Where to find some Evidence - pregnancy

This is a great Blog - 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: Evidenced Based Birth Tutorial:

Virtual IMD reflection

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.
Also a big thank you to Sarah Stewart who organised the Virtual International Day of the Midwife a wonderful event. If you want to listen to Dr Lokugamage presentation just follow this link.

(Ref pic: http://www.i-choose-self-improvement.com/left-brain-right-brain.html)

Dr Amali Lokugamage “Why doctors fear homebirth”
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 “ The heart in the Womb”. ...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.
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.

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.....

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, 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).

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. (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.)
Also discussed was Homebirth evidence, we know the – two largest homebirth studies; 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, 1177-1184 . Birthplace in England Collaborative Group. 2011. Perinatal and maternal outcomes by planned place of birth...BMJ. 2011 Nov 23;343;d7400; for multiparous women low risk is safe at home. 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.

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.
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.
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.....

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"....

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 ....

At the end of this month there will be a Human Rights conference in the Hague....so watch this space.
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.

Ref pic: http://www.i-choose-self-improvement.com/left-brain-right-brain.html

The Face of Birth

Great inspiration:Homebirth movement in the US took 40 years......

The Face of Birth

Interesting:

Homebirth: A reminder July 2012 is looming

Following on from my previous blog which generated much discussion; lets remember the figures we are talking about: In Australia less than 1% of women homebirth: In the UK 10% of women homebirth and there is a call by doctors to increase that figure and have more 'low risk' birth centres and homebirth: I wish the AMA would say that:

The role of the midwife is clearly defined; anything outside of 'normal' needs collaboration with an obstetrician in partnership with the woman. However we do have some serious issues within maternity services that force women to birth alone (freebirth) which is unacceptable: as I have alluded to before partly due to there being no support or protection for the midwife under the legislation.

The Determination (National Health arrangements for Midwives) of 2010 set out the rules for collaboration which to this date has been difficult to secure. As far as I am aware there are only a few collaborative arrangements in this country, one of them being Melissa Maimann (Eligible Midwife) and Dr Andrew Pecese.

As privately practising midwives in Australia we are in real threat to losing the ability to support women at home for a 'normal' homebirth, so where will that leave HBAC, (homebirth after Cesarean section): HBAC needs to be done in collaboration with an obstetrician; come July 2012 the exemption for private practice midwives / independent midwives (these terms are used interchangeably) will cease to exist. If we or the government cannot secure insurance for Homebirth we will lose this right: and only publicly funded homebirth programs will exist.

As I have said before the consumer must help to take this forward: we saw the result from the Homebirth Rally in Canberra. We all have to work in partnership with , professional bodies and consumers: Women need to be asking their obstetricians for midwifery care: Ask your GP surgery, what is their position regarding Midwives; will they facilitate shared care with a midwife outside a hospital system? we need to focus on the AMA - we need to get them to the table and debate these issues with the consumer groups such as Childbirth Australia.

My real fear is that we will go down the same path as the USA (Pregnant and Miscarry....Do not pass go; Go directly to Jail) and we will lose rights for women and gain more fetal rights; choices for women will be limited due to legislation, we need to act now by working together and find a solution: One solution is for 'continuity of midwifery care'.

There is no quick fix to these issues, this will be a long slow political journey of negotiation to get what we want: which means providing different models of care, such as 'continuity of midwifery care' access to hospitals for privately practising midwives: the right of the midwife to support the informed choice the woman has made: This has to be a united journey not fragmented into separate issues, Homebith v HBAC or 'low risk' v 'high risk'.
We need to move towards 'every woman needs a midwife' and 'continuity of care'.

Challenging times for women and midwives (HBAC)

Sad and disturbing times for both women and midwives:

As a private practice midwife it is very important to understand the boundaries of my role as a midwife; some are outlined in my previous blog “government paying us lip service”. Many midwives are facing complex ethical dilemmas:
As a UK trained midwife I was used to being able to do a homebirth for a woman who has risk factors and has had collaboration and consultation with an obstetrician through the local Health Authority and has chosen a homebirth despite these risk factors. The difference being that in the UK there is a Supervision system of midwives (supervisor of midwives) that provides midwives with support and backup. Also within the UK system you are protected by legislation that states that only a midwife or a doctor can assist with the birth except for an emergency in which case anyone can help.

S16 (1) A person other than a registered midwife or a registered medical practitioner shall not attend a woman in childbirth: Nurses Midwives and Health Visitors Act 1997(UK)

In the UK a woman’s choice is respected in that she can birth at home and the local Health Authority has to provide a midwife for the homebirth if one is available (National Health Services Act). Also the Royal College of Obstetrics and Gynaecology (RCOG) and Royal College of Midwives have a Joint Statement No.2. -April 2007 supporting homebirth and work together to support this. However here in Australia a major problem is that the AMA categorically opposes Homebirth.

