Women need to debate if its time for fetal rights:

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

As Dame Elizabeth Butler-Sloss in Re MB (1977)

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

’

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

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

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

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

Whilst discussing fetal rights it seems unfair that the AMA (WA) should be targeting pregnant women with drug and alcohol issues saying there needs to be some sanctions applied to these women. Where will we draw the line.... obesity, working, sport...this is a preposterous argument we will drive women away from health professionals -

Dr David Mountain stated "there should be penalties for some of the "wild extremes" of homebirth/freebirth advocates where misinformation is deliberately given to women about the risk to their unborn child. I was very clear that in this situation it is the purported expert who misleads a mother into endangering their unborn child that should be considered to have recklessly endangered the child"

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

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

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

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

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

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

The challenge of collaboration:

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

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

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

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

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

The pamphlet explains to women that

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

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

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

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

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

Head on the chopping block – HOMEBIRTH:

Homebirth the hot topic: combine that with autonomy, women’s choice of place of birth no matter what the risk factor and you have an explosive cocktail and a subject that will divide a nation. There has been much written on this subject and sadly what is bringing it to the forefront again is term foetuses (babies) dying at home, with or without a health professional.

In 2009 there were 30,760 women giving birth in WA and the average age was 29.5yrs, the majority of women (98.8%) gave birth in hospital. Non Hospital births 1.2% including Born Before Arrival (BBA) (0.4%) and babies born at home (0.8%). The caesarean section rate was 33.3% (10,241) of the women recorded as having had a previous caesarean section 87.1% had a repeat section. What we need to be doing is reducing the caesarean section rate and concentrating on is promoting normal birth.

In 2010 WA had 245 homebirths, 203 occurred with the Community Midwifery Program and 42 homebirths with private practice midwives. We have 19 private practice midwives registered with the Health Dept and 5 eligible midwives.

This debate about homebirth revolves around less than 1% of women, not that I am suggesting that their views are not important; however there are 99% of women that need midwifery input to improve their birth experiences. It seems that a disproportionate amount of time is spent on homebirth in relation to the work that needs to be done to improve maternity services for all women.

I will start with my position as a midwife on the subject in the current Australian context;

Do I believe that women have the right to choose where and how to give birth? YES.

Do all women need a midwife throughout the continuum of pregnancy, birth and postnatal period? YES.

Should homebirth be an option for all women? The evidence shows that homebirth is safe for uncomplicated pregnancies.

Should all women have a midwife? YES

Should high risk women birth at home supported by a midwife? This is the six million dollar question; professionally and personally I would answer NO, based on the lack of protection for the midwife to facilitate this choice. However it is not that simple; usually women who are choosing homebirth for high risk pregnancies have experienced some sort of birth trauma, are extremely fearful of hospital and usually have knowledge of the associated risks, each case needs to be evaluated individually. It is unfair to label all these women as zealots or radical. What needs to happen is to listen to what the issues are and find more flexible ways to support these women providing continuity of midwifery care, collaboration with an obstetrician within a safe health system.

What is a problem is if midwives / or de-registered midwives keep supporting high risk homebirth without collaboration and health service support. Recently there have been several high risk homebirth deaths. If the term fetus (babies) keeps dying in the homebirth setting we will be endangering homebirth for uncomplicated pregnancies. Worse still women will lose their autonomy because the term foetus will be afforded more rights similar to what has happened in the USA. Currently in Australia a foetus has no rights under law until born alive, but this concept is being challenged.

What needs to happen is that health services need to be more flexible, by having visiting rights for private practice midwives allowing them to bring their women into hospital and continue to caring for them. When fearful women present they should be facilitated to birth in a low risk setting such as a secondary hospital or birth centre supported by the tertiary hospital. Specialist obstetricians could travel to see the women and support the secondary hospital – it is about being flexible – considering the psycho-social issues of the women. Having all high risk women being herded into a hospital like cattle is giving them no choice or options therefore creating more fear. Remembering there is established legal principle that a mentally competent woman can refuse treatment. It is no wonder that these women choose to birth at home or freebirth. Freebirth is an unsafe and unacceptable practice and Health Services are failing women if this is the only option they feel they have.

We as midwives need some sort of supervision or mentoring system to support us in difficult clinical situations therefore allowing us to support these women. We need legislative changes to protect the midwife to stay with women no matter what the risk and where she chooses to birth, we need health services to be more flexible and supportive. We need women to be demanding that Health Services and Doctors be flexible, it’s about open communication and negotiation.

Three questions:

What do you think about the homebirth debate?
Would you have a high risk birth at home?
Would you freebirth?



Ref: WA Mothers and Babies 27th Annual Report – Midwives Notification System
photo credit: http://offthebroiler.wordpress.com/2006/11/21/death-of-a-turkey/

Privacy Act: patient consent to collect and disclose information:

This is a gentle reminder for all privately practicing midwives to get patient / client consent to collect and disclose information, especially now that there are eligible midwives: something else we have to set up for the practice........

All organisations that provide a health service are covered by the Privacy Act (whether or not they are small businesses). Organisations providing a health service include:
traditional health service providers such as private hospitals and day surgeries, doctors and specialists
• pharmacists
• allied health professionals such as psychologists
• complementary therapists like naturopaths and chiropractors and
• in some cases other services like gyms, fitness services and weight loss clinics, child care and schools (if they provide a health service and hold health information).

