>'NO' </b>and have the right to say <b>"NO"</b> to any treatment they do not want.<br />
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<i><b>Informed decision-making, informed consent, and right of refusal are accepted legal principles in Australia. Each and every woman has the right to make informed decisions, including consent or refusal of any aspect of her care. Women must be respected in the choices that they make.</b></i></blockquote>
I also think that the College is compromising the position of midwives on this issue, because most state-wide hospital policies all state that <i><b>'water immersion for labour/and or birth is recommended for low risk women'.</b></i><br />
We have only recently taken the step to have water immersion in labour and/or birth accepted as a part of the childbirth care options.....and some hospitals are still not offering this to 'low risk' women let alone 'all' women.....lets take some baby steps first....otherwise we will lose the lot.....all it will take is one bad outcome and it's gone.........<br />
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<b>Take some time out and give some feedback</b><br />
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DEADLINE FOR SUBMISSIONS: 5pm (Canberra time) 21th December 2012: Submissions received after this date will not be considered.<br />
Submissions (and any questions about this consultation process) may be sent by email to: sarah.stewart@midwives.org.au<br />
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picture ref :<a href="http://watersongline.com/wisdomcorner/waterways/" style="font-family: Calibri, sans-serif; font-size: 11pt; line-height: 115%;">http://watersongline.com/wisdomcorner/waterways/</a><br />
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InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-71284952226182941962012-08-28T23:28:00.002+08:002012-08-28T23:28:26.495+08:00Freedom for Birth - One World BirthTake some time and have a look at this website: <a href="http://www.indiegogo.com/freedomforbirth">http://www.indiegogo.com/freedomforbirth</a><br />
Take back birth - pregnancy is not a medical condition - question your Medical Practitioner, be empowered take back childbirth:<br />
Make birth better,1000 premiere movie's at one time; Check out where the film is showing in your State / Country;<br />
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For WA see:<br />
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<span style="color: red;">Premiere screening of Freedom for Birth</span><br />When: September 20th, 7pm<br />Cost: $5.00 or donation<br />Where: Boulevard Centre, 99 The Boulevard (next to Floreat Forum shopping centre)<br />RSVP: To get an idea of numbers please RSVP on:<br /><a href="mailto:admin@ccbcwa.com">admin@ccbcwa.com</a>.au or call 08 61960463 to guarantee a seat.</h2>
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InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-59607097197781277632012-08-12T22:34:00.000+08:002012-08-12T22:34:02.320+08:00Lobbying pays of.......<div class="separator" style="clear: both; text-align: center;">
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Picture ref:<a href="http://safetyatworkblog.com/2012/02/06/the-lobbying-for-control-impedes-corporate-and-ohs-growth/" style="background-color: transparent;">http://safetyatworkblog.com/2012/02/06/the-lobbying-for-control-impedes-corporate-and-ohs-growth/</a>
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If you have followed this blog you will know that with the maternity reforms came the Determination, which on the one hand gave midwives access to a Medicare provider number and with the other hand effectively tied both our hands together by demanding that we have a collaborative arrangement with an obstetrician, this seemed an unfair advantage to obstetricians..... Now this might of worked if the obstetricians agreed to collaborative with midwives however this proved difficult for one reason or another and only a hand full of midwives were able to obtain a collaborative arrangement. Midwives wanted collaborative arrangements to be with a Health Service rather than with an individual doctor….. hopefully this system would be a fairer option.</div>
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Midwives began to collect data,that is evidence that collaboration was not working. Private midwives have been actively seeking collaboration for two years and there are only a few arrangements within Australia. We began to lobby the government for change…and finally this has happened. There was a round table consultation in July with key maternity stakeholders including the AMA and RANZCOG to discuss indemnity insurance and collaboration or the failure of the Determination in its current format…. hence the announcement after the Health Ministers meeting 10 Aug…..</div>
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<strong style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Professional Indemnity Insurance for Privately Practicing Midwives.</strong></div>
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<strong style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> Ministers agreed to an extension of the professional indemnity insurance exemption for privately practising midwives until June 2015. This will mean that privately practising midwives will continue to be covered by the national registration and accreditation arrangements.</strong><span style="background-color: transparent;"> </span></div>
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<strong style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The Commonwealth agreed to vary the determination on collaborative arrangements to enable agreements between midwives and hospital and health services.</strong></div>
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<strong style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ministers agreed that WA would develop a paper on longer term arrangements and that this would be presented at the November meeting of Ministers</strong></div>
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<a href="http://www.ahmac.gov.au/site/home.aspx" style="background-color: transparent; border: 0px; color: black; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">http://www.ahmac.gov.au/site/home.aspx</a></div>
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comments made in the Canberra times: </div>
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<em style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The health ministers also agreed yesterday to change the existing rules which require midwives to work in collaboration with doctors.</em></div>
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<em style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">They'll now be able to enter agreements with ''hospital and health services'' as well. That move will be welcomed by midwives who have long argued the current determination effectively gave doctors a veto over midwives.</em></div>
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<em style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">But doctors are outraged, with the Australian Medical Association labeling the decision ''dangerous and unexpected''.</em></div>
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<em style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">''If the Commonwealth proceeds with today's decision it will be essentially allowing independent practice by a midwife,'' AMA president Steve Hambleton said in a statement.</em></div>
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<em style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">''When the collaborative care arrangements were being developed it was agreed the midwife could have an agreement with a doctor in a hospital who would ensure appropriate care arrangements were in place.</em></div>
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<em style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">''This decision is transferring sensitive patient care and management from a doctor to a bureaucrat. It must not proceed.''<b style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> AAP</b></em></div>
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<span style="background-color: transparent; border: 0px; line-height: 17px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Read more: <a href="http://www.canberratimes.com.au/national/midwife-exemption-gets-extension-20120810-240a3.html#ixzz23FsqH6gN" style="background-color: transparent; border: 0px; color: #003399; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">http://www.canberratimes.com.au/national/midwife-exemption-gets-extension-20120810-240a3.html#ixzz23FsqH6gN</a></span></div>
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It is not surprising then to see that the AMA is not happy with this outcome…however to say the <em style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">"decision is dangerous and unexpected"</em>…is unacceptable and scare mongering…..Midwives are heavily regulated through legislation, (AHPRA) Registration, Quality and safety framework, policies, guidelines and Professional Standards….. this is about implementing the maternity reforms, offering women more choice and allowing midwives to practice as autonomous practitioners……midwives are always willing to collaborate..</div>