The Nursing and Midwifery Council (NMC) works in the same way as AHPRA in its role to protect the public to ensure that midwives work within their scope of practice which is low risk ‘normal’ and provide a safe environment for birthing women. Independent Midwifery is also under threat in the UK as there is no insurance for private practicing midwives: see Homebirth and the Law reference list: http://www.homebirth.org.uk/law.htm

The Health System is different in Australia; therefore we cannot really compare with the UK except to say that both regulatory authorities work in the same way, in protecting the public and ensuring that midwives provide safe and competent care for the woman.

Legal Advice: I am not a lawyer and not giving legal advice; this is my interpretation of the legal advice given to me)

I have to state that my position as a midwife is that yes I believe in “women having choice in place of birth” and I believe that every woman should have midwifery care. I also have to state that I believe my role as a midwife is dealing with the “normal” and anything that falls outside of the parameters of “normal” I will collaborate with an Obstetrician, working in partnership with the woman to achieve a mutual arrangement and provide midwifery care throughout. I would like to see more liberal / flexibility surrounding place of birth for high risk women instead of always sending women to tertiary centres where they often feel alienated and fearful this would be a step in the right direction.

In light of the recent debate surrounding HBAC, I have sort some legal advice regarding the issue of VBAC (vaginal birth after caesarean) and having a homebirth. I wanted to know where I stood legally when a woman approaches me as a midwife asking for this service, should I decide to book a planned homebirth for H/VBAC – in terms of my responsibilities and my registration/licence: You have to remember that a good lawyer can argue a defence for anything and there is always a defence to be had.

The first question you have to ask is - What does the professional bodies say about HBAC / VBAC?
The professional bodies are the AMA and ACM – (the AMA has 90% membership, do not support homebirth, and is very powerful & political) does this give you an idea of what the answer will be to the first question.

Second question: What does the regulatory body stipulate about HBAC/ VBAC? Here you have to look at the current codes and guidelines that govern midwifery practice; you could compare with the UK, NZ and USA;

Thirdly : Have you provided unbiased informed choice, have you got collaboration (Dr; support) for the H/VBAC is it clearly documented, have you clearly documented the risks associated with HBAC/ VBAC , are you providing a safe environment for the woman; and have you an emergency care plan, are you working within your scope of practice?

There may be a possible defence, how successful this would be is the unknown quantity as it has not been tested yet and I can assure you I am not going to be the first to do this.

Women do have a choice of place of birth; however the choice to have a midwife present in the home environment for a risk associated birth is a limited option due to the legislation and the regulatory authority. However if the midwife chooses to accept the HBAC he/she maybe risking disciplinary action which could mean losing his/her registration and or having restrictions on his/her practice together with a lengthy legal case that will be distressing and costly.

How to move forward:
The answer is to work on changing legislation, to something similar to the UK and gaining support from the AMA to collaborate with midwives in listening to what women want. Helping and facilitating women achieve the kind of birth they want in a safe environment with a health professional to support them, whether that is in hospital or the home. Providing different models of care which include continuity of care no matter what the risk factor is.

It is very clear that the consumer/woman has to lead the impetus for change, the demand must come from them otherwise nothing will change; it is the power of the voter to change legislation.

It’s been a while since I blogged.... life in the fast lane

Canberra - Autumn

I have really missed blogging even felt guilty about not writing and sorry to my faithful readers for the lack of updates, but as usual the build up towards the end of semester (marking, studying, and meetings) takes its toll on my time to blog....

Let’s see where I got up to.... sorting out collaborative agreements... progressing with CeMGP “the practice”.... writing copious letters and getting limited responses....working three days a week at Uni.....my commitments to the College continue...picking up three units in my study this semester was not a wise move...note to self “don’t do that again”, no more than 1 or 2 units or drop something else... almost forgot I was sick....feeling better now... the mediation continues.... it really keeps me sane I do notice my anxiety levels rise when I don’t meditate... Thank God on Saturday I get an injection of super duper all day retreat... that should centre me again.


Jasmine - I think mummy ate all that chocolate

On the grandchildren front the birthday season for this year has begun, as they get older they are harder to buy for.... Jasmine is now 7, Dylan (June) 6yrs & Jessica (Aug) 6 yrs, Talia (June) 4, Sam (July), Isabella (July) and Logan (Oct) will be 3yrs old and off course our newest one Tayla is 7weeks old.... by far the greatest pleasure I get is from the grandies...they are truly delightful and the light of my life.....


Talia's party:

As the semester comes to a close and the marking is complete, its time to read a book or novel.... today as I was buying birthday pressies for family and friends I spied a couple of books that leapt off the shelf into my bag via the cashier.... I wanted them all...but alas some are for gifts, however I will keep and read “The Wish” it did appeal to me.... so will give some feedback once I’ve read it.... I think I am back in the swing for my blog... will update on the political agenda for midwifery in my next entry:
Ciao!