The National Privacy Principles set out how organisations should collect, use, keep, secure and disclose personal information. They cover collection, use and disclosure date quality
Further information on the new privacy legislation can be obtained from the Australian Privacy Commissioner’s web site http://www.privacy.gov.au/

Don’t leave Privacy to chance:

10 steps to protecting other people’s Personal Information:

1. Collect only the information your require
2. Don’t gather personal information just because you can and just in case you require it
3. Tell people what you are doing with the personal information you are collecting
4. Consider whether you should be using personal information for a particular reason
5. Think about whether you need to divulge the information
6. If people ask, give them access to the personal information you hold about them
7. Keep personal information secure
8. Don’t keep information longer than you need to
9. Keep information accurate and up to date
10. Consider making someone in your organisation or agency responsible for privacy

Use and Disclose example: with my consent, the practice staff will use and disclose your information for purposes such as:
- account keeping and billing purposes
- referral to another medical practitioner or health care provider
- sending of specimens for analysis
- referral to a hospital for treatment and or advice
- advice on treatment options
- the management of our practice

Ensure that you gain the clients consent (best to have written consent) for the practice or midwife to collect, use and disclose personal information as outlined and I understand that I may withdraw my consent as to use and disclosure of my personal information......

ref pic:http://health-link.com.au/PrivacyPolicy.aspx

What’s in a name? Independent; Private Practice Midwife; Eligible Midwife

As I ponder how to advertise myself on the Internet I look at the possible variables and it comes down to “independent midwife” or “private practice midwife”, so let’s have a look at what difference a name makes:

What's in a name? That which we call a rose
By any other name would smell as sweet.

Shakespeare

By definition: dictionary.com “independent” –an independent person or thing.... not influenced or controlled by others in matters of opinion.... thinking or acting for oneself..... not subject to another’s authority or jurisdiction. – A free thinker.... not influenced by the thought or actions of others....

“private” – belonging to some particular person ( personal belonging)...pertaining to or affecting a particular person or a small group of persons; individual; personal; undertaken personally or individually without the presence of others; alone

“private practice” – independent and not as an employee; mainly pertaining to medicine;

Quote by George Bernard Shaw;

“He said that private practice in medicine ought to be put down by law. When I asked him why, he said that private doctors were ignorant licensed murders.”

Thesaurus.com: private practice by definition pertains to general medical care.... family practice and independent pertains to separate, liberated, free – alone, aloof, self governing

When I did a Google /Yahoo search of “independent midwife” the search generated pages of independent midwives Australia wide and internationally. The Google/Yahoo search with “Private Practice Midwives” generates equally a list of midwives however I have to say not as many as “independent” and more groups and associations....

It is interesting to note that the new Health Practitioner Regulation National Law Act 2010 refers to Private Practice Midwives and makes no mention of Independent Midwives: therefore I think there is a change in terminology .... moving towards private practice....

The upshot of this exercise highlighted that it doesn’t matter about the name women will find you whether you are called “independent or private midwife” so to throw the cat amongst the pigeons I am going to call myself “eligible private midwife”. My rationale for this is to focus on the legislative changes for midwives by highlighting the ‘eligible’ aspect therefore informing women of the ability to access Medicare rebates for midwifery care.

Remember; a midwife is a midwife is a midwife.... eligible, independent, private makes no real difference what matters is that you are a midwife.

How to apply for eligibility:

Today I sent in my application for an eligible midwife; like anything new the process is TIME consuming and there will be teething problems: I am hoping that I have completed everything as required; You do not need insurance to apply for eligibility; I have to say that I have had to send my application to Sydney as WA is not ready for this process: Here is my step by step process:

Step 1; Go to the AHPRA website and download on the first page fourth heading ‘Registration’ on drop down menu second one down click ‘Registration Process’; left hand side blue box; fifth one down; click common registration forms; Standard Format for Curriculum Vitae:print and save this form.

Step 2; While on the AHPRA website go to the Nursing and Midwifery site and download the Registration Standards for the Eligible Midwife third from the bottom; then on the left hand side fifth from the bottom click on forms; a third of the way down the page look for the heading Notations; click on Application for addition of notation as an eligible Midwife; print and save this form.

Step 3: Now you need to read and complete the forms; to make sure you meet these requirements before you apply; I have heard that there has been a problem with Independent Midwives who do not have Midwifery Managers.... so watch this space.... I would think that maybe one way around that might be that they could sign a statutory deceleration..... as this is legally binding.... but that will be for the Board to decide....lets hope they will work it out soon...

a. Current general registration as a midwife in Australia with no restrictions
on practice; You need to add your registration number with AHPRA:

b. Midwifery experience that constitutes the equivalent of 3 years full time
post initial registration as a midwife; Here you need a letter from your current Midwifery Manager outlining that you have worked across the continuum of midwifery care, antenatal, intrapartum and postnatal this letter is dated and signed;
You also need a statement of service; this is obtained from your HR department; I rang Health Corporate Network and gave them the years I work at the government institution and they sent me a very detailed statement of service;

c. Current competence to provide pregnancy, labour, birth and post natal
care to women and their infants; this can be proven by completing the Midwifery Practice Review (ACM) or some other accredited program(I don't know of any other one apart from the ACM one.

d. Successful completion of an approved professional practice review
program for midwives working across the continuum of midwifery care; as above

e. 20 additional hours per year of continuing professional development
relating to the continuum of midwifery care; if you have MidPLUS this will be easy you will just print out your summary; If you do not have MidPLUS you will have to produce evidence of attaining these points; copy your certificates and get them certified copies; I did not send any originals of certificates they were all certified copies.

f. Formal undertaking to complete within 18 months of recognition as a
eligible midwife; or the successful completion of: I wrote a letter using this wording saying that i will formerly undertake the course when it is ready.

i. An accredited and approved program of study determined by the
Board to develop midwives’ knowledge and skills in prescribing, or
ii. A program that is substantially equivalent to such an approved
program of study. As above.

Step 4: Follow the Standard format for CV; as it is slightly different to your current one; I just cut and pasted from my regular CV. One thing that is very different is the request for clinical / procedural skills - with this one I made up a table that gave the dates of my general clinical competences such as Obstetric emergencies; suturing, IV cannulation, neonatal resuscitation etc; and added certified copies of the certificates; You must make a declaration that your CV is true and correct and sign it. The CV has to be an original not a copy;

Step 5; add payment for your application; $90.00

Step 6: you also need someone to witness your signature when you have completed the application form

Step 7; Make sure you go through the checklist it is helpful to ensure you have completed everything; although the checklist does not ask for a letter from the manager and this is a requirement; Not sure why when you provide a statement of service;

Step 8; Take a copy of what you have prepared, I find this always good practice; double check it again and then post it to the AHPRA office in your capital city; if in WA post to Sydney NSW for the interim until the office is more settled in WA, as we only came on board middle of October.