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Private midwives want access to hospitals to enable women continuity of midwifery care…. putting women at the centre of their care.</div>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com1tag:blogger.com,1999:blog-4297301321247868053.post-77269605151303372962012-07-16T23:04:00.000+08:002012-07-16T23:04:20.866+08:00Improve access to maternity care by midwives known to women<br />
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<span style="color: #333333; font-family: 'Trebuchet MS', sans-serif; line-height: 18px;">A colleague of mine Beth O'Neil started a </span><a href="http://www.change.org/petitions/wa-minister-for-health-improve-access-to-maternity-care-by-midwives-known-to-women?utm_campaign=share_button_modal&utm_medium=facebook&utm_source=share_petition&utm_term=7175386" style="font-family: 'Trebuchet MS', sans-serif; line-height: 18px;" target="_blank">petition on change.org, </a><span style="color: #333333; font-family: 'Trebuchet MS', sans-serif; line-height: 18px;">the aim of the petition is to get 3000 signatures: what is the petition about? its about Improving access to maternity care by midwives known to women. </span></div>
<span style="color: #333333; font-family: 'Trebuchet MS', sans-serif;"><span style="line-height: 18px;"><br /></span></span><span style="font-family: 'Trebuchet MS', sans-serif;"><span style="color: #333333;"><span style="line-height: 18px;">Currently GP's will only refer to obstetricians and midwives are finding it difficult to get a collaborative agreement with obstetricians. What we need is for GP's to start referring pregnant women to midwives who are experts in providing continuity of midwifery care - what is continuity of care - it is the same midwife caring for you throughout your pregnancy, labour, birth and postnatal period.</span></span></span><br />
<span style="font-family: 'Trebuchet MS', sans-serif;"><span style="color: #333333;"><span style="line-height: 18px;"><br /></span></span></span><span style="font-family: 'Trebuchet MS', sans-serif;"><span style="color: #333333;"><span style="line-height: 18px;">We need <b>women to be asking their GP to refer them to a midwife </b>for continuity of midwifery care.... take a look at the petition have a read and then sign it..... pass it on to your friends, lets get it moving get the word out Midwives are here to offer you continuity of midwifery care.... shared care with your GP and or Obstetrician... we can all work together to give women what they want.... that is different models of care with informed choice and the same midwife throughout their care......</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS1GZEZYx-CaeATPauq-41RhU6pm31A3JAY8vufBeBI7ODBRGXDJ0L67WNvOibzL0NaQM0AfihyphenhyphenNMOC_O0BALfhdspxyebKIqYnR_pIKfAzJDvnmxLnfOKih4Zpue7FYhJDXrzxxc5Pvk/s1600/stool.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS1GZEZYx-CaeATPauq-41RhU6pm31A3JAY8vufBeBI7ODBRGXDJ0L67WNvOibzL0NaQM0AfihyphenhyphenNMOC_O0BALfhdspxyebKIqYnR_pIKfAzJDvnmxLnfOKih4Zpue7FYhJDXrzxxc5Pvk/s1600/stool.jpg" /></a></div>
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<span style="font-size: small;">The ups and downs of life, yes we all have them hopefully there are more ups than downs. I have so many blogs to write, this blog is going to be about ethical behavior; integrity, principles and veracity it seems to be foremost in my mind, it is my attempt to be philosophical. It is to get you thinking about the people, jobs, organizations and activities you are involved in..... stop and take a breath, and remember the basic principles of life, integrity and veracity. Abraham Lincoln said "<i>Important principles may, and must, be inflexible"</i>. </span><br />
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<span style="font-size: small;">I have been contemplating veracity, principles and integrity and how is it that people make decisions - I was conducting Health Assessment exams with students as I was intently watching the student go through the process of auscultation (listening) of the heart sounds - aortic area, pulmonic area, ebbs point, tricuspid and mitral (apical).... her actions and explanations were good, then she listened with the stethoscope to detect the different sounds, here the student has to listen with the diaphragm (wide bit) firmly on the chest, then lightly with the bell (with our stethoscopes you have to turn bell around so you can hear. This student listened with both the diaphragm and bell without turning the bell, therefore she would not be able to hear the heart sound. I asked the student to explain what she had just done and could she tell me what the heart rate was using the bell - and she did. I was surprised that the student would lie outright - when I asked her to listen with the bell of the stethoscope and tell me what she heard - her eyes met mine, then her head drop, she held her breath and then said sorry - it was the moment of realisation - its the oh F___K moment....her eyes dropped, the moment of shame. There was no need for me to say anything.... the student knew the impact and we all felt the disappointment. </span><br />
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<span style="font-size: small;">My question is whose principles are correct - <i>I demand from you in the name of your principles the rights which I shall deny to you late in the name of my principles</i>....Walter Lippmann.</span><br />
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<span style="font-size: small;">So we are all on the same page, I'll start with Integrity - according to dictionary.com it means;
adherence to moral and ethical principles, soundness of moral character and
honesty. Ralph Waldo Emerson said "<i>A little integrity is better than any career" </i>and Oprah Winfrey said<i> " For me real integrity is doing the right thing, knowing that nobody's going to know whether you did it or not".</i></span></div>
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<span style="font-size: small;">This then leads nicely on to Principles again
dictionary.com states an accepted or professed rule of action or conduct
a person of good moral principles. Franklin D Roosevelt said <i>"Rules are not necessarily sacred, principles are".</i></span></div>
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<span style="font-size: small;">Finally veracity as per dictionary.com, means conformity to truth or fact, accuracy., such as, honesty, truthfulness, credibility and many more. Thomas Henry Huxley said, <i>“veracity is the heart of morality”</i>. I just love the word veracity..... it's not used much these days.</span></div>
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<span style="font-size: small;">I wonder how many people get disillusioned with the lack of these very important principles in life? yes we all know the meanings of the profound words and probably all profess to abide by them, but do we truly do that? I challenge you to think about it.... why do people particularly leaders known for integrity and leadership engage in unethical activities?</span></div>
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<span style="font-size: small;">Is it they think they won't get caught or believe that the elevated status puts them above the law? was this the first time they did something inappropriate, or have they been on the slippery slope for years and no one knows.....is it as simple as being in a situation where you have to make a choice between what is right and what is easy? remember the famous words from Martin Luther King Jr “<i>The time is always right to do what
is right”.</i></span><span style="font-size: small;"> </span><br />
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<span style="font-size: small;">Sometimes it is just much harder to do what is right, no one knows that better than Toni Hoffman<b><span style="font-weight: normal;"> the senior nurse who put her career on the line to expose <a href="http://www.theaustralian.com.au/news/investigations/patel-whistleblower-treated-like-a-leper-by-queensland-health/story-fn6tcs23-1226223423898" target="_blank">killer surgeonJayant Patel</a> in one of Australia's worst medical disasters - Queensland Health and the Bligh government had treated her "like a
leper" since she blew the whistle.</span></b></span></div>
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<span style="font-size: small;">Another person that springs to mind is Tiger Woods, no one expected his life would unfold to the public and expose such a degree of infidelity <a href="http://bleacherreport.com/articles/629880-tiger-woods-fall-from-grace-can-he-recover-or-is-this-the-beginning-of-the-end" target="_blank"><i>"Gone is the mystique that once surrounded him. His aura of invincibility has evaporated, leaving only the very human man where the red-clad, club-twirling superhero used to be".</i></a></span></div>
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<span style="font-size: small;"><a href="http://www.sodahead.com/united-states/sodahead-slideshow-who-had-the-biggest-political-fall-from-grace/blog-325293/" target="_blank">John Edwards </a>former Senator of North Carolina<i> During his presidential run and wife's cancer battle, Edwards had an
affair, fathered his mistress’ child, and lied about the mess. </i>Sadly the list is endless.</span><br />