Rules of engagement and Facebook:

Firstly I want you to think about why do you engage in Facebook (FB)? What is your primary focus?...this question is very important as you will read further into this blog. For me it is about connecting with people, friends, associates, overseas family, local family, it’s about linking, networking and disseminating information.... FB is one of the fastest growing social mediums in the world...it is changing the way we communicate.... I see it as a fantastic way to get information out to the cyber world..... and remember it stays there forever:

A recent study shows that 54% of Australians use FB.........

Recently a friend described and instance where she was reprimanded in her work place over a Facebook (FB) comment, in fact she did not write the comment she ‘liked’ the comment; I thought that the reprimand was a rather excessive step, so I delved into the possible legal implications of such an activity and have decided that there are some specific rules that you need to consider when engaging on FB.... in fact we all know the rules I think that often people believe the comments they are making are so ambiguous, insipid or insidious that it won’t be connected to them or their work place..... Think again.

The term ‘friend’ on FB is a false term it lures you into a artificial sense of security; come on think about it.... how many of us really have 200-300 friends in real life?.... when I was growing up they use to say “if you are lucky, you will be able to count your true friends on one hand”..... In FB the people I allow in yes are called ‘friends’ and some truly are but the majority are valued colleagues, acquaintances, ex students, friends of friends...etc... not what I consider true ‘friends’, I have to say I like them otherwise I would not invite or accept them..... but in the true sense of the word friends.... most of them are not.... please don’t misunderstand this.... but it is a fact of life: Therefore I go back to the question Why do you engage in FB? You have to really consider who you let into your FB world and what you publish. Keep work and FB separate.

After doing a web search regarding some legal issues on FB... I have come up with a list of rules that might help you keep out of trouble in the work place or anywhere else relating to FB.

Rule 1: really consider carefully who you are letting into your FB as a ‘friend’, if you allow mangers, work colleagues/associates this means you let your work into your private life. Ensure you have a closed privacy setting.

Rule 2: Do not mention anything to do with your work place no matter how insignificant you think it is... if you can be connected to your work by your comment you probably break the golden rules of ‘confidentially’ and ‘Code of Conduct’.

Rule 3: Be mindful of the photos of yourself you allow on FB, these photos become the property of FB and if you are acting in an unbecoming manner this could come back to bite you later. Don’t allow people to take your photo without asking you and letting you know if it is going on FB.

Rule 4: Do not write on FB when you are angry or under the influence of alcohol once the information is in cyber space it stays there: Internet Defamation is the fastest growing litigation ....so don’t write anything derogatory about anyone.

Rule 5: People seem to believe what you do outside of work does not affect your work life....WRONG....this is dependent on what it is and if you have you bought your profession/company/school into disrepute? Just think of our footballers .....there is a prime example of unbecoming behavior.

Rule 6: Social responsibility: this is like a duty of care to society, a reciprocal duty: we owe society and society owes us a mutually beneficial obligation. Be kind to each other.

The bottom line FB is on your employers radar; remember be careful who you invite in your world, don’t talk about work, don’t say anything derogatory and be mindful of the photos you let FB have:

Have a read.. How to use FB without loosing your job over it.....
Happy Facebooking!!!!!!!

Homebirths in the news again....

It is interesting that the debate is always around homebirth...is it safe or not.... however should we ban hospital births because babies die there as well. The language used "doctors divided" "the Health Dept" is allowing homebirth to continue... where is the choice factor here for women.. in fact where is the discussion with the women... in what other form of health treatment do you get autonomy so blatantly ignored as in this one...if someone refuses treatment the doctors accept this ...why is it so different in this instance.... Women have the right to choose where and how to birth....a well informed woman will make the right decision for herself and her baby....no where do I see any of these considerations here.

See the full story on 6 minutes Doctors divided over homebirth reports
We all know that statistics can be manipulated.... and the figures don't break down the women who choose to birth at home when they know their baby is going to die through an abnormality.

I would also like to know if BBA (Born before Arrival not planned homebirth) and en route births are registered as a hospital or homebirth.... also we know that statistics can be manipulated to which ever outcome you want....the figures also do not separate the women who choose to have a homebirth whose baby has an abnormality:

The other group of women that are missing from the report are the ones that Freebirth.... this is an unknown entity...we know it happens and these figures would alter the homebirth outcomes.... so really we still don't have a good indication as to the statistical value of the current outcomes.

The more the medical profession demand that women birth where they want them to the more the divide will grow…. It is time to listen to what women want…. The choice to have information and make and informed choice whether it is one the medical profession agrees with or not…... It is called autonomy. Dome doctors are openly hostile about homebirth. It is about communication, trust, building a therapeutic relationship, not based on fear, it is about being flexible and learning new ways of doing and communicating with women about birthing options.

