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!

The greatest good.....for the greatest many;

What do we do when we have a moral dilemma? we examine our values and beliefs....where do these values and beliefs come from???? Values determine what we appreciate in life, what we reject and what we feel dispassionate about.

Take our current dilemma within Midwifery - do we? don't we accept the current determination? that is the question; now as I don't have a crystal ball, I have to judge by the facts; before I do I will explore two ethical theories that applies to our dilemma:

Deontology: which is duty bound based on a moral action regardless of their consequences; I like to think of the classic example is that we should not lie, however many people lie to save the feelings of the other person. However you are duty bound to tell the truth regardless of the consequences; for the good of a single person;

Telelogy - Utilitariansism - also known as consequentialism; actions can only be judged right and or good on the basis of the consequences they produce - therefore 'the greatest good for the greatess many' - therefore opposite to Deontology;

I always considered myself more deontology than utilitariansim.... however on this occasion I am the opposite;
A friend of mine gave me a classic analogy about the determination: it goes, " Dear Santa, thank you for the new red bike, but I really don't like red, and the wheels are two small, so no thanks I would rather go without my brand new bike" or the alternative response could be "thanks Santa for the new bike, yes I don't like red and the wheels are two small, but in the mean time I will ride the bike until l save some money paint it and put new wheels on"

I have always considered that the midwife provides continuity of midwifery care to "normal" "low risk" women.... once a complication arises then it is time to collaborate with our colleagues the obstetricians; this is done as professional to professional...... this is not recognised here in Australia.

I have circulated information far and wide about the issues at hand; the majority of feedback from midwives and some women has been to accept the the determination and the main reason being it is the first step to bigger better things; we can change something we have, not something we don't have;

There is much rhetoric about this subject; I fail to see how we are harming by accepting this, if the choice is this or nothing; yes I understand it is not perfect and I for one do not want to be beholding to an obstetrician. However I come back to the same point that this is very new to Australia, midwives are not as autonomous as our counterparts in the UK and NZ... so there has to be a period of trial or adjustment change is always difficult and does not come without a price......this is the first step to massive change... we have to keep working at it to get what we want....at the end of the day you can choose to accept this process or not.... you don't have to have a medicare provider number.... women still can choose an independent midwife.....and not claim a medicare rebate......

The facts remain the same:

The Determination:
Will not prevent private midwives being able to practice (they can still access insurance)

Will not prevent women being able to make choices –If you are having a homebirth and choose not to access Medicare you do not need a signed agreement with a doctor.

Only affects midwives seeking to access Medicare and midwives can choose not to do this.

Is not included in the NMBA Quality and Safety Exemption Framework supporting private midwives providing homebirth services

Does not re-define the ICM definition of a midwife – it does not define the role or scope of practice of midwives in Australia. It only defines how midwives can access Medicare if they choose to do so. Midwives can still work in public and/or private practice and access insurance and register as a midwife (under our current regulatory requirements that have an accepted definition and scope of practice of the midwife in Australia).

Does not mean that midwives must have a signed agreement with a doctor – this is only IF YOU CHOOSE TO ACCESS MEDICARE - Midwives can have
a. an individual signed agreement with a doctor
b. a referral of a woman to you
c. clinical privileging
d. an agreement signed by the medical director of a hospital.

Does not mean you need acknowledgment in writing - we have been told by the Minister’s advisors that a midwife writing in her own clinical notes that results etc have been sent to the hospital/doctor where they have a collaborative arrangement meets this requirement.

"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

Do you have to believe in God to lead the country?

I was outraged the other morning to hear that Archbishop Barry Hickey is questioning whether Julia Gillard should lead the country because she is an atheist……. Well two things came to mind for me…would he have the same question if the opposition leader was not a so called devout Catholic and second many people turned to atheism when they discovered there so called spiritual leader “priest’ was a child paedophile or an abuser of some sort…….I think that the Archbishop should stick to religion and cleaning up his own back yard before criticising Julia Gillard’s belief’s and the church should keep out of politics…… The Catholic Church is renowned for keeping women as second class citizens…….... and also look at what the 'so called good priests and nuns' have done in the past in relation to child and sexual abuse...not sure that their belief in God made them good people......