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<span style="font-size: small;">Do you think it is ever justified to tell a lie? This is a question I always ask my students in my ethical lecture, and as usual its a split class, sometimes I have majority that say its OK to lie and other times the decision is reversed. Most students will agree they should not lie and it is good practice not to lie, but in reality this does not happen, often it has been a split second decision to lie.... and this can be detrimental as the domino effect of the lie takes place together with the inevitable consequences of the lie.. However most students also seem to accept that lying is a fact of life, and that there are many degrees to lying.</span></div>
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<span style="font-size: small;">This attitude is highlighted in a <a href="http://www.telegraph.co.uk/news/uknews/9037421/Rise-in-dishonesty-signals-looming-integrity-crisis-in-Britain.html" target="_blank">A study in the Uk</a> that showed<i> </i>Lying, adultery, drug taking, breaking the speed limit, drink-driving, and
handling stolen goods are all seen as more acceptable than they were at the
turn of the century. <a href="http://www.telegraph.co.uk/news/uknews/9037421/Rise-in-dishonesty-signals-looming-integrity-crisis-in-Britain.html" target="_blank">Prof Paul Whitely</a>,..... <i>“It appears
Britons are growing more and more tolerant of low level dishonesty and less
inclined to sanction activities which would have been heavily frowned on in
the past.” </i></span></div>
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<span style="font-size: small;">As a society, if trust is eroded this will lead to economic and social consequences. I think its time to enforce these basic fundamental principles of integrity and veracity as essential elements to maintaining a cohesive society.</span></div>
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<span style="font-size: small;"><span class="style1"><i>"Public
confidence in the integrity of the Government is indispensable to faith in
democracy and when we lose faith in the system, we have lost faith in
everything we fight and spend for</i>".</span></span></div>
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<span style="font-size: small;"><span class="style1">(Adlai E Jr Stevenson)</span></span></div>
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<i><span style="font-size: small;"><span class="style1">Next time you are going to tell a lie, think twice and choose not to lie. </span></span></i></div>
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<span id="hotword"><br /><span id="hotword" name="hotword" style="color: #333333; cursor: default;"></span> </span></div>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-60984809212677910432012-06-18T01:28:00.000+08:002012-06-18T01:28:26.134+08:00Choices Women Make in Childbirth<!--[if gte mso 9]><xml>
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This is a short blog about a few conversations with several
women regarding the choices they made for the birth of their babies....I was <span style="mso-spacerun: yes;"> </span>in a shopping center promoting midwifery and
chatted to some pregnant women..... <span style="mso-spacerun: yes;"> </span>I’m
sharing some of these conversations for two reasons; because the choices these
women made blew me away and in light of the vigorous homebirth debates after
the release of the SA coroner’s report where he suggested that women who have a
high risk factors should possibly consider a caesarean section rather than a homebirth or words to that
effect...... (which will be my next blog).</div>
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I have to note that the women concerned all had private
health insurance and wanted to birth in a private hospital. First two women were
35 and 36 weeks respectively, they were having repeat caesarean sections. When
I asked how they felt about their impending c/section Mary said “look I have
accepted that is my reality”, I asked was she happy to discuss her decision and
she said she was happy to share and talk about it.... she went on to say “my
first section was an emergency.... when I was pregnant again we saw the same obstetrician
and we were told the risk of the scar tearing was high and its best to have
another section. I then said I would get another opinion..... You know, I could
not find another obstetrician that serviced the private hospital that would do
a VBAC.....and besides my husband did not want to take the risk and I have to
consider his wishes,” I asked “did she know the risk was really low...as in
0.04%” and she said “yes, but my husband did not want to take that chance, I wanted
to have my baby in a private hospital and did not want to go to a public hospital,
so I accepted the second section, now its baby number 3 and that’s the choice I’ve
made, it would of been nice to birth normally, but that’s the choice I made, I
wanted to have my baby in a private hospital”.</div>
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Janie who was her friend had a similar story.... except this
was her second section...she also knew about the risks involved regarding a
VBAC but really did not mind having a section, again her main reason was she
wanted to birth in a private hospital as opposed to a public one....</div>
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Sally was an older professional woman, 39yrs old first baby
and elected to have a caesarean section, currently she was 34 weeks and was not
interested in a vaginal birth, she said ‘I never wanted to give birth naturally,
I want to protect my pelvic floor and besides it took me longer to get pregnant
than I thought, don’t think I could deal with all that unexpected stuff, now I
know the date my baby will be born.....’ her mind was made up – we did go to
talk about breast-feeding to which she was not interested in, however we did
manage to talk about skin to skin at birth for bonding and the possibility of
expressing for the first few weeks and bottle feeding with <span style="mso-spacerun: yes;"> </span>breast milk as an option.... I asked had she
ever spoken with a midwife, her response was ‘I have private health insurance
therefore I have a very good obstetrician.... and he does have a midwife I see
from time to time....but he makes all the decisions....”</div>
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The last woman was 35 weeks booked for her repeat section at
a private hospital – first section was an emergency, no VBAC offered and she
elected for a section because her husband is a fly –in-fly-out and she wanted
to plan his time off for the birth and this was the easiest way....she also did
not want to birth in a public hospital....”on no I only go to private
hospitals, that’s why I pay for private health insurance...”</div>
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Out of the 10 women I spoke to 5 were having elective
sections, 3 were booked in secondary hospitals and another two for private
hospitals and hoped for a vaginal birth but all knew about the chance of a
caesarean section.... “if all goes well, I will have a vaginal birth..... we
have discussed if the need arises we might have a section”.....</div>
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I must say the aspect that surprised me most was the desire
to birth in a private hospital even if it meant having a c/section as opposed
to birthing in a public hospital.....that puts a different perspective on some
of the issues.....what is it that the majority of women want and is this the expected norm of place of birth?</div>
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Again I come back to the point of education and informed choice..... these
women wanted to birth in a private hospital and how that happened did not matter, their main issue was the place of birth.....food for thought.</div>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com4tag:blogger.com,1999:blog-4297301321247868053.post-13892743786733557622012-06-01T13:06:00.000+08:002012-06-01T13:06:18.534+08:00One World birth - have a look and join up - make a donation<a href="http://www.indiegogo.com/freedomforbirth?c=home&a=652956" target="_blank"> One World Birth:</a> take some time and have a look<br />
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<iframe frameborder="0" height="429px" scrolling="no" src="http://www.indiegogo.com/project/101763/widget/652956" width="224px"></iframe>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-52864577522628167482012-05-31T23:37:00.001+08:002012-05-31T23:37:24.875+08:00Women need midwives and midwives need more autonomy<div class="separator" style="clear: both; text-align: center;">
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Firstly I should be studying not writing this blog...... way to procrastinate.....Life has been very busy as usual for me especially with hubby not being well .. the garden is in disrepair, months of ironing waiting to be done and as for the dusting... forget it.... but life must go on.... most importantly I have to make time for my beautiful grandchildren.....<br />