The one thing that’s a reality is that women are being bullied and made to feel guilty, for choosing a homebirth. Their autonomy is being eroded and paternalism reigns supreme. It is time to change this……its about informed choice and autonomy.

Medicare Provider Number:

At last I have my Medicare Provider Number.... yeah...First eligibility,(see blog how to apply for eligibility) then Medicare Number and Insurance... all set to go.... website, business cards, flyers, something is missing.... yes the "women" wanting continuity of midwifery care.... I have booked my first woman.... and so life goes on... poor Ian is wondering how we are going to pay for the insurance......???

Applying for a Medicare Provider Number is relatively easy, however I have to say for WA applications are not processed here they are sent to Canberra so might take a few extra days for this reason..... interestingly you have to provide a signed form for every address that you will be working from and you will receive a provider number for each location.... for example if I was to work out of two officers, I would give each address and for a home visit I will use my home address as the office... therefore potentially you could have several address and provider numbers...

I have sent my application for my MIGA insurance today... and hopefully that will take a week or so to sort out and then I am set to go.....this is an interesting journey.... a brave new world....

First Eligiable Midwife for WA:

At last on my return from Tanzania I received a letter from AHPRA (16th Dec) that they had met on the 2nd December and have approved my application:

"An eligible midwife competent to provide pregnancy, labour, birth and post natal care and qualified to provide the associated services and order diagnostic investigations required for midwifery practice. In accordance with relevant State and Territory legislation.

Eligible midwife, but NOT qualified to obtain endorsement under section 94 to prescribe Schedule 2, 3, 4 & 5 medicines required for midwifery practice in accordance with State and Territory legislation".

It goes without saying that all midwives once you have successfully completed your course are by definition eligible midwives, we just have another criteria to get now for legislation and that is "eligibility" (three years experience post registration across the full scope of midwifery).... see the AHPRA website for more information.
A notation goes on the public register so that anyone can see if you are eligible or not.....
Next step is applying for a MBS provider number, I will be doing this between Christmas and the New Year;
One of next year's plan is to complete the Prescribing and Diagnostic courses....which are not up yet.....but will start following this up... Roll on the New Year..... NOW come on all you WA midwives start applying for eligibility:

ref pic: henry.k12.ga.us

Midwifery in Tanzania

This is a snapshot of midwifery in Tanzania from my perspective, it does not refer to anyone specific, the judgements are made from my personal observations:
Tanzania a country in which health resources are minimal and much help is required: the lack of staff, general caring and privacy being high on the agenda.
Clean room

In the public hospital the labor ward has approx 12-14 beds; the beds are hard and there is no visible linen, the windows and doors remain open and there is a problem with flies. I did notice curtains around some of the beds, but they are rarely used. The ward is split into three sections, with a resuscitation area for the babies, however I did not see any resuscitation equipment.

Labor bed

There is a long wooden bench for the women to sit on after birth; and there is a clean and dirty room, however it is a stretch of the imagination. There is a small room attached that has four beds and this is called the eclampsia ward...... the incidence of eclampsia appears to be high, and the antenatal care is insufficient in the prevention of the condition... this could be due to the low resources therefore not enough education. There are some rudimentary posters on the walls for treatment of PPH and Eclampsia, generally the ward is constantly busy, noisy often used as a thoroughfare.

A normal 24hrs could see anywhere from 74 – 120 births; on the days I spent there the average birth rate over 24hrs was 75-85 births a quiet time; the lack of staff is a massive problem and the ward is laden with students; as I commented in my nursing in Tanzania blog.... the structure of nursing is very different to Australia.... nursing and midwifery are together in every course and I suppose this also will assist with the shortage of staff.... just to remind you of the career structure..... enrolled nursing & midwifery is now a 2 yr course ( previously 4yrs) entry level is equivalent to yr 10 (form IV), as student midwives these students conduct 20 normal births and 10 high risk (breach, face, brow presentations etc) supervised by a qualified midwife. Diploma nurses and midwives if they have moved up from enrolled nurses will do a further 10 normal births and 5 high risk, and this takes a further 1 yr, also supervised by a qualified midwife. Diploma nurses/midwives straight from school good scores for form IV, three yr course. These nurse/midwives if they want to convert to a degree course will have to do another 3 yrs (6yrs in total). Lastly there are degree nurses and midwives (3yrs course) entry level form VI (TEE / TER level) these students require 30 normal and 15 high risk births. Confused......it took me a while to work it out.....


