The government is paying us lip service:

There are three burning issues for me currently: Mandatory reporting, women’s choice to birth where and how they want and ‘continuity of midwifery care’; each deserves a separate blog.

I have refrained from blogging recently because things have been politically difficult and I have been trying to keep a low profile, but it hasn’t worked, so I might as well just carry on and express my opinions.

I am in a real quandary as with many midwives, there is a fine line we walk and I have erred on the side of caution and to no avail. What keeps me on the straight and narrow is the fact that I value my registration. That is not to say I don’t value the woman’s choice, but if that choice compromises my registration I will think very carefully about the consequences before making a decision.

Up until recent times this has not presented a problem, however since the introduction of the new legislation namely the Health Practitioner Regulation National Law (WA) 2010. With this legislation came mandatory reporting, if I had known the implications of this piece of legislation I would have fought harder to see it changed. I had no idea until it started happening, that is the reporting of midwives. This is not about pitting midwife against midwife; this legislation is about ‘mandatory reporting’ the same as ‘mandatory reporting’ for child abuse...... it is the law and if you don’t there are consequences for not doing so ( it is noted that there are no penalties prescribed under the National Law for practitioners who fail to notify, but you may be subject to conduct or performance action)....Most reports have been made by Health Services or Medical Practitioners, however it is interesting to note that it seems that only midwives are being reported using this clause: s140(d)
s.140 of the National Law defines ‘notable conduct’ as where a practitioner has; (a).., (b).., (c)..., (d) placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards.’
The explanation given in the AHPRA document Guidelines for mandatory notifications (p4)
The term ‘accepted professional standards’ requires knowledge of the professional standards that are accepted within the health profession and a judgement about whether there has been a significant departure from them.
The notifiable conduct of the practitioner must have placed the public at risk of harm as well as being a significant departure from accepted professional standards before a notification is required. However, the risk of harm just needs to be present - it does not need to be a substantial risk, as long as the practitioner’s practice involved a significant departure from accepted professional standards. For example, a clear breach of the health profession’s code of conduct which placed the public at risk of harm would be enough.

Maybe we should start reporting doctors for placing the public at risk by overzealous reasons for caesarean sections, or rupturing membranes when it’s not required, or induction of labour for social reasons. I am sure there are many reasons doctors give that are unfounded and put the public at risk. Why are health services or midwives not reporting doctors for unsafe practice or out of scope practice as readily as they are reporting midwives, there seems to be a real disparity in the reporting mechanism.
If hospitals are going to use this piece of legislation then use it fairly on all health practitioners not just midwives, this is paramount to a witch-hunt we have moved back 20yrs, why not just burn us at the stake.

Our problem lies with the legislation, it is the law and this is what needs to be addressed to resolve some of these issues. Australia currently has no protection for midwives who choose to support the woman's choice of care which falls outside of the recommended standard of care - a midwives role is "normal" - I can hear all the rhetoric.

Choice:
It seems that women do not have choice; choice seems to be relative to the situation or dependent on certain conditions – if your BMI remains normal, if your glucose level stays low, if you don’t have a scar on your uterus etc etc,. Working within frameworks is not something new for midwives and balancing the woman’s autonomy against these frameworks can be difficult and often puts the midwife in a stressful position which may lead to an inquiry and threats of negligence.

Informed choice is a fundamental issue, autonomy the right to self determination – not when it comes to health and perceived risk. Mavis Kirkham states that ‘in our own culture, obstetric ideology is particularly coercive. The medical definition of safety and risk means that while minor choices exist, conceptual choices cannot.’
“.......You can have your baby any way you like as long as you understand that I must step in when the safety of you and the baby is involved’ (Shelley Romalis 1985 p 190). How many times have you heard this?

The women the consumer must stand up and demand what is rightfully theirs, the right to birth where and how they want and protection for the midwife who cares for that woman’s choice.

The gloves are off, because I think the government is paying us as midwives lip service. Since November 1 2010, we have seen many changes, Medicare rebates, eligibility and insurance for midwives; however the maternity reforms certainly in WA are lacking in substance and commitment from the State government.



ref:Informed Choice in maternity care: Edited by Mavis Kirkham (2004)

Waiting patiently for grandchild no 8.....

The art of patience I think is disappearing, we are always in a rush for things to happen or to be done, we want everything yesterday...sadly this is a reflection of the times.

Pregnancy traditionally is anywhere from 37 - 42 weeks, which is nine months and one week. More than 90% of babies do not arrive by the predicted date. So it is not unusual for a mother not to go into spontaneous labour just because its her due date. Technically you are not overdue until 42 weeks, but alas you see women are being offered inductions of labour (IOL) from 37 weeks.

Some mums battle with health professionals consistently about this issue..why is it that once you get to about 38/39 weeks you are offered and IOL, it seems like we are trying to change the boundaries of normal gestation times: Fair enough if there is a medical reason for an induction: as in the fetus (baby) is at risk or the mother, but not because you look uncomfortable or because we can.... IOL can lead to a cascade of intervention and we all know where that ends up. We need to let nature take its course, it stands to reason if you have reached 40-42 weeks and you have not gone into labour your body is clearly not ready....and you have to wonder have we got the dates right? This can already be disheartening for the mother who is eagerly awaiting her new arrival and can sometimes be annoying after so much of anticipation and excitement and pressure from family and friends.

Sadly it is not just health professionals that put pressure on mums, it is society that is friends, family, acquaintances, all saying when is this baby coming.... why don't you just get induced and have it over and done with....it seems everyone is in a hurry....sometimes too this is born out of fear, fear that something may go wrong and we as midwives need to be constantly reassuring about the normal processes of birth.

Then off course comes the advice about how to be induced naturally...and believe me everyone has a story about this one.... (some women have tried it all and none of it worked, like wise some women have tried one or two and it has worked....you never know your luck until you try)
Some of the traditional ways are:
Walking, housework, spicy food (curry) raspberry leaf tea, nipple stimulation and if you are really game clitoral stimulation; intercourse (love making) which releases the hormone Oxytocin which is called the love hormone... this then gets the contractions started; essential oils such as lavender and clary sage; membrane sweep; acupressure and most importantly be calm and think positively..... but like anything it is