I found this process tedious especially having to photocopy and get 16 copies certified of my qualifications and certificates; the CV was not problematic but had to be changed from my usual format; the letter from the employer was not difficult nor was obtaining the statement of service you just need to allow for the time to prepare for this application; I am hoping now that I have all this information that hospitals who require credentially will not want any more than this and when you have prepared it once it is then done.... life should be easy now....NEXT STEP MEDICARE PROVIDER NUMBER:

Lets hope I have not forgotten anything and have completed the application as required... will let you know how I get on......go on be daring take the step and apply for eligibility;

For more information visit the AHPRA website;

Ref: picture; http://www.clipartof.com/details/clipart/46255.html

Pondering the profession of Midwifery:

I have spent the weekend away from the email and work to try and recuperate from a really bad dose of the flu..... I must be run down, I have taken the opportunity to ponder my future..........The recent months have created much, discussion, passion, excitement, lobbying, stress, anguish, disillusionment, tension and more recently a more pronounced division within the profession of midwifery; even to the point of a midwife reporting the Australian College of Midwives to the ICM (International Confederation of Midwives) which I find extraordinary, I would of thought this would be saved for something so terrible; not here a modern, young progressive country such as ours with excellent maternal and infant outcomes however not so good midwifery services.... I am lost for words at this dissatisfaction within the ranks.....from what I can determine there is a strain of midwives that believe that no matter what the risk factor a midwife can provide the primary care without the necessary collaboration: I am particularly thinking of the twins, footling breach, high blood pressure, more than 1 caesarean at home type births; the homebirth that is not recommend at home. Any high risk category requires an obstetrician, this does not mean that you cannot have midwifery care but you have to collaborate with an obstetrician and birth in hospital.


Tawny Frog Mouth Owl (Male)

This has caused me to reflect on what my own vision is for midwifery within Australia as we are on the cusp of change or no change as it may be. Before I can discuss this it is important to say that I have only practiced midwifery in Australia for 7 years now after completing my midwifery in the United Kingdom and working there for several years, so my basic ideology of midwifery comes from my experiences in the UK. When I first arrived back to Australia as a Midwife it was extremely different and difficult to work as an autonomous midwife to the same level as in the UK, in fact impossible: I even tried the Birth Centre where I was told “no we do not do water births, you have to pull the plug out”, tried independent practice but the thought of no insurance and no support system was too much of a risk, I nearly gave up the profession several times as I felt it was a losing battle.

Nevertheless what kept me strong was the idea of being a change agent and influencing the public perception (namely women and not just the minority of women) of midwifery in Australia so I continued the journey for change and the freedom of midwifery from the medical model which is so prevalent in Australia. So how does one go about change in such a huge way, it seemed only right that you should join the peak professional body for midwives, which is the Australian College of Midwives; whose philosophy is.... “Our vision is to be the leading organisation shaping Australian maternity care for the benefit of women and their families”. The college’s work is to provide a unified voice for the midwifery profession, supporting midwives to reach their full potential and ensuring all childberaring women have access to continuity of care by a known midwife”....The College has grown significantly recently as the profession has gained recognition and respect. The numbers of midwives within Australia has been difficult to quantify.... and so too are the numbers of independent midwives; with nursing and midwifery being lumped together; However due to the new National Registration and separate registers for nurses and midwives, we will finally be able to separate nurses and midwives and determine the numbers of midwives etc;


Tawny Frog Mouth Owl (Female with baby)

Traditionally in Australia midwifery has been seen as a tack on postgraduate course to nursing....in recent years we have seen the introduction of the Bachelor of Midwifery course which will also improve the profile of midwifery as being separate from nursing; ....... ever since I can remember (20yrs ago) the reputation of midwives is that “they are outspoken/bossy women” “consider themselves better than the rest” “ a bunch of dykes or lesbians” “difficult women” ‘feminists” and I am sure you know more than me, you have to wonder who put these labels upon us? And as I ponder my future.... all these anecdotal comments about midwives are no different now to 20yrs ago..... I have to say I aspire to being a “feminists in the truest sense of the word” I have always valued and wanted equality for women and I firmly believe to be a high-quality midwife one of the qualities is to be a feminist or have feminist ideology.
There are three main facts that I think are imperative to where we currently stand politically: What is a midwife: Medical dominance in obstetrics; Private Health Insurance:


The leaning tree

The role of the Midwife: I was amazed on my return to Australia how very little was known about who a midwife is? What is the role of the midwife? Coming from a system where every woman sees the midwife at 6/8 weeks at the GP surgery to women not seeing a midwife until 19/20wks...... unforgiveable for a woman & midwife. Therefore the first trimester is left to the GP/Obstetrician......no wonder they don’t want to give this up now as it is money lost to them......I realise that funding is different here in Australia as compared to the UK, but this just illustrates that there are huge changes required for women and the medical profession in Australia; interestingly if you examine midwifery history you will see that the UK and NZ have gone through several battles similar to the ones we are going through on two fronts, that from outside midwifery (political/medical) and internally from the difference of opinion from the independent sector of midwifery.

The second main point is the medicalisation of childbirth; it seems to me that in Australia generally women take on face value what a doctor says and takes very little responsibility for their own health care or pregnancy.... they seem to have the notion that “Doctor knows best” “just do what you think is right” you are the doctor, however I think this is slowly changing, I am hoping women are changing and taking more control of their bodies and their pregnancy;



Thirdly is private health insurance; here in Australia the uptake of private health is far greater than in the UK, and women seem to think that private health equals better, higher quality health care, which is not the case. Most importantly women think that obstetrician means best possible care whilst pregnant, and this is definitely not the case; private obstetric care means higher caesarean section rates and longer stays in hospital. Yes you need an obstetrician when things go wrong or you have a high risk factor.... but there is no reason why a woman should not be seeing a midwife alongside the obstetrician....but this rarely happens.....



As far as childbirth goes, Australia has a history of being medically led, midwives and midwifery is starting to gain some recognition, up until this point there has been no funding to support the profession of midwifery; the AMA is very strong and with its blanket rule of no support for homebirth this clearly indicates there is no support from that front. The independent midwives feel that the ACM is not supportive enough because they choose to take the safe route which will benefit many women & midwives rather than a few...and this is not to say that the few are unimportant, absolutely not, but small steps of change need to occur in order for greater change to follow; therefore working towards changing a medically dominated system that cannot be changed overnight and made to accept midwifery led care when this is a whole new way of thinking, in this country....... I have always thought it is best to take small careful considered steps to success rather than giant steps trampling on people to get the same result.