Part of the problem is that students outnumber the registered staff... and you don’t know who is an enrolled /diploma or degree nurse/midwife student until you ask and then I was still not clear who is accountable for what. On my shift there were 6 students and 2 registered nurse/midwives and a doctor........ at one stage I had four labouring women at fully with just me myself and I.... oh and my nursing students (as if in a maternity setting) it was frantic.....The African women need to bring with them 4 Kanga’s..... these are traditional cloth /dress, pieces of material (2 meters long) one piece is cut in half... so there are two for the baby.....the women use one as a sheet on the bed, they often have one they are wearing and the others are for after the birth and the baby.....often the women are naked, privacy does not seem to be an issue..... People walking in and out of the labor ward as if it was a thoroughfare.... flies were annoying.... it was hot/humid everyone was sweating, no way of cooling down.....there was no visible water anywhere, at times I felt useless and helpless.....I allocated my nursing students to stay with each woman attempting to provide some comfort.... and encouraging them to drink some water, which the women bring in themselves; I found a pinard on the desk, so was showing the students how to use one....there was no electrical fetal monitoring.... (not such a bad thing).

Delivery pack

Two women had syntocinon running, so I listened to their fetal hearts first.... all seemed well.... then I moved to the second two women..... These two seemed to be going head to head as to who was going to deliver first..... I called out for some help..... and a doctor came forward.... he was less than helpful....however he did yell for someone else to assist.... whilst he was with me I asked if he could translate to my women as I wanted her to stand up or turn over to aid her birth..... his response was “no we like them on their backs so we can see what is happening” he promptly called for a student midwife to assist me and yelled at the women to push harder......I regretted asking him to translate..... as we were preparing for birth.... I found the delivery pack.... but could not find a cord clamp..... by now the woman was pushing well the student midwife had disappeared momentarily ..... so I asked my favourite doctor who had taken his spot at the desk... watching the events...no curtains.... three naked women in the room all pushing....”excuse me, I can’t find a cord clamp I ask”.... “ ah you want a cordie clampie ask the woman or look in her bag, she has them”..... now the student has returned... and I am informed that the women bring in a cord clamp, a roll of cotton wool for the birth and her kanga’s, food and water for herself. If the woman does not have a cord clamp you find some cotton or tear a piece of material to tie the cord.... thankfully the woman has purchased a cordie clampie.....I could not find the scissors to cut the cord.... emm that’s because we use a blade....at one stage I needed to clean around the perineum and asked my student nurse for a paper towel..... forgetting where I was (the poor student went looking for one until I called sorry forgot where we are, we both nervously laughed) it was tough to use cotton wool for everything....it is hard doing a vaginal examination using cotton wool....it was a beautiful birth....a truly special moment...third stage went well, syntocinon given as usual.... the woman was exhausted...now it was time for her to get up and go and sit on the bench... I had taken too long and the student midwife was hurrying me along.... it was only 40mins after the birth..... the student midwife cleaned the bed with the two dirty Kanga’s, “I asked what happens to them now” she continued to clean the bed, rolled them up and put them in a plastic bag and gave them back to the woman...... no laundry required.... the woman sat on the bench drank her water and had a bite to eat (a piece of bread I think)... and started breastfeeding....

We then weighed the baby..... the woman was then transferred to the postnatal ward (we walked her across) within 90mins..... she then stays on the ward for 6hrs and walks home or catches the bus with her baby..... the postnatal ward may have two or three women to a bed.....I counted 12 beds, saw no baby cots...... the women lay exhausted on the bed with their babies...some crying...soulful eyes watching you... they have a resigned look on their faces...as if this is my life.....the nurse is sitting at the desk......the ward is packed a sea of faces.... there were be a couple of nursing assistants walking around assisting with breastfeeding.....it was heartbreaking, poignant and I was sadden by the obvious pain of life.

Resuscitation bed

It wasn’t long before there were two more babies..... All healthy and well.... the last woman was having difficulty and was going for a Cesarean section..... they don’t have forceps or ventouse births in this hospital, however I could see the benefit of using a kiwi cup ...... but that’s a different story.....the Cesarean section rate is about 20% and on the increase......only about 40% of women birth in the hospitals, the rest are out in the rural areas.....

Traditional Birth Attendants

We did visit a dispensary that was well equipped for births and I did meet some traditional birth attendants..... who also state they birth women on their backs on the floor... I did find this interesting.... I tried to share my experience of changing positions and it was met with great laughter.....

Transport poster rural area

In the rural clinic the women come whenever they have time or feel they need to attend.... with their first babies they seem to be more vigilant and clearly the more babies they have the less inclined they are to come to the clinic early they normally show up at about 32 weeks.... the clinic we visited was 2.5 hours away from the hospital.... and transport if things go wrong is difficult..... they often have to cope or find alternative ways of getting to the hospital.....

My students really enjoyed this placement and I am sure that 4/5 students will go on to do their midwifery; for me I was dismayed and the visions stayed with me for days and I am still troubled by the conditions that women are in.... and I would be keen to be able to help in a more substantial way.........The issues that struck me most: Technology v no technology: Caring / compassion v no caring / compassion: women being totally alone with no support: the total lack of staff: Birth flat on their back in bed:


There was a complete contrast in the private hospital.....the birth rate for November was approximately 50 for the month, there were no patients on the day we spent several hours there.... privacy is still an issue with three labour beds in the one room... the labor ward has just been renovated so was very modern ...