I have currently just completed a Human Rights assignment and this got me thinking even more about the dilemma in Australia particularly in WA with Medical dominance, the strength and power of the AMA and the deliberate non engagement with private midwives for collaboration. It seems that the obstetricians are happy with the status-quo that is monopolizing childbirth - remembering in WA the uptake of private health insurance is approx 40%, (people think if they have private health insurance they get better care and value for money) and 99% of women want to birth in a hospital. WA has less than 1% of women who are choosing homebirth - with these small numbers and the high uptake of private health insurance, together with the failure of GP's to refer women to midwives, as they only refer to obstetricians..... it seems the only way forward for both women and midwives may be a Human Rights approach.<br />
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Continuity of midwifery care is almost absent in WA. The lack of autonomy for midwives whether they work in a hospital or as a private midwife in Australia is shameful. Even worse is the denigration of women's right to choose place of birth no matter what the risk and be afforded the right to have a midwife support that choice is non existent. Clearly the midwife would need some support if it was 'high risk' as this would be outside the scope of practice - this is where a <a href="http://www.nmc-uk.org/Publications/Midwifery-Supervision/" target="_blank">supervision model </a>would be beneficial similar to the UK. But instead women are pushed to the brink and birth alone without a health professional present. The question is who will protect the midwife who chooses to support the woman when she chooses outside of the recommended boundaries? Next question is who protects the fetus when things go wrong.... yes I know the fetus has no rights until born alive, but this rule is being challenged each time there is an adverse outcome.... watch this space.... This brings me to the first ever <a href="http://www.humanrightsinchildbirth.com/" target="_blank">Human Rights in Childbirth Conference</a> being held in the Hague...as I write this blog....I have paid to be part of the webinar but alas it is not working.... will have to do a blog on it when I finally get to listen to it. This conference is going to debate and discuss all the issues surrounding place of birth, maternal fetal conflicts and rights - how fascinating... I truly wished I could attend.<br />
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As I have stated before there is no legislation in Australia that will protect the midwife if she chooses to support the 'high risk' woman at home. The midwife would more than likely be reported under the current <a href="http://www.ahpra.gov.au/Legislation-and-Publications/Legislation.aspx" target="_blank">Health Practitioners Regulation National Law Act 2010</a>, be disciplined, which could mean a fine, restrictions on his/her practice or de-registered.<br />
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I am hoping that out of the Hague conference will come some true discussion from the lawyers, midwives, academics, doulas and who ever else is contributing to the conference about the maternal / fetal debate and the right of women to choose where and how they want to birth - and what happens in the countries where true choice is not valued. Here's hoping..........................<br />
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<br />InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com1tag:blogger.com,1999:blog-4297301321247868053.post-69396257558161623102012-05-07T00:32:00.001+08:002012-05-07T00:32:33.360+08:00Virtual IMD reflection<div class="separator" style="clear: both; text-align: center;">
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Virtual IDM reflection: this was taken from listening to Dr Amali Lokugamage present, it was an excellent presentation, food for thought. This is my understanding of the presentation.<br />
Also a big thank you to <a href="http://sarah-stewart.blogspot.com.au/">Sarah Stewart</a> who organised the <a href="http://internationaldayofthemidwife.wikispaces.com/Recordings">Virtual International Day of the Midwife a wonderful event</a>. If you want to listen to Dr Lokugamage presentation just follow this <a href="http://internationaldayofthemidwife.wikispaces.com/Recordings">link</a>.<br />
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(Ref pic:<a href="http://www.i-choose-self-improvement.com/left-brain-right-brain.html" target="_blank"> http://www.i-choose-self-improvement.com/left-brain-right-brain.html</a>)<br />
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Dr Amali Lokugamage
“Why doctors fear homebirth”<br />
Amali started by sharing she had a homebirth – an obstetrician who has had a homebirth – this was fantastic news, it was so inspirational to hear her talk about her experiences and try to explain the position of the obstetrician. Not that I never considered the position of an obstetrician before, but Amali made it so clear for me. She went on to say that prior to her own homebirth she did not understand why anyone would have a homebirth. She describes her homebirth as a profound experience so empowering. Which led her to write the article “Why doctors fear homebirth”.
Amali described that her pregnancy changed her views, she had an intuitive connection with her son, she talked about her connection...this led her to writing her book “<a href="http://theheartinthewomb.com/"> The heart in the Womb”</a>. ...which I must order.....She contributed her fear of childbirth to her lack of knowledge in this area, and her medical education, lack of knowledge leads to mass cultural blindness on normal birth and the basics of physiology of birth.<br />
Litigation is on the increase, therefore defensive practice is prevalent – obstetricians fear preventable bad outcomes. Doctors worry, will I survive litigation, they are fearful of it and try to avoid it at all costs, you can understand why they are fearful as this is their lively hood and sustains there family and lifestyle.<br />
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Interestingly Brittan does not have an issue with homebirth – as they largely have a public system and homebirth is provided within the healthcare system and provided for in legislation. Where as when you look at countries where health care is privatised, a greater private sector, she talks about a war on money – how true is this; I firmly believe part of our problem in Australia is that a large percentage of women have private health insurance, and GP’s refer directly to obstetricians, they do not offer midwifery led models of care...and often women think having obstetric care equates to high quality care.....<br />
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Dr Amali made another interesting point about the politics of homebirth by looking at how the Obstetric Colleges support or do not support homebirth – the only one I know off that supports homebirth and works together with midwives is the UK RCOG. (RCOG v AMA, ACOG) this might reflect the culture of the country. She went on to say Doctors want to fix, solve, not considering autonomy, because it’s about fixing the problem for what they perceive as the best. They are taught the importance of Maternal Mortality – 358,00 women die in childbirth each year – mostly in developing countries -, therefore they want to make things better......she also discussed,
<i>The three delays model – delays which lead to trouble pregnancy complications, delay transport, receiving g adequate care one transferred (“The “three delays” as a framework for examining maternal mortality in Haiti” Barnes-Josiah D, Myntti C, Augustin A, Soc Sci Med. 1998 Apr:46(8):981-93).
</i><br />
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This next point was most revealing was that there was an audit conducted of the Evidence in O&G practice, the audit found only 1/3 of the recommendations put forward by the ACOG was based on good and consistent scientific evidence, that is grade A. This is appalling considering that ACOG is most aggressive about homebirth and women’s right to autonomy. <i>(Obstet Gynecol. 2011 Sep:118(3);505-12. Scientific evidence underlying the American College of Obstetricians and Gynecologists practice bulletins. Wrigh JD, Pawar, Gonzalez JS, Lewin SN, Burke WM, Simpson LL, Charles AS, D’Alton ME, Herzog TJ.)</i><br />
Also discussed was Homebirth evidence, we know the – two largest homebirth studies; <i>de Jonge, 2009 low-risk planned home and hospital births – low risk equivalent to birth in hospital. BJOG: An International Journal of Obstetrics & Gynaecology, 116, 1177-118</i>4 .
Birthplace in England Collaborative Group. 2011. Perinatal and maternal outcomes by planned place of birth..<i>.BMJ. 2011 Nov 23;343;d7400; for multiparous women low risk is safe at home. </i>
Birth place in England - last study to say it was cheaper to have birth at home – and we all know this... it seems that the evidence is only used to discredit home birth and not when it is showing the benefits.<br />
<br />
It was refreshing to hear an Obstetrician talk about - 'Obstetric latrogenesis' (that is problems caused by the hospital / health professional) – increasing - induction, epidurals, surgical delivery, reduces bonding, reduces chances of reducing breast feeding;
Normal birth leads to adaptive physiological function in the baby, endocrine, immune system thyroid function, respiration promotes high breast feeding rate, greater bonding.<br />
Clearly you can see – healing is viewed differently between the – midwifery model v medical model.