My vision is similar to that of the College in that I think that every childbearing woman should have access to continuity of care by a known midwife and that

I would like to see the ACM have its own industrial arm and legal support for its membership

(separated from the ANF)...... however in saying that.....I do despair for the future of midwifery in this country with such fragmentation within the profession........ As for me I am still pondering..... Shall I stay or shall I go? Is there a point to all this?


Isabella 2yrs old, her expression says it all!

It is time to be thankful......

In this political climate when everyone has a different opinion I thought I would remind everyone to be kind and gentle with each other..... there are feelings around:

It is central to remember the most important things are kindness, empathy and we do respect each others point of view even though it is different. It does not mean that we are not nice people....so remember when making comments and sending emails, not to be unkind rude and personal..... I came across these pictures and thought I would share it..... as a reminder to us all... that life is short, and there is time to be thankful for the wonderful things we have in life and how lucky we truly are:

The AMA has put out its Collaborative Arrangements:

There is much speculation surrounding this document; yes there are parts of it that make me cringe.... however it must be equally difficult for the AMA, not that any midwife wants to hear that;
Collaborative Arrangements what you need to know? the irony of this document has to make you laugh or cry:

"Working with other health professionals is an everyday feature of clinical practice for a modern medical practitioner. Effective teamwork can improve patient outcomes, create new opportunities for learning,and build a shared understanding of the skills that each person brings to the care of a patient."

Oh yes everyone is a patient even the well woman = this equals paternalism at its best; yes our medical colleagues are great at being paternalistic they feel they have the right to make that decision for the woman because they believe they know what is best; consequently, if the vulnerable woman is not able to make decisions or is not in a position to do so they are often coerced or made to feel fearful therefore making the decision the doctor wants.

“In a sense, this statutory requirement reflects the planned team care arrangements that have set parameters for collaboration in areas where doctors, midwives and nurses have always worked together - our hospitals.”

If we examine this statement they do say that it is “planned team care” and the word ‘collaboration’ means working together – not the GP/Obstetrician is in charge – it means a two way street. It will be interesting to see this work! because the doctors have the power and the money.... and automatically think they are in charge.

For me there are four main points that are important:

If we do not embrace these changes, then pressure will mount on the Government to relax the requirement for collaborative arrangements to be in place. This would risk fragmentation of care to the detriment of patients.

This is the most telling statement of all.... this means the AMA is seriously concerned that if they the doctors do not collaborate then changes will be made......this is in our favour.

Yes they are correct in saying that

“Some doctors will be challenged by the Government’s reforms, which will fund new models of patient care.”

This is clearly an understatement, we as midwives are certainly challenging them and if this collaborative framework does not work it will be changed; The doctors are back pedaling, they are fearful of losing money... so they are picking up stumps and are not going to play.

What should you do when a patient does not want to follow agreed clinical guidelines?

This may place you in a difficult situation.
The AMA believes that the best way of handling this is to ensure that your written collaborative arrangement clearly states that you will only provide care in accordance with accepted medical practice and within accepted clinical guidelines.
It should also clarify what will occur in circumstances where a patient declines to
follow these guidelines. If this occurs and you decide you cannot provide ongoing care for that patient, you will need to ensure that you advise the patient and the midwife/ nurse practitioner so that an alternative arrangement can be put in place by the nurse practitioner/midwife.
How you will address this issue if it occurs needs to be agreed prospectively in order to avoid a situation where you are forced to continue care because of a lack of
alternative arrangements.

This is nothing new, this is how the AMA works in every day practice, so this is no surprise....the only thing that is different is that they are blatant about and it is in writing.... there is no such thing as the clients right to choose the type of care they want or the right to refuse treatment.

Lastly I would like to be able to check the credentials of the doctors...what are their statistics, are they registered? how many women are not happy with their care etc? we should be able to check their register; that would be fair and just, equality.

Despite these issues I do think that we need to push forward, these are challenges put in our way and in time it will seem like a storm in a tea cup.

My vision is that all women will have the choice of continuity of midwifery care with a midwife and the right to claim a Medicare Rebate for fee for services;
Whilst I do not like the wording in this Determination I can see that this is still a historic time for midwifery....Opportunity is knocking..... walk through and make it work...if it doesn't you can always reject it.... but if we don't try we will never know it will always be a speculation

Together we stand, divided we Fall

The universe is change; our life is what our thoughts make it.

A strange phenomenon occurring in the universe around Australia, their is great indecision around, everything seems to be 50/50; first we have an election that had all the bookies saying it will be very close; this therefore means a society that is split; split in every sense of the word; values; principles; taxes and the people who will lead us: there was no clear leader presented....or party..... what is that telling us about our present status? indecision; This means we will have an election sooner than later.... because a divided house will fall.

The AFL final that is a draw...not that I care really accept that I do like to know who wins and loses these main events.... fancy not having a sudden death outcome, like a 5th quarter, extra time.... goal kicks something rather than repeat the game...that seems like a huge money spinner for the AFL........it is time to rethink the rule about a drawn game......

Then we have the Midwifery legislation - Determination for collaborative care; which has the midwifery profession up in arms talking, lobbying at great lengths; however I do not believe for one moment that this is 50/50 it is more like 70/30; 70 for 30 against; The profession is unanimously agreed that the wording is not correct. However what splits them is whether to accept something that is not quite right or throw the whole thing out and not have it at all for possibly years to come.

An interesting point is that it is now in the hands of the parliamentarians... who are equally as indecisive.... in the mean time; women, midwives, homebirth midwives, independent midwives, consumer groups are all pitting themselves against each other, saying some horrible things...making accusations to each other who's right/wrong ... it is all very sad.... in many instances bullying each other to get the perceived upper hand just as bad as the politicians... and at the end of the day we will all lose...... WOMEN & MIDWIVES and the AMA is clapping knowing they are the true winners here!
Something is in the air!