.....there were brand new beds.... however I was dishearten when I saw the strips remain in place on the bed.... for me this would mean because they are there they will be used..... There was a CTG machine...... in another room there were two labor beds... and there was one private room....( the executive room of course at a price). What was surprising was they had a spar bath.... it was great to see... however would need education re its use..... (I was asked to give a lecture on waterbirth that’s another blog). There seemed to be more staff here and they did seem more caring...and providing one-to-one care... but this was only a snapshot so I really could not give an accurate account......it was reassuring.... but sad at the same time.... because most women could not afford this care.......

My maternity time was an experience,as was my whole Tanzanian clinical practice....... I met some phenomenal people and some I hope to continue to keep in contact with...... more in my next blog......

Dreams; Dreaming:

Last night I dreamt that I was swimming in the ocean, it was a beautiful clear ocean, I love the sea.....my husband was standing on the shore as he normally does..... I was a little afraid a healthy respect of the ocean, it was a nice sunny day and I just love to swim in the ocean, so continued to swim. I then noticed some fish middle size fish... this frightened me a bit more but they seemed non threatening..... so I continued to swim...... more and more fish came.... they seemed to have their mouths open and looked half out of the water.... I was starting to panic the more fish that I sore... and then there seemed to be snakes and eels in the water, now I was terrified and swam for the shore completely panicked...... I woke in a sweat.... afraid there were just too many fish and eels in the water.......I was out of breath and afraid..... I looked around and thought “thank God I am in my bed, it was a dream”.......



In trying to make sense of my dream, I thought is must be that I have been a busy the few months, in fact an extremely busy year; certainly ending in a big way, in many ways very difficult I have to say I am tired, and sadden by many great women being wounded and continue to be wounded all in "the best interest" of midwifery, women, life, work.....I have to ask the question is it worth it? But deep down I know it is for the sake of all women and midwives, not just one or two groups... the one’s who shout the loudest.....and care the lest for all women and midwives.

The poverty and lack of resources in most parts of Africa - the uncaring of our fellow man/woman/child......it leaves me feeling completely drained...however hopeful of progress with help and resources.... I enjoyed teaching in Singapore.... it is was worlds apart shopping on Orchard Road v Dar Es Salaam .........it really is food for thought!



A dear friend of ours, not so close these days but from the past, well thought of & loved, lost their son of 34yrs (Peter); our boys all use to play soccer together: Peter was larger than life, enjoyed life to the fullest; listening to his eulogy it was a full life packed into 34yrs, but oh so young to die & so suddenly: the memorial service was packed and there was not a dry eye, men, women and children all crying........as we sat in the Limerick Bar at Rosie O'Grady's celebrating Peter’s life " I pondered as you do on your own life" what would they say about me? I have so much more to do.... so much more to give.... so much to share.... the energy spent on nonsense is a tragedy.... I want to yell from the highest mountain...pull your heads in......get on the same page!!!!!!!


The Kids putting up the Xmas tree....

Family is most important.... letting them know how much I love and am proud of them, watching the grandchildren grow up and being able to influence that growth....sharing the passion of life...teaching them to reach for their dreams and passions......everything is possible.....not to get bogged in the minutia of bullshit......listen to your inner voice and you will know what are the correct things to do in life.... that is really one of the most important lessons..... That is to trust your own judgement...... listen to and trust your inner judgement..... then follow that ...... you can’t go wrong........



It is times like these I like to go back to a favourite poem of mine Desiderata:

Go placidly amid the noise and the haste,
and remember what peace there may be in silence. .......... Avoid loud and aggressive persons;
they are vexatious to the spirit.......... Exercise caution in your business affairs,
for the world is full of trickery....... Take kindly the counsel of the years,
gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.......... Beyond a wholesome discipline,
be gentle with yourself.
You are a child of the universe
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.
Therefore be at peace with God,
whatever you conceive Him to be.
And whatever your labors and aspirations,
in the noisy confusion of life,
keep peace in your soul.
With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Be cheerful. Strive to be happy

Singapore 2010

My feet are not touching the ground:

This is usually a busy time of year....semester finishing, marking, getting ready for Christmas etc, etc, etc; However for me this is a particularly busy time.... semester is finishing and I have my usual marking....thankfully I love this assessment so it is easier to mark and the students also enjoy it and usually do it well, this makes marking so much easier...and as a teacher it is rewarding to read so many good papers;

I am taking on a new challenge...GLOBAL HEALTH ALLIANCE next Saturday i leave with 20 students from 5 universities (4 students from my university) in an inaugural project to Tanzania...to broaden their healthcare skills, provide care to people in the developing world, and to expand their cultural awareness.
“The placements are unique in that it is the first time the five WA universities have collaborated, as part of the GHAWA program, in sending a combined student and supervisor cohort to a developing country,”

“The trip will expose students to a unique healthcare environment which will improve their ability to work in challenging settings and help them to adapt to new cultural scenarios.”