‘God’ it’s hard to be a successful woman in a man’s world, Julia Gillard has good leadership qualities. Who is anyone else to judge what sort of person she is because she announces she is an atheist….....how shallow are people..... the qualities I see in Julia Gillard is that she is law abiding, conscientious, kind and considerate... intelligent articulate etc etc etc....

We need to be looking at policy not gender or belief in God......

It is an exciting time of the year..... the new semester

Sorry I have not blogged for a few weeks....
I had a mini break.... it was a girlie weekend in Sydney for one of our friends 50th birthday, it was planned early last year... just brilliant...just what the doctor ordered... I spent on night in Sydney it was fantastic, it has a bitter sweet place for me, I spent the last few years of high school there, the first few years of my working career, my first love and the birth of my son.... and heartache about my mother and family life...walking around Martin Place and the city bought back many memories both good and bad... it feels like going home, even though its not.


I met up with an old nursing buddy from 30 yrs or more ago....it was interesting sharing dinner and reminiscing....its good to do that from time to time. I then caught the train with the gang and spent the next few days in Brooklyn.

Brooklyn on the Hawkesbury: NSW



Life is grand as you sit and contemplate it on the edge of a pier, the sun is rising, chorus of the birds in the background and in the distance a reminder of city life with the constant drum of traffic catching your eye… this is a little piece of heaven…. A secluded secret part of the world… as I sit and write this blog I am watching the birds on a tin roof preen each other chatting away and I think how privileged I am to be witness to such a life…. Now the waft of bacon and eggs drift across my nostrils and remind my stomach of how much alcohol I consumed last night…… it was wonderful to see Jen again and be with such lovely people….there is something special about a group of women sharing, drinking, laughing… there is no stone unturned… we are a force to be reckoned with… and as much as I think it’s a mans world there is nothing more forceful than strong women……maybe money….. These birds can be noisy buggers……. It’s time to get some breakfast……




I met up with some of our Eastern States midwifery colleagues who are for me truly inspirational... and gives me the reason to continue the journey for the recognition of the "midwife" in Australia, I like to use the analogy of the Suffragettes fighting for the equality of women....in trying to get the vote....when describing the political battle midwives are having to be heard, seen, given the right to provide women with continuity of midwifery care, informed choice, the right for women to choose where they want to birth....and for midwives to work autonomously, and not be subjected to being signed off or controlled by an obstetrician..the medical model..... Collaborative care is a two way street....
It was fab talking to other midwives and gaining a broader perspective of the issues midwives and midwifery are facing in these challenging times.....



Back to reality with a thud...it is the beginning of the semester... new students.....it is always so exciting to see them...the enthusiasm is palpable and as for me I just love the thrill....I love the first lecture.... this is when you have the most students and you can have them eating out of the palm of your hand.... sharing the knowledge its just brilliant... however my workload is exceptionally high.... I know, I can hear every academic saying "yes whats new".... I tried going into work on Monday with a new philosophy...."I have enough time in the day to get everything I need to get done...completed"... well that was a complete farce...it got from bad to worse and I am just chasing my tail.... the email inbox still needs to be emptied...on second thoughts maybe it was a bad time to go to Sydney... better planning next time..but alas you really cant choose when you are going to be 50... it was a brilliant time and I am thankful for the wonderful time I had...ah well there is another day tomorrow.....and the work will still be there.....

Meeting Kevin Rudd - The Hon Prime Minister of Australia

not a good photo of me....but it had to go on the blog.....

Yes it was good to be invited to the Australia Day Celebrations at the Town Hall on Thursday 21st January. I bought a great pair of new high heel red shoes to wear for the occasion...together with my pearls, I was set to go... by the end of the evening my feet where killing me as we had been standing for several hours....