How is it that there can be such diverse beliefs and each thinking there's is the only right way.......the Homebirth/independent contingent is the loudest complainant shouting the loudest saying we are destroying midwifery...but have never given it a go..... in the survey that I have conducted the numbers are 20:4 in favour of accepting rather than losing everything and the counting continues; If we use the election as a marker to what people believe we can see that life does go on... it is how you go forward to make it work is the real task....... what ever happens it is evident that there is a clear divide between midwives; and I firmly believe this is because not all midwives work within their scope of practice;

As for the future of midwifery "together we stand, divided we fall" that is up to us!

Interesting that the Gospel states; (eg. Mark 3:25: If a country divides itself into groups which fight each other, that country will fall apart". Never a truer word spoken.

PLEASE EVEN IF YOU HAVE A DIFFERENT POINT OF VIEW BE KIND TO EACH OTHER;

Ref; picture & first quote comes from Why affirmations work

The Homebirth debate: I want to pull my hair out!

Some arguments presented; I am working through some thoughts and decided to blog it!

I will start with the role and scope of a midwife; the midwife is the specialist in dealing with the 'normal' pregnancy & birth and recognising when things become abnormal and then refer to an obstetrician. All medium and high risk pregnancy should be seen by an obstetrician, you could have shared care or good collaborative care so that the woman can have continuity of care with her midwife whilst seeing the obstetrician.

I can see some independent/private midwives totally disagreeing with my definition of what a midwife's role or scope of practice is. However this is determined by the ANMC competency standards / Ethics / Conduct and the ANMC decision making framework. The scope of practice for a midwife is clear; that is dealing with what is 'normal'. The ACM referral guidelines are also used to guide midwives in private practice - there are recommended conditions of which women should be referred (evidenced based) and when to refer women. this document protects the midwife if followed.

The government funds a small percentage of homebirths through the CMPWA programme, therefore women can claim through medicare - this is for approx 450 women per year. The program accepts healthy low risk women and the demand is greater than what is available.

As far as I am aware there are no Midwifery Group practices in WA, which really is a tragedy, as most other states have several MGP both private a publicly funded.
I do wonder if the women who choose independent midwives know the scope of practice of a midwife and to what extent she/he can practice? and do independent midwives ever say to the women this is out of my scope of practice I am not qualified to do this? however I will support you in the hospital setting?

There are a number of independent/private midwives who practice in WA, these are separate from the government funded midwives. Independent/private midwives will have a fee for service for which women cannot currently claim through medicare. This can be limiting for women and expensive.

Interestingly like private obstetricians private midwives are not required to follow public/government policy because they are privately employed. However they are responsible to the regulatory body which for midwives is the Nursing and Midwifery Board of Australia (from October for WA).

I do understand and empathise with the woman that has been so traumatised that she just cannot face going to hospital or even seeing a doctor due to her mis-treatment, this is very real and happens all too often. Recently this was evident in the 750 submissions made by women/men when asked about maternity services in Australia. Who cares for these women? The women are so fearful they would rather freebirth.... this is a terrible reflection of the state of maternity care in Australia. We are letting these women down.

I am frustrated with the homebirth debate; on one hand you have the independent midwife who at all costs will defend the right to support a woman of her "choice" to birth at home whether she is medium or high risk (and rightly so otherwise who looks after them). They believe that the woman has the right to choose homebirth because she is well informed and knows all the associated risks with birthing at home with a risk factor, therefore has the right to self determination and the right to refuse treatment. There are health professionals who do believe the midwife should walk away from this woman in other words abandon her in labour because your registration is at risk. There are obstetricians who believe that women do not have the right to choice when they are high risk......that it is the obstetricians professional right to make the correct decision in the 'best interest of the woman and baby'.

The law in Australia does not protect this midwife when she/he works outside of the scope of practice. Unlike the UK where the midwife is protected by legislation and is not allowed to abandoned the woman..... We need this type of protection in Australia for the midwife. Currently the independent midwife works out on a limb and is not supported and alienated by the hospital system.

The problem I have with the above scenario is that the midwife is not qualified to care for the high risk woman she/he would be working out of the scope of practice, because this is not within the role of the midwife and this worries me. I am not saying our role as a midwife is not to support this high risk woman, it is to support and provide collaborative care for the risk factor associated with the pregnancy, however often doctors will not collaborate unless the woman does as the doctor suggests.......this is a lose - lose situation.

The trouble as I see it is that fundamentally women are not being heard by health professionals, they feel pressured, bullied and are often scared into submission by the health professional, therefore choose an alternative model of care this may include freebirthing (birthing without a trained health professional present). Hospitals are not flexible, they are rigid and not prepared to meet the woman half way.... it appears that's its the hospital way or the highway...and women will choose the highway.

So what is the answer?
If I sound frustrated I am?
Please tell me how we move forward?
How do we stop women from feeling alienated and force independent midwives to work outside their scope of practice?

Deciding who to vote for?

Deciding who to vote for?
The Australian election is on Saturday and it is down to the wire...it will be a close call. What is it that makes you decide who to vote for? This election I have been more political than ever before...why is this? Because women and midwifery matter and now more than ever I feel that my vote counts more than ever. The recent battle for the profession of midwifery is almost equal to what women went through to get the vote (the SUFFRAGETTES)... equal rights the right to choose how to birth, the right to refuse treatment also more importantly the right to informed choice & continuity of care of a known midwife.

Your vote matters.......

We know who the major parties are; Labor; Liberal and Greens; over the years I have fluctuated between all the parties and in the days of Democrats, I was a staunch supporter. I will decide on Saturday.......and I will VOTE!

I do believe that the Labor Party Nicola Roxon as Health Minister has truly broken boundaries and put midwives, midwifery & nurse practitioners on the map..... however her latest Determination of 2010 has seriously let us down...and yes I can see that the AMA played a large part in this equation immediately prior to an election.... you are going to do what you think will get you re-elected.... however the Determination is seriously flawed and will not work for women, midwives or obstetricians and they the doctors currently hold the balance of that power, this is un-Australian..... midwives are currently regulated and do not need to have Dr’s veto their practice in order to claim a Medicare rebate.....I do feel that the Labor party are aware of this problem now and will change it if re-elected......