The student nurses will travel with expert clinicians and will commence placements at Hubert Kairuki Memorial Hospital and Amana Hospital in the Tanzanian former capital of Dar Es Salaam.

We will also travel to two rural community health centres, Masaki and Masangaya Health Centres, where the students will undertake supervised clinical practice.

We are hoping that the international placements will allow the students to develop skills and knowledge in dealing with transcultural healthcare issues.



I am so excited...but as you can imagine this has increased my work load... preparing for this trip has been interesting and I don't know how I am going to fit all the protective equipment in my suitcase, together with the text books I want to donate as well as some other essentials...so watch this space for how the trip goes....but that is next Saturday....before then...I should be studying instead of writing this blog...but its called a break....

I am sitting two exams next week...Tuesday and Thursday.... finish my marking... have a couple of meetings....did I leave anything out.... ah yes there is still the surprise to announce which I anticipate to be middle next week....see the family and get on the plane..I think I also have a performance review......its called effective time keeping: or insanity:

I return after two weeks have two days to get Board of Examiners and supplementary papers out and then go to Singapore for three days of intensive teaching.... for trimester three..and two days shopping of course...can't forget that.... home for several hours then off to Canberra for another meeting... no wonder my husband and family think I have too much on my plate... but you know I have done all the Christmas shopping the grandchildren have their presents... if I get time I will wrap them before I go :)..... I will be home for the 17th December.... YEAH: enough time to sort out the Christmas dinner:

My mantra is " I have enough time in the day to get all I need to do done"
ok back to cramming now......

Update for eligibility: still waiting!

Update on my application; I thought that I was very meticulous with my application but alas this was not the case; there is particular certified list of people that are required and I used a university academic which is not allowed;
the Certified List for AHPRA

Justice of the Peace, Bail Justice, Registrar or Deputy Registrar
 Commissioner for Declarations, Commissioner for Oaths, Commissioner for Affidavits (dependent on jurisdictions)
 Lawyer
 Accountant (member of the ICA, ASA, NIA or CPA)
 Registered members of the teaching profession
 Member of the police force
 Sheriff or Deputy Sheriff
 Public Notary
 Permanent staff member of AHPRA (I think it would be easier to take your certificates and copies into your local office to be certified)

Second I have written a two page letter to the Chair of the NMBA to ask why they are asking for the last 5yrs of experience (Statement of Service) instead of the 3 yrs required by the Registration Standards; I did send a letter from a manager who did deem me competent, however did not address the ANMC competencies, this was rejected for that reason. Finally why when we have successfully completed the Midwifery Practice Review (MPR) do you require a letter from a manger addressing the ANMC competencies? the goal posts keep moving;

Anyway I have resent my documents certified in the correct manner by a commissioner of declarations (a pharmacist) together with the letter asking for clarification and I have had no response to date. I have also forwarded this information onto the National ACM as evidence of issues relating to applying for eligibility; Really this process is cumbersome and unacceptable. I guess these issues will come up at the next Board meeting which I think is the 18th November; just as well I am not in a hurry, I feel for those midwives who do need this urgently;

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

Do we ever learn from history?

I found this pearl:

In 1960 they asked 'Why are most mothers in this country delivered while lying flat on their backs? Traditionally it would seem thatwomen were delivered in a sitting position. Recently it has been re-discovered that this position can reduce pain fromsevere back-ache during labour. The sitting position also reduces by 23% the strain on the heart compared with therecument (sic) position. Many women find that lying on their backs during the second stage of labour is uncomfortable(especially so as they are so often required to do this on a high, hard, narrow "bed") - "like a stranded whale". Surely aproperly designed delivery chair would not be beyond the bounds of 20th Century ingenuity?’Sonia Willington, AIMS Newsletter 2

Why are we asking the same question 50yrs later?

Sad state of affairs for WA homebirth! Give me a break

Currently in Western Australia there are several options for having a baby.... you can check out this website; Having a Baby in WA - birthing options; the website offers information relating to most birthing options; Recently there has been much debate over Homebirth, with the Maternity Services Review and National Registration which now makes it law for midwives to have insurance cover and this is attached to registration; with an exemption to homebirth insurance for two years;

WA has a government run homebirthing program; Community Midwifery WA which provides a homebirthing option; the website carries valuable information for the women of WA including the pros and cons of Homebirth; The AMA has taken it upon themselves to object to this information saying that Homebirth is not a safe option and wants a warning on the website to alert women to this issue;
Today there has been great debate over this point; on the ABC radio show this morning; The health Dept chief medical officer Simon Towler says... that homebirth was a safe option... However the Health Dept says there has now been a warning included to the homebirth site,
now this is a very clever point; there is more than one way to skin a cat.....