I have heard this argument presented before that, Obstetricians only look at a snap shot of the woman's life – intellectual technical knowledge of birth as opposed to wisdom, feeling of birth. Obstetrics dominated by the left brain as opposed to midwives who use both sides of the brain.<br />
I liked the idea that Amali talked about how oxytocins may affect us – fight and flight, so low oxytocins for obstetricians as opposed to high levels of oxytocins calm, considered composed = midwives; this is a very interesting concept, she also says that it is possible that obstetricians and midwives are physiologically different...certainly food for thought, I liken it to Men are from Mars and Women are from Venus.....<br />
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I was surprised to hear the number of specialist doctors that have had successful homebirth (but I guess they are in the UK) – Dr Amali gave no answers to how to resolve the issues of the power imbalance, she thought that it would be almost impossible to convert them from left brain thinking...."it is difficult", maybe showing more video’s such as orgasmic birth"....<br />
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Dr Amali closed with that a possible solution maybe that Birth is a Human Rights issue.. as human rights will over rule obstetricians...maybe this is the way forward.... for me this will be a whole separate blog (as this is not as simple as it sounds and takes a long time)...as I would like to go through the case of Ternovsky v Hungry, a woman’s right to choose homebirth whether low or high risk ....<br />
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At the end of this month there will be a <a href="http://www.bynkershoek.eu/activities/bh-research/bhr-reproductive-rights/bhr-human-rights-in-childbirth-conference/">Human Rights conference in the Hague..</a>..so watch this space.<br />
Thank you Dr Amali Lokugamage for an inspiring presentation, I will try to view the 'Obstetrician' from a more left brain angle rather than just being paternalistic and disregarding a woman’s autonomy.<br />
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Ref pic: http://www.i-choose-self-improvement.com/left-brain-right-brain.htmlInfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com5tag:blogger.com,1999:blog-4297301321247868053.post-22664612175123476392012-03-27T20:41:00.002+08:002012-03-27T23:45:25.764+08:00Hitting a Brick Wall<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWIpFJI2oP3WH3iLmGr-h1yNcfnGYVEpgc0c9-gc4K1i-LBUZl7nwUwvNumagqJjkSFishjw9h4P_Tgpo3EanaJnodjyn7fXKvf7khH4_uhZAlsu2Q38nbBddYWuFu9Rqyni_MgGq7woI/s1600/brick_wall.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 214px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWIpFJI2oP3WH3iLmGr-h1yNcfnGYVEpgc0c9-gc4K1i-LBUZl7nwUwvNumagqJjkSFishjw9h4P_Tgpo3EanaJnodjyn7fXKvf7khH4_uhZAlsu2Q38nbBddYWuFu9Rqyni_MgGq7woI/s320/brick_wall.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5724603035842221186" /></a><br /><a href="http://www.comlaw.gov.au/Details/F2010L02105">The National Health (Collaborative arrangements for Midwives) Determination of 2010</a> (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. <br /><br />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’?<br /><br />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. <br />Here are some comments from Obstetricians<br /><br /><blockquote>‘ I will do the birth you can do the rest’<br />‘I will not collaborate, I am happy with the status quo’<br />‘we do not support homebirth regardless of the risk, therefore I will not collaborate’<br />’I am very comfortable with the situation as it stands and I am not interested in supporting your model of care’<br /></blockquote><br />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?<br /><br />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. <br />Call or email your local member of <a href="http://www.aph.gov.au/Senators_and_Members/Members">Parliament</a> and have you say: Ask for your right to see a Midwife and claim your Medicare rebate:InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-42455566780793305152012-03-02T23:04:00.009+08:002012-03-03T00:34:21.133+08:00Women need to debate if its time for fetal rights:<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3WguRZ9kIYdWE4AJr-RaKGgwt3WkBsuVB0SSftPqxlrDQ-PEmVcErZe1_Tbs_ruG5OcU8FqtdtOe3W-1tQNcF_2y10u74ktVZeW0NQKQANioAca1RjTn42x-nhAz9EwTs0PeEzL-UYJs/s1600/womens+rights.png"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 204px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3WguRZ9kIYdWE4AJr-RaKGgwt3WkBsuVB0SSftPqxlrDQ-PEmVcErZe1_Tbs_ruG5OcU8FqtdtOe3W-1tQNcF_2y10u74ktVZeW0NQKQANioAca1RjTn42x-nhAz9EwTs0PeEzL-UYJs/s320/womens+rights.png" border="0" alt=""id="BLOGGER_PHOTO_ID_5715336363747816610" /></a><br />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.<br />Education, communication and choice about place of birth is the answer...not mandating through legislation what happens to the woman's body.<br /><br />As Dame Elizabeth Butler-Sloss in Re MB (1977)<br /><blockquote>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.</blockquote>’<br /><br />Also Justice Cardozo on a Patient's "Rights"<br />"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,".<br /><br />Consent in law is very clear, as is the current status of the fetus - it has no rights until born alive. <br /><br />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).<br />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).<br /><br />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.<br /><br />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 - <br /><blockquote>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"</blockquote><br /><br />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....<br /><br />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.<br /><br />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?<br /><br />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. <br /><br />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.<a href="http://au.news.yahoo.com/thewest/a/-/wa/13017489/charge-reckless-mums-doctors-union/"><br />Charge reckless mums: doctors' union</a><br /><br /><span style="font-weight:bold;">Questions to ponder:</span><br /> - what do you think about fetal rights?<br />- Is a term fetus a human being? and does it deserve some rights?<br />- in what circumstances should a term fetus be awarded rights?<br />- should a health professional be accountable for the death of a fetus? <br />- what responsibilities does the mother have when making choices about her fetus?InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com2tag:blogger.com,1999:blog-4297301321247868053.post-73515754613112508692012-02-21T17:58:00.002+08:002012-02-21T18:01:29.761+08:00The Face of Birth<iframe width="560" height="315" src="http://www.youtube.com/embed/HFLzxdZG30Q" frameborder="0" allowfullscreen></iframe><br /><br />Great inspiration:Homebirth movement in the US took 40 years......InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-2346102660239547792012-02-21T17:55:00.001+08:002012-02-21T17:56:47.919+08:00The Face of Birth<iframe width="560" height="315" src="http://www.youtube.com/embed/BTWlH8A-vLY" frameborder="0" allowfullscreen></iframe><br /><br />Interesting:InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-91260680318755968132012-02-09T08:33:00.002+08:002012-02-09T08:35:30.507+08:00Collaborative Maternity Care Agreement - give your feedback<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3sp_2e2Nvom46ThaE1_PO4yN1j6UBsHscoTmj1wo285H3DZPp3k-h_wCTk2rZXI3jT1YDe-TUXK5z-N1IzPnc1X1dMQUiF0RJRGUMseR9XVB1iicXqW1-Y96BJqVXxwweA8BCPozuaLRK/s1600/have-your-say.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 211px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3sp_2e2Nvom46ThaE1_PO4yN1j6UBsHscoTmj1wo285H3DZPp3k-h_wCTk2rZXI3jT1YDe-TUXK5z-N1IzPnc1X1dMQUiF0RJRGUMseR9XVB1iicXqW1-Y96BJqVXxwweA8BCPozuaLRK/s320/have-your-say.