I am willing to give the devil I know another chance as opposed to the devil that is worse......a chance to prove it is worse... but will decide on the day....

On the other hand Liberals Tony Abbott has notoriously ignored the plight of midwives and our colleague nurses, a female dominated profession. He is a staunch Catholic therefore Pro life and not Pro Choice.....Tony Abbott’s history as Health Minister speaks for itself...non productive... and I am not so sure he is compassionate in terms of refugees......I wonder if he is promising to reduce the surplus where are we going to pay for it?.....

The problem with elections is that we get so many promises we end up not knowing who to believe......I would not want to be a politician...

The Greens Rachel Siewert....The "Australian Greens said today that midwives are furious with the Federal Government over recently released regulations governing the way they practice".
......The Greens are great supporters of midwives they are the only party that has a Homebirth policy and that have put women, midwifery and midwives openly on the agenda..... and it is very important that they control the senate to keep the bastards honest.....and maybe control the balance of power.......

Issues are numerous..... Refugees; Work Choices; Health; Education, Surplus, and the list goes on.... my message is don’t waste your vote...... if neither of the major parties don’t do it for you then vote for Greens or an Independent.... but vote because it matters.

"Greens Will Act to Help Midwives Media Release"

Read what the Greens have to say about “the collaboration determination”

Greens Will Act to Help Midwives Media Release | Spokesperson Rachel Siewert Saturday 24th July 2010, 10:01am

The Australian Greens said today that midwives are furious with the Federal Government over recently released regulations governing the way they practice. Greens spokesperson for Health, Senator Rachel Siewert has committed to immediate action on the regulations upon the resumption of Parliament.

“As soon as the Senate next sits, the Greens will move a motion to disallow the collaborative arrangements regulation,” Senator Rachel Siewert said today.

“This regulation puts doctors in total control of midwives and makes a mockery of the Government's $120 million “Medicare for Midwives” reforms,” said Senator Siewert.

“The government released its definition of collaborative arrangements for midwives out of parliamentary session, and it’s easy to see why- their approach is unacceptable and demeaning to midwives and they didn't want to draw attention to them during the last week of sitting.

“Midwives are concerned that this determination effectively means that if a doctor does not agree with a woman’s choice of midwife, they do not have to participate and will withdraw their collaboration.“Midwives will have to work under the control of a doctor in order to access Medicare payments.

They must have a signed agreement with a doctor who agrees to the way they are providing care or have all elements of care planning acknowledged at every step.“We’re speaking about trained and regulated professionals who have been insulted by the reforms put forward.

“If the government does not trust regulation of health professionals to ensure that practitioners are working safely, it is a very sad indictment of their own health care system.

“The government has failed to deliver anything like the promises they made for midwifery reform and at the same time have given power of veto of one medical profession over another.

"Women are outraged that they have been told that Medicare rebates will be available for private midwifery care and now the reality is that this will be limited to those employed in an obstetric model which many women have said over and over again that they don't want," concluded Senator Siewert

Collaborative arrangements for Midwives:

Well; after a long awaited time we finally know what the collaborative arrangements are.....I must say I am disappointed...after lots of negotiation I feel let down and that the machinery of money, politics and power have yet again trampled on the profession of midwifery.

The other issue is the upcoming election; we are in a crucial stage....Labour stays so does the current status quo...Liberal in and we lose it all....I do think that NICOLA ROXON Minister for Health and Ageing has tried to do the best for Midwives and also trying to accommodate the AMA.....without losing any ground and yes she too has to protect her position so that Labour remains in power.

This document is hard to read, you need to read it several times to work out exactly what it is saying.
For example if you read this section:

Specified medical practitioners
For the definition of authorised midwife in subsection 84 (1) of the Act, the
following kinds of medical practitioner are specified:
(a) an obstetrician;
(b) a medical practitioner who provides obstetric services;
(c) a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative
arrangement.

First impression is that an independent midwife or private practice midwife cannot practice without having an obstetrician sign them off..... however (c) indicates that any hospital doctor can act as an collaborative partner...therefore the hospital will act as an collaborative partner....

Now if we look at section 7: this part is more hopeful in that if we get a hospital to support private practice this will work as collaborative arrangement: we could extend it to domino births.....the problem with all this collaborative how much is truly required.... if everything is normal then there needs to be no collaboration....and yes...there has to be a hospital booking which will mean collaboration with a doctor...at least once..but thereafter you would not see the doctor again if everything is normal....and this is as it should be.....

Arrangement — midwife’s written records
(1) An eligible midwife must record the following for a patient in the midwife’s
written records:
(a) the name of at least 1 specified medical practitioner who is, or will be,
collaborating with the midwife in the patient’s care (a named medical
practitioner);(b) that the midwife has told the patient that the midwife will be providing midwifery services to the patient in collaboration with 1 or more
specified medical practitioners in accordance with this section;
(c) acknowledgement by a named medical practitioner that the practitioner
will be collaborating in the patient’s care;

If doctors truly were collaborative they would be referring more women to our current Birth Centers, but they do not because they want the control and money.... It is hard to even imagine that doctors will refer to the midwife....for normal care...because they do not even believe in Birth Centres.... how will they make this massive change when they do not even support homebirth.....?
I would like to see that they are made to refer women to midwives... instead of the old school boy tie club and kick backs to specialists.....

The bottom line is, it's the women's choice....it is about continuity of care and that every woman needs a midwife.

Keep focused on the dream, the passion and the right of women to choose where they want to birth their babies, the right to informed choice and the right to have a midwife.

Click on this link:
National Health (Collaborative arrangements for midwives) Determination 2010

Eligible Midwife Australia.....this is what it looks like

The Nursing and Midwifery Board of Australia has submitted to the Ministerial Council for approval: the Registration Standard for Eligible Midwife and Registration for Endorsement for Scheduled Medicines for Eligible Midwives.