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists do not endorse homebirths.
You can read their College Statement here.
The Royal College of Obstetricians and Gynaecologist in the UK do support homebirths – see here for their joint statement with the Royal College of Midwives.

Read the article; "Website promoting homebirths amended";

The AMA's WA president David Mountain said the website information about home births was misleading and did not warn about the dangers involved....

The article also goes on to mention that women should speak to an expert in this area.... well that has to be a midwife an expert in the 'normal process'.
51 WA doctors 'too dangerous' to treat patients without rules

In one case, an obstetrician found guilty of conducting rogue surgery has been allowed to continue practising - but has been banned from using forceps when he delivers babies

Another story over the weekend..... Parents sue over botched forceps birth....."A BABY boy could be left with brain damage after a WA obstetrician's bungled attempt to use forceps during his delivery".

I challenge the AMA Dr David Mountain to please put a "a warning for low risk women having a hospital birth for all iatrogenic injuries caused by a hospital admission for birth". More than 2,500 people die from hospital related injuries.... the Cesarean section rate is higher than ever..and still there are injuries and deaths associated with that....the risks for women having an unnecessary cesarean far outweigh the risks of a homebirth...see the ican website for the facts. .....

Give us a break AMA; Why don't you listen to what women want!

Time, Love, Passion and Life: Children:

Time is of the essence; My mother use to say "Pauline there is only time for the quick and the dead" I wish I had Hermione Granger, time watch... that alters time so you can fit it all in...from the Harry Potter movies. There is no doubt that I am a work-a-holic... I have been very well trained for this...again mother use to say "don't sleep your life away, get up and do something".

Over the years I have learned to relax and wind down... I love spending time with Ian on our spontaneous outings...or our occasional golf game.... and the day trips with the Grandchildren are a genuine treat..this is what memories are made of.....even the sitting and watching a Disney cartoon with them is delightful.... Finding the balance with 7 soon to be 8 grandchildren, and a passion for my work can be difficult....but I think the time spent with the children make it more special for both of us....if I was to ask the grandchildren what are their favourite moments with me, it will have something to do with going out on one of Nana's trips...



I have collected a few sayings that really sum up what I think about time.....that relates to family, work and life..... can you guess which one I like most?

Time is making fools of us again. ~J.K. Rowling

Time is the coin of your life. It is the only coin you have, and only you can determine how it will be spent. Be careful lest you let other people spend it for you. ~Carl Sandburg

If you want work well done, select a busy man - the other kind has no time. ~Elbert Hubbard

"Time is a great healer, but a poor beautician." - Lucille S. Harper

"Dost thou love life? Then do not squander time, for that's the stuff that life is made of." - Benjamin Franklin

"The bad news is time flies. The good news is you're the pilot." - Michael Altshuler

"All the flowers of all of the tomorrows are in the seeds of today."- Chinese Proverb

"I am only one, but still I am one. I cannot do everything, but still I can do something. I will not refuse to do the something I can do." - Helen Keller

Love makes the world go round.....I think of love and remember the first movie I saw about love.....yes the classic "Love Story" with Ryan O'Neil & All McGraw:

"Where do I begin (Andy Williams)
To tell the story of how great a love can be
The sweet love story that is older than the sea
The simple truth about the love she brings to me
Where do I start

The other great movie that I watch when i just want to switch off or feeling low...that gives me a lift is the wonderful "Sound of Music" I love the scene when Christopher Plumber kisses Julie Andrews for the first time... on the garden bench....it is just such a romantic moment...I know it's sad... but I love it...



love is what makes life worthwhile, I could not be me without my family and friends; the profound love that you have for your children is for some reason multiplied with your grandchildren.... and I think this is because you are wiser, less strict, you can see the error of your ways as you get older.... or you become a soft touch for those beguiling eyes...they are just so beautiful....

It's kind of fun to do the impossible. Walt Disney

If you want to make enemies, try to change something. Woodrow Wilson (1856-1924)

Life is short and we have never too much time for gladdening the hearts of those who are traveling the dark journey with us. Oh, be swift to love, make haste to be kind. Henri Frédéric Amiel

When we are motivated by goals that have deep meaning, by dreams that need completion, by pure love that needs expressing, then we truly live life. Greg Anderson

Teach only love for that is what you are.
A Course In Miracles

I love life, my family and I am passionate about women, midwifery, midwives, law, ethics, fairness & equality and having fun with my children..... but most of all I want to achieve my dreams and vision...and teach the grandchildren about being passionate and following dreams.....for this I need the love and support from my family.....because this is who I am and what is most important next to them.....time is of the essence:





ref for picture;http://www.flickr.com/photos/shewatchedthesky/2835193235/
Passion: http://www.art.com/products/p10345310-sa-i1058105/paula-scaletta-passion.htm

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!