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5706925764789245522" /></a><br />RANZCOG has developed a template for <a href="http://www.ranzcog.edu.au/members-services/fellows/resources-for-fellows.html">Collaborative Maternity Care Agreement between Eligible Midwife and Specialist Obstetrician or General Practice Obstetrician </a>for use by Specialist Obstetricians or GP Obstetricians and Eligible Midwives.<br /><br />It is very important to give your Feedback.<br /><em><blockquote>It is acknowledged that the template agreement will not be suitable for all settings and that not all Obstetricians will wish to enter into a collaborative arrangement, but all comments will be considered.RANZCOG</blockquote></em><br /> <br />Please send feedback to Rupert Sherwood by email to <strong>ganderson@ranzcog.edu.au or by fax to +61 3 9419 0672.</strong> <br /><br />Sending your response is important, this is how your voice and numbers count, please be proactive, <strong>read the document in its entirety... and give your feedback.</strong>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-74201132919089529822012-02-08T21:47:00.021+08:002012-02-08T23:35:21.300+08:00Born Alive Rule - is it time to rethink<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihWfbvKW0a1MVTC6gg29ZkQUhoqoEin3Ym3Qx984IqV_BQ6Jk-2d7bmovH9_SLQQMBMCzt4SdY-CLEkoPFdSLRKA7B9lXavDGp8ZthSZTUkB0Zv5M2RJm_TKC5ZQTj_X40xUVYFEhX0X0/s1600/Human_infant_newborn_baby.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 208px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihWfbvKW0a1MVTC6gg29ZkQUhoqoEin3Ym3Qx984IqV_BQ6Jk-2d7bmovH9_SLQQMBMCzt4SdY-CLEkoPFdSLRKA7B9lXavDGp8ZthSZTUkB0Zv5M2RJm_TKC5ZQTj_X40xUVYFEhX0X0/s320/Human_infant_newborn_baby.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5706773501632864658" /></a><br />A few seconds after birth:<br /><br />There is much debate over recent months regarding this issue; traditionally in Australia and some other countries a fetus has no rights until “Born Alive”, otherwise considered the “Born Alive Rule”. This rule has been around since the 17th century, at this time viability was considered when the woman could feel the fetus this was generally known as “the quickening”. It is now the 21st century technology is advancing at great speed, ultrasound is very definitive, there is no question now about the viability of a term fetus, is it time to reconsider the rights of the term fetus. An embryo is usually from fertilization, early stages of growth and then a fetus from 12 weeks of pregnancy; The definition of a term fetus is when it is considered that the fetus can survive outside the uterus without any assistance this happens from 37 weeks - 40 weeks. Once born most people refer to the infant as a baby.<br /> <br /><br />When considering the question of fetal rights it is important to consider what is considered a human being? Is the fetus a human being? What or who is a person? Can the fetus survive outside the woman’s body? These questions raise many ethical questions: My masters 10yrs ago was, is it time to re think fetal rights, and I concluded then that a woman’s autonomy was sacrosanct. 10 yrs on I think it is time to open Pandora’s box and debate the issue again.<br /><br />The born alive rule can be viewed from several perspectives; women - pregnancy – domestic violence – violence against pregnant women – criminal responsibility. I am going to view several circumstances; This blog is not a judgement of anyone, I am expressing a point of view to illicit debate on the issue of does a ‘term fetus’ need rights:<br /><br /><a href="http://au.news.yahoo.com/thewest/a/-/breaking/12826179/baby-heartbreak/">A recent case in WA</a>, <a href="http://au.news.yahoo.com/thewest/a/-/breaking/8413939/legal-loophole-over-baby-s-death/">Matthew Silvestro</a> who had a history of domestic violence was found guilty of causing grievous bodily harm when he drove his car into another car, causing his pregnant partner Vanessa De Bari serious harm (she spent 8mths in hospital recovering from injuries) including the death of her 8 month fetus. His sentence was a two year driving suspension and $8000.00 fine to which he pleaded he was unemployed and unable to pay this fine he ordered to pay costs of $119.20<br /><br />South Australia’s coroner has been conducting an inquest into several homebirth deaths of term fetus’s. The issue of “sign of life” and the “Born Alive Rule” has been bought into question and debated. Another issue that has been debated during the SA coronal inquiry is the decision to have a home birth, particularly because it involved twins a higher risk – and that no backup plan was made. One twin was born alive at home and the second suffered brain damage and died later. This is not a judgement, this is about questioning what is a human life? And does a fetus have a right to life? Do we have the right to dictate by our actions whether a term fetus lives or dies? It is time to debate this question further.<br />Dr McCaul said at the SA coronial inquiry:<br /><em><blockquote>"I had a strong sinking feeling because I felt she strongly still wanted to go ahead with a home birth," she said.<br />"I don't think it's safe to deliver twins at home. I think the risk of complications is high.<br />"She listened to what I had to say but I didn't feel that it was influencing her. I don't know that frustrated was the right word. I felt a bit powerless I think."</blockquote></em><br />Another case from SA that has a questionable ruling that of <a href="http://www.courts.sa.gov.au/courts/coroner/findings/findings_2010/Spencer-Koch_Tate.pdf">Tate Spencer-Koch </a>case in which the coroner states <em><blockquote>“Tate had been a perfectly viable fetus until the time of her delivery........the PEA (Pulseless Electrical Activity) that excited in Tate after her birth, acknowledging as I do that it was slow and could not support a mechanical heart beat, and could not be reversed, is to be regarded as the last vestige of her human existence. This last vestige existed at a time after she had been fully delivered. As such it was a sign of life that existed after she had been fully delivered. (1.27)<br />.......the PEA of 15 beats per minute that was detected in Tate approximately 10 minutes after she was fully delivered was a sign of life for the purposes of the law......all facts of the born alive rule have been satisfied in this case and I find Tate was a person in the eyes of the law and for the purposes of the jurisdictional requirements of the Coroners Act 2003”.(1.28)</blockquote></em>This case will change the course of history if this definition of a sign of life remains......it is my opinion that PEA is not a sign of life and that is because at this stage there is no cardiac output, you are essentially dead....there is only an electrical current that runs through your body as the last automatic process of the body....it does not mean you are alive.... It is however interesting to read the process and see how the coroner has come to his conclusions, it is all about words and how they are used and what they mean.<br /><br />Interestingly in the case of <em>R v Iby</em> a case of an assault that caused the subsequent death of a fetus/child. This case heard that the presence of a heart beat was sufficient to satisfy the born alive rule. It was also found that there was no ‘common law definition of what constitutes ‘life’ for the purposes of the born alive rule (248).<br /><br /><a href="http://www.who.int/healthinfo/statistics/indmaternalmortality/en/index.html">WHO defines live birth as</a><br /><em><blockquote>Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born</blockquote></em>.<br /><br />Fetal rights is a real dichotomy the right of a woman to her own autonomy and her body v the right of a fully formed term fetus who would live if able to be born..... what is the answer...In my mind there is no question that a term fetus is a human being: What is required is that there is community support / structures for midwives who choose to support women who make these choices; one thing is for sure, women have the right to choose where and how to birth – what is required is for hospitals and health professionals to be more flexible.