What does this mean for the average midwife in Australia?
Requirements
To be entitled to be identified as an eligible midwife, a midwife must be able to demonstrate, at a minimum, all the following:

Current general registration as a midwife in Australia with no restrictions on practice;

Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as a midwife;

Current competence to provide pregnancy, labour, birth and post natal care to women and their infants;

Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;

20 additional hours per year of continuing professional development relating to the continuum of midwifery care;

Formal undertaking to complete within 18 months of recognition as an eligible midwife; or the successful completion of:

an accredited and approved program of study determined by the Board to develop midwives’ knowledge and skills in prescribing, or

a program that is substantially equivalent to such an approved program of study, as determined by the Board.

My understanding of the above is that you can be deemed an eligible midwife and give the undertaking that you will complete within 18 months further study for prescribing and diagnostics.

Now we have to wait for the realise of the courses that we are to do...those from WA who have already completed the Eligible Midwife program which was four units...should get some RPL (recognition for prior learning).....
Until these units are established it seems that midwives are required yet again to jump through hoops to give continuity of care.....

the bottom line is that you will have to have three years experience across the continuum of midwifery before you can become an eligible midwife..... complete your Midwifery Practice Review and do further study.....oh and don't forget you need to be insured.....
We are the midwives paving the way for the future.... don't give up....lets beat the bastards and prove this can be done.....

Starting MidPLUS my journey.......into the abyss

I can hear you saying what is MidPLUS..... well you might just ask that.... I am usually very diligent with maintaining paper base professional portfolio, I always have not sure why some people are just analy retentive about things like that and I am one of them. I am slowly moving to an iPortfolio as well....but that is another blog. What I like about MidPLUS is that it can be both paper or computer base which ever you prefer.....as I am in limbo it is great for me...

What is MidPLUS

MidPLUS is a best practice continuing professional development (CPD) program for Australian midwives. MidPLUS is uniquely designed by midwives for midwives.
MidPLUS aims to help you to plan and participate in CPD activities that are relevant to your learning needs and your midwifery practice or role. In so doing, MidPLUS supports the provision of high quality, woman-centred midwifery care. (ACM)

When you enroll in MidPLUS you receive a Portfolio (folder) and reflective practice guide; planning pro formas; a personal online CPD log; regular updates about quality CPD activities for midwives, and ongoing support to assist you to keep up-to date with developments in midwifery practice. its a great package..... well worth it and the support when you call because you are unsure of how to complete a section was tremendous.

With National Registration and Eligibility looming I wanted to be up to scratch.... ready to go....so that means having evidence to prove I am an eligible midwife.

The challenge for me has been starting MidPLUS, the folder has been sitting collecting dust on my bookshelf, staring down at me begging the question "when are you going to start me and see what I am all about. You paid good money for me - so now put me to good use".
Procrastination is a great thing...... but today I conquered MidPLUS and it wasn't that bad.... in fact I am impressed....in total I logged 711 hours of continuing professional development (CPD) once i started i couldn't stop....and I am going to share how I did that.

Firstly I write all study days, conferences, meetings,reviewing policy, reading an articles, and teaching sessions in my diary. My certificates are usually in my portfolio and reflections stored in my computer. It was a matter of collating all that information into the new format. It was good flicking through my diary for the dates....

There are two ways of logging actives: Active and Passive; attending a study day would be active and reading an article would be passive. You need to complete 30 hours of active CPD in a year, but you know we generally do more than that, this is a way of logging what we do.

First step; login to MidPLUS then scroll down and choose Log an activity - here you will write the description of the activity, date, time and small reflection of what you learnt, then you will log the hours it took - so I will use the Magic of Midwifery study day as an example - the points awarded for the day would be 6 points which is equal to 1 point per hour (not including breaks).... this is the general rule, this would be active; as I was on the education committee and I would be reviewing the presentations I could log that time as passive so I would log 2 hours for reviewing the program and presentations. To validate this activity I would upload the certificate of attendance or the program for the day, I would also upload the minutes from the education committee meetings as proof of my participation.

Another example would be I am asked to review the hospital policy on transferring neonates to the teritary unit. I would log this as active, the time it takes me to review the policy and the articles I read to improve the policy and keep it evidenced based.... therefore this may take me a few hours over several days.... in total 2 hrs a day for a week = 10hrs of active CPD.... I would upload the new policy as evidence of the activity. Remembering that my MidPLUS is totally confidential.

Take the first step and start your MidPLUS.....if you haven't enrolled yet into MidPLUS now is your opportunity...... click here for more information.....go ahead it is well worth the effort....

Today by the time I logged the ACM Conference in SA, my presentation & poster, meetings as an active member of the college and NMBWA, together with my blogs I was surprised to see how it all added up...... I also created learning needs for this year.. On reflection of the activities of the last year I did also realise that I need to reduce my work load.....

My daughter said if I could put this passion into my health I would be fit.... instead of battling to find time to walk everyday..... but that's another blog.... she also said to practice saying the word "NO" when it comes to work..... strange phenomenon that would be for me.....

A historic day today for Midwives in Australia

Today's legislation gives midwives the right to a Medicare number come the 1st November 2010, whether you are a supporter or not of the new legislation this is a monumental day… never in Australian history has such recognition be afforded to the profession of Midwifery.

It was good to listen to the proceedings in Parliament and hear the words 'midwife' 'midwifery' continuity of care' spoken so many times and in such a positive light and for the first time to hear the AMA take a bit of heat...it was truly exciting and it will be worth reading the transcript.......for prosperity...

The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009

The Midwife Professional Indemnity (Commonwealth Contributions) Bill 2009

I have thought long and hard about this legislation and despite its short falls I still think it is a good place to start. Recently I had the pleasure of meeting an esteemed midwifery blogger who introduced me to a new way of contemplating this legislation, that being: it is a ploy by the AMA to manipulate midwives and midwifery through the process of collaboration, that this is what the government had planned all along and we as midwives were lambs to the slaughter…….. Although I am open to this suggestion ….. I like to believe other wise that the Health Minister had the best interest of women and midwives in creating this step towards the emancipation of midwifery and midwives to provide woman centred informed choice…. the freedom of choice, place of birth for women and access to a named midwife.