Over 400 hundred guests were present, there was a welcome to country and speeches...read the Prime Ministers speech.....the guests included members of parliament, multi denominational religious dignitaries, associations, unions, volunteers, hospital and health officials....... too many for me to mention, however a mixture of peoples. We were greeted at the door by the Hon Kevin Rudd, he held out his hand and said “hello I’m Kevin”...... not what I was expecting and on his right was the Hon Colin Barnett. It was all so surreal, the hall was very hot, the drinks were flowing freely and people mingling and talking, it was great....

We met the Federal Member for Hasluck Ms Sharryn Jackson MP, I had recently sent Ms Jackson an email, asking her what her position was on Homebirth, MBS, PBS and Midwifery models of care.


We were also fortunate to meet the Hon Nicola Roxon, the Minister for Health and Aging, what a delight Nicola is.... we spent quite some time discussing the issues surrounding midwives and midwifery... the take home message for midwives: was to work together, all come from the same page and support each other, which also means supporting the Australian College of Midwives who is actively fighting for the rights of the midwife in Australia.

I enjoyed the evening particularly networking and spreading the word about midwives, midwifery and all facets of our wonderful profession....to some people who did not know what it is we do....I feel it is on these occasions we are able to spread the word and hopefully make a difference.....

Who will be the next American President? My view!

BBC World news
Democratic convention - Denver
Whilst away in Singapore teaching I happened to be watching the BBC World news, as you do when in a hotel room and listened to a speech delivered by Mr Bill Clinton, he received an overwhelming standing ovation. I know you might think that is sad, however I do think it is important for the world to know what is happening in America and the world can certainly do without another George Bush. I found Bill Clinton to be charismatic and interesting to listen to. He was a diplomat and inspiring. Clinton suggested that “America needs to be strong at home before strong within the world” – how true is this, you have to love yourself before you can love someone else.
I think Clinton is an easy man to look at, not a hair out of place, he presents very well – despite his admission of his indiscretions, I think he still does a good job and goes to show that we are all human and make mistakes. The other way to look at this is off course, is that I am being pulled into a false sense of security and falling for his charm and really he is a womaniser, I will reserve my judgement. However I do think that a President should be above reproach. He paid tribute to his wife Hilary Clinton, who I am disappointed is still not in the running; however I can see why Hilary could not be Obama’s right hand person. I do like both the Clinton’s and see why they have made a good team. However I have never understood why Hilary remained by her man, unless it was a pact, so that she could achieve her dream, only time will tell. Bill’s speech was directed at Hilary’s followers and other democrats to support Barack Obama, saying, he is ready to be President:– well by the time he finished his speech I was ready to agree with him, not because he said so, because his speech outlined all aspects/issues of what is required of the next American president: global warming, health care for the poor, poverty, military, rising costs of gasoline, food, utilities – equal opportunities for women etc; I am not sure if Barack Obama can achieve all this but he seems to me a better option than McCain and Palin.
I was disappointed that I did not get to listen to Obama’s speech as I had teaching commitments, but it did get good reviews. Barack Obama accepted the Democratic Party presidential nomination, declaring that the “American dream has been threatened” by rule under President George Bush and the McCain represented a continuation of policies that undermined the nation’s economy and devalued it standing around the world.
How cleaver of the Republicans, to choose a woman as second in command, but then, how, appropriate to be behind the man. Now let’s look at Sarah Palin, normally I would be supportive of a woman in this position, but Sarah Palin is pro-life, pro guns, pro war, her son is just off to Iran to war, but I guess it depends on what side of the fence you sit on, this is certainly not my choice. I think that this is a step backwards for women in terms of pro-life issues. America under the current Presidency has put the women’s movement in America backwards by giving the fetus more rights than the women that carry the fetus.
This will be a closer race than first anticipated now that McCain has a woman at his side; it will be very interesting to watch. Whichever way this election goes, history is in the making, the first black American to be President, or the first woman to be Vice President.

ref picture: Alan Davidson: Daily Mail: http://images.google.com.sg/imgres?imgurl=http://img.dailymail.co.uk/