<br /><br />In 1999 <a href="http://www.sccourts.org/opinions/displayOpinion.cfm?caseNo=26484">Regina McKnight</a> the first woman in South Carolina was convicted of homicide by child abuse in 2001 after a jury bought scientifically unsupported arguments that her cocaine use caused the stillbirth. Regina suffered the charge for suffering an unintentional stillbirth after having used cocaine during her pregnancy.<br /><br />McKnight unsuccessfully appealed her conviction in 2002, challenging the constitutionality of using murder statutes to prosecute women who experience stillbirths. But in a split decision, the state Supreme Court upheld her conviction, offering a novel interpretation of the state's homicide laws. The court held that any woman who unintentionally heightens the risk of a stillbirth could be found guilty of homicide with "extreme indifference to human life." Under this doctrine, the court held, any pregnant woman who engages in activity "potentially fatal" to her fetus could be charged with murder.<br /><br />In 2008, the Supreme Court ruled that McKnight had an unfair trial... McKnight argues that counsel was ineffective in her preparation of her defense through expert testimony and cross-examination...and the court also found that the information given to the jury about the supposed link between McKnight's cocaine use and her stillbirth was not scientifically supported. More importantly this ruling sends a clear message to lawyers as it was found that current research simply does not support the assumption that antenatal exposure to cocaine results in harm to the fetus, and the opinion makes clear that it is certainly ‘no more harmful to a fetus than nicotine use, poor nutrition, lack of antenatal care, or other conditions commonly associated with the lower socio economic group. This ruling will send a clear message to lawyers to get the facts right and not be misguided by medical misinformation.<br /><br />It is a travesty that Regina McKnight spent 9 years in prison for a crime she did not commit and in <a href="http://stopthedrugwar.org/chronicle/2008/may/16/pregnancy_south_carolina_supreme">South Carolina 90 women </a>have been convicted of drug use during pregnancy, this is not the answer to the problem.<br /><br />As a midwife sometimes this issue creates a dilemma for me as I firmly believe in the woman’s right to choose what happens to her body. That is under no circumstances should she be forced to accept any treatment she does not want. How do we balance the need to protect the term fetus that is a fully formed human life, but for the fact it has not been born alive it has no rights.... one minute in utero it has no rights, however once born and shows a sign of life you cannot kill it..... this just does not make sense to me........ <br /><br />I do think a term fetus should be afforded some right to life.....but I'm not sure how we can do this without impinging on women's right to autonomy, which must take precedence. <br /><br /><br />References:<br />CORONERS ACT, 2003 SOUTH AUSTRALIA RULING OF CORONER<br /><a href="http://www.courts.sa.gov.au/courts/coroner/findings/findings_2010/Spencer-Koch_Tate.pdf">http://www.courts.sa.gov.au/courts/coroner/findings/findings_2010/Spencer-Koch_Tate.pdf</a><br /><em>R v Iby</em> (2005) 63 NSWLR 278, 248<br /><a href="http://stopthedrugwar.org/chronicle/2008/may/16/pregnancy_south_carolina_supreme">http://stopthedrugwar.org/chronicle/2008/may/16/pregnancy_south_carolina_supreme<br />26484 </a>- McKnight v. State; <a href="http://www.sccourts.org/opinions/displayOpinion.cfm?caseNo=26484">http://www.sccourts.org/opinions/displayOpinion.cfm?caseNo=26484</a>National Advocates for Pregnant Women: http://www.advocatesforpregnantwomen.org/<br />Doctor says mother ignored homebirth warning:<br /><a href="http://www.abc.net.au/news/2011-11-17/home-birth-twins-death-coroner/3677156">http://www.abc.net.au/news/2011-11-17/home-birth-twins-death-coroner/3677156</a><br />Pic ref: <a href="http://www.solarnavigator.net/animal_kingdom/humans/babies.htm">http://www.solarnavigator.net/animal_kingdom/humans/babies.htm</a>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-36062902287538773982012-01-23T21:39:00.009+08:002012-01-23T22:05:52.225+08:00The art of listening and compromising with women<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwCrmpkgUdSBG8liFDRy1xHM89aBgEpyKeyip57zcIG8jGBC2n8Qnr34pb7AvwtywGcZIa-qepg3XHaiRWKVuNbqJ-coB2IIiVYrzlgaqUy4Ecsh-fF_I6K0pbTdg8-yfThmyc3rP5CXg/s1600/ear.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 266px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwCrmpkgUdSBG8liFDRy1xHM89aBgEpyKeyip57zcIG8jGBC2n8Qnr34pb7AvwtywGcZIa-qepg3XHaiRWKVuNbqJ-coB2IIiVYrzlgaqUy4Ecsh-fF_I6K0pbTdg8-yfThmyc3rP5CXg/s320/ear.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5700827782007197890" /></a><br /><br />As a midwife the art of listening is imperative, not only listening but hearing what the woman is saying and wanting. This in its self comes with its own inherent problems because as a midwife you know what a woman wants, however this can be like walking a tightrope as a midwife is bound by rules and regulations, therefore it is about the language you use and the compromising you can implement to satisfy both the woman and the institution.<br /><br />Language is commanding, it is all in the way it is presented; an example would be; you are having trouble monitoring(cardiotocograph (CTG) a woman and she is having a syntocinon (a synthetic form of a hormone oxytocin) infusion for an induction of labour (IOL). It is important to monitor the baby’s heart rate through this procedure as sometimes babies have a negative reaction to the drug and it needs to be stopped. The policy states that a woman having a syntocinon infusion needs to be on a CTG –however in this instance you cannot effectively monitor the woman. What is the midwife to do? The midwife reports to the doctor, the instructions are “the woman must be monitored, put a fetal scalp electrode on”. The procedure is explained to the woman, a small, tiny hook is put on the scalp of the baby, so we can monitor the baby – the woman flatly refuses this option, a definite “NO”. Next: the woman is told, “If you don’t have the scalp electrode and we cannot monitor you, our policy states we must do this. Therefore we will stop the drug and you can walk around for an hour, and if you don’t have contractions, we will start the drug again and you HAVE to have the scalp electrode attached”.<br /><br />There is something profoundly wrong with this statement: the language is authoritarian, demanding, controlling, there is no compromising, no listening, no discussion, and it creates fear and rebellion and backs the woman into a corner. There has to be a better way of walking the tight rope without losing our balance and falling off. It may be sometimes possible to hold the monitor in place enabling a good CTG reading, thereby giving a good outcome, however I acknowledge that this can be difficult.<br /><br />What do you do if a woman is refusing best practice, policy, or guidelines?<br /><br />The answer, discuss the issues in a non-threatening way; give the reasons / evidence why it is important to do whatever it is you want; get the doctor to discuss the issues with the woman; clearly document all discussions and the reasons why the woman is refusing the treatment, however ensure that the woman understands the implications for her decision. It is also a good idea to read back your notes to the woman so that she clearly understands the implications of the discussions and it is how she sees the situation.<br /><br />At the end of the day the decision will lie with the woman, if she is of sound mind, she is able to consent to treatment or equally refuse treatment. Part of our job is to give her balanced information to enable women to make an informed choice.<br /><br />A policy is usually best practice and is to be followed. A guideline is as it suggests a guideline that usually outlines how the policy works; both are usually well referenced and evidenced based. In a legal proceeding the policy and guidelines of the time are called to guide the current practice at the time and the expected care to be provided.