The fight must go on to define the terms’ collaboration’ and also defining ‘eligibility’ what is the ‘eligible midwife’. Midwives have the right to work autonomously and not be controlled by doctors or obstetricians…… Midwives are the expert in the ‘normal’ process of birth…… Homebirth is not illegal it is a reliable choice for women, for which they should be given the option….. And not controlled by the medical model. Someone recently said to me “rules are meant to be questioned, we should not follow blindly” and our cause is one such case…… we need to stand up and be counted…..we as midwives have the right to birth women at home if it is the woman’s choice and it is safe for her to do so…… We must remain vigilant, posed ready for battle to defend this right…… and make sure that the government, doctors and anyone else that may wish to deter us from being able to provide women with the freedom to choose what health care want.

Seeing Red - the use of the word "midwife"

Now I have seen & heard it all.... This is an interesting concept, a "Postpartum Doula", I am not sure this is the most apt title for them.

what infuriates me more is to see the words midwife and doula interchanged - yes I know this is an American article and YouTube..... but its time to be weary....when you see this sort of article.....

"Doulas can be two types, the mid-wife who assists the birth of your baby and the doula who assists with all the non-midwifery work"

What does this say?
It makes no difference if the word mid-wife is hyphenated or not... it still intimates a 'midwife' which indicates a professional status, a level of education and qualification, which the doula does not have in terms of midwifery or as "midwife". In Australia it is against the law to use the term 'midwife' if you are not a qualified 'midwife'.

The word doula comes from Ancient Greek δούλη (doulē), and refers to a woman of service as a slave.My understanding of a Doula is an assistant, someone who provides non-midwifery, non-medical support to a pregnant woman more physical and emotional support. They may begin in the antenatal phase through labour and in the postnatal period. the postnatal period would be as support, errands, housekeeping, cooking and childcare.... but no medical or midwifery input.

The 'midwife' is still responsible for the woman for up to 6 weeks postpartum. Yes i think that the "postpartum doula' has a place in society but use a different title because if you are working beyond the 6 week period.... you are assisting with newborn care and parenting issues or the transition to parenthood... this then becomes the early childhood period...

The roles of a Doula need to be clearly defined and the consumer/woman needs to fully understand the difference between the roles of a doula and a Midwife.

Definition of midwifery from Wikipedia: Midwifery is a health care profession in which providers give prenatal care to expecting mothers, attend the birth of the infant, and provide postpartum care to the mother and her infant including breastfeeding.

International Confederation of Midwives definition of a Midwife:

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.
The midwife is recognised as a responsible and accountable professional who works in
partnership with women to give the necessary support, care and advice during pregnancy,labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

another post relating to Freebirth......

I am wondering is the rise of Freebirthing or unattended childbirth two fold... one women are not being heard... and secondly they are taking matters into their own hands, that is making their own decisions... without medical advice. This may be because once they seek medical advice they are bullied or made to feel guilty that they choose to do it alone.....
Unfortunately it is when things go wrong that everyone sits up and takes notice..... I can blog till the cows come home as to how unsafe Freebirthing or unattended childbirth is.... but until something goes wrong... no one is really going to listen or do anything.... and that is the tragedy....every thing seems easy and 90% of the time it is.....however life is not that clear or easy....

I have to agree with Regina's post on The Fun Times Guide Pregnancy site.... where she intimates the Freebirth figures are pretty scary.

No one has answered my question as to how do we fix the problem? is there a solution? or do we wait for infant and maternal mortality to rise first then act?

Life is very busy; too much work to get done.

My feet have not hit the ground since being home. I have been back from holidays for 12 days and now feel like it is time for another holiday….my university marking (150 papers) is almost completed, my personal study: Visual learning is way behind….and I am trying to catch up… I never realised how difficult this unit would be… One of the assignments is to look at a floor plan of a house … that someone else has chosen, so you don’t see the finished product and you have to draw the house around the plan. For me this is very difficult as I am not a visual person in that sense…. I don’t seem able to look at a floor plan and then imagine what the outside of the house is supposed to look like…. So I will have fun doing that one…. The second issue with this unit is working out the computer programs so that I can create and alter images…. So really this is not only a education unit but a computer one as well… as you are learning several skills.
Also there is the family to see..... keeping up with the kids and the grandkids, friends etc.... we managed to catch up with friends from the country which was good and I also managed to start a new clinical position one day a week, which will keep me grounded and realistic with my expecations of the students I teach and aware of changes at the coalface.

Attended “The Magic of Midwifery”… on Friday 13th it was an excellent study day….. The education team did a phenomenal job on organising this day… when you have such a successful day you have second thoughts about resigning from the committee and continuing…. On the other hand it is good to go out on a high note. For me it is time to move on and contribute in some other way to the College by doing something else and allowing fresh blood into the education team and a new stream of thinking.
There are several key components for organising these conference / educational days, initially you do need topics that will attract midwives to attend, and this can often be difficult because the needs and wants of midwives within the State are varied, you have public, private sector and independent (private practice) midwives all with different needs. Also considering the costs involved, because if it is too expensive they will not attend. Secondly it is choosing presenters that will be inspirational, because I think midwives attend these days not only for education but to be inspired and network. Work places can be stressful and the load on a midwife can be mammoth therefore it is essential from time to time to refocus and remember why you became a midwife and be motivated to be ‘with woman’ with like minded people.

The aspect I enjoy most about the Australian College of Midwives (ACM) study days, conferences etc is the networking the collegiality and they are never at the same venue. There is always the ability to network; discuss different models of care; debrief cases; and discuss different ways of approaching issues. …… You always learn something new and strike up new friendships and partnerships…. It’s just a fantastic forum of like minded people. So next time there is a conference or study day…. Go…. Experience it and utilise the experience by networking……. Share the learning experiences.

Often my husband feels I am having an affair with my computer, off course it would have to be a virtual one…… (Wonder if that happens in second life?) Just kidding! ... As I spend so much time on it….. Working…. Emailing…. Studying…. Blogging….. Writing memoirs…to think we use to use pen and paper…… how times have changed….that seems so tiresome now…..some times just browsing or surfing the net…. But I get so caught up and passionate about midwifery I can be browsing for hours on end.

After this conference my new soap box discussion topic will be memberships to Professional Colleges….. And why are they important for professional bodies…… so watch this space. Do you think they are important?