<br /><br />Midwives are not and should not be expected to be doctor’s messengers; if doctors have these sorts of explicit instructions, they should be discussing this directly with the client/woman and not expecting midwives to pass on these instructions. The ANMC Competency standards, code of ethics and code of conduct all state that collaboration is essential with health professionals, this means discussing and sharing finding the middle ground, not just regurgitate doctors sentiments, doctors need to be building this relationship with the woman to also find a way to compromise. Midwives need to be mindful of the issue of “failing to obey a doctor’s order” this is a whole separate blog which I will be doing very soon. Working within a system you could face disciplinary action or be sacked for “Gross misconduct”…. Watch this space.<br /><br />It must be remembered that the woman is the consumer, with her own freely chosen subjective preferences and desires. Doctors tend to practice paternalism – thinking that they know best. Paternalism in medicine is defined as acting for the welfare of the woman, often interfering with or disregarding the woman’s autonomy. Doctors need to find the middle ground.<br /><br />Autonomy means ‘self-rule’, to act autonomously a woman needs liberty and independence from controlling influences, it is the right to hold your own views. As a midwife we walk a tightrope, balancing the woman’s needs, the requirements of the regulatory bodies and doctors recommendations…….the bottom line remains if a woman is of sound mind, well informed of her choices, she can refuse any treatment, however she needs to clearly articulate these choices together with the possible implications of her choice.<br /><br />ref pic: http://lukespad.wordpress.com/InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-34994599238812294322012-01-18T21:53:00.008+08:002012-01-18T23:18:15.821+08:00The challenge of collaboration:<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj401SehKmsbE_apa8rwSP9ih3WHhx2qBu8z1UpM5ZtNwvrKwdhwG7KJmAyXuVJ8xXDaWNX-97Lzxc4w_N2WV8SziohAsgacC3nCabCRP8LawIQfb02reDICXnVtJF8QA5FJktjUugMMWI/s1600/collaboration+doc.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 177px; height: 249px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj401SehKmsbE_apa8rwSP9ih3WHhx2qBu8z1UpM5ZtNwvrKwdhwG7KJmAyXuVJ8xXDaWNX-97Lzxc4w_N2WV8SziohAsgacC3nCabCRP8LawIQfb02reDICXnVtJF8QA5FJktjUugMMWI/s320/collaboration+doc.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5698989476412681010" /></a><a href="http://www.nhmrc.gov.au/guidelines/publications/cp124">http://www.nhmrc.gov.au/guidelines/publications/cp124 </a> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; ">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. <o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; ">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.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; ">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.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; "><a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp124_maternity_brochure_update081110.pdf">NHMRC was commissioned by the Dept of Health to develop national guidance on collaborative</a> 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. <o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; ">The <a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp124_maternity_brochure_update081110.pdf">pamphlet </a>explains to women that</span></p><p class="MsoNormal"><span style="font-family:"Arial","sans-serif""><i></i></span></p><blockquote><i>“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”</i></blockquote><o:p></o:p><p></p> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; "><i></i></span></p><blockquote><i>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.</i></blockquote><o:p></o:p><p></p> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; ">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.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family: Arial, sans-serif; ">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.<o:p></o:p></span></p> <p class="MsoNormal">Here’s to ‘continuity of midwifery care’, every woman having the opportunity to have a midwife and doctors and midwives working in partnership.<o:p></o:p></p>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0tag:blogger.com,1999:blog-4297301321247868053.post-6708744686483741282012-01-18T16:05:00.008+08:002012-01-18T16:33:44.107+08:00What you need to do if you want to be a Private Practice Midwife in WA<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_jMBm74drlFAcAv_IxDRPvmaW_912VjYhP9uNxjzwySXR47g5BgoVgzbK-JLekko3I9uj0BeFFXzFeeOysxQVLkUhhBM-cds74fojpxn0BXYHbAgX4R_AZ1UM0ppXdSmDV_Lh23c1Uvo/s1600/imagesCAUE2CMB.jpg"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 194px; DISPLAY: block; HEIGHT: 259px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5698885073683009186" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_jMBm74drlFAcAv_IxDRPvmaW_912VjYhP9uNxjzwySXR47g5BgoVgzbK-JLekko3I9uj0BeFFXzFeeOysxQVLkUhhBM-cds74fojpxn0BXYHbAgX4R_AZ1UM0ppXdSmDV_Lh23c1Uvo/s320/imagesCAUE2CMB.jpg" /></a>Western Australia is unique in many ways, but particularly in the area of Midwifery, it is the only State in Australia where you have to declare your intention to practice midwifery as a private practitioner to the Health Dept. In principle I think it is important for the regulatory body to know who is practicing independently, however I think rules pertaining to this should be National, not state by state. However despite my personal views it remains that for WA you need to register your intention to practice privately (independently).Therefore it is important to take several steps:<br /><br />1. Ensure you are eligible to practice midwifery<br />2. <a href="http://www.nursingmidwiferyboard.gov.au/">Be a registered midwife (NMBA - AHPRA)<br /></a>3. <a href="http://www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx">Review recency of practice standards<br /></a>4. There are no rules as to how long after registration that you can practice privately(exemption until July 2013)<br />5. <a href="http://www.slp.wa.gov.au/legislation/statutes.nsf/main_mrtitle_1563_homepage.html">Review Health Act Regulations 1914 Midwives Notification<br /></a>6. Lodge the form to the Health Dept (your intention to practice) Notification<br />7. Secure Insurance (VERO or MIGA) all private practice midwives (independent) must have insurance<br />8. <a href="http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx">Review guidelines for insurance (NMBA - AHPRA)<br /></a><br /><br /><div>Medicare for Midwives: for this you need to be an Eligible midwife (private/independent)<br /></div><br /><br /><div>An eligible midwife has completed three years midwifery covering antenatal, intrapartum and postnatal care.<br /></div><br /><br /><div>1. Complete Midwifery Practice Review (or equivalent)<a href="http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccms.r"> (ACM)</a><br /></div><br /><div>2. <a href="http://www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/Endorsements-Notations.aspx">Review the application form for addition of notation as an eligible midwife</a><br />3. Currently registered as a midwife, with no restrictions</div><br /><div>4. Current competence to provide pregnancy, labour, birth and postnatal care to women and their infants.</div><br /><div>5. Midwifery experience that is equivalent to three years full time post initial registration as a midwife.</div><br /><div>6. Formal undertaking to complete within 18mths - course for prescribing (course has to be approved by the Board)<br />7. 20 additional hours per year of continuing professional development relating to the continuum of midwifery care.</div><br />That's it, not much to do.....but please remember to register with the Health Dept your intention to practice privately. Also remember there is currently no insurance for Homebirth.<br />We need more eligible midwives, so please consider taking up the challenge, and offering women continuity of midwifery practice.<br /><br /><br /><div></div>InfoMidwifehttp://www.blogger.com/profile/00843289052323073178noreply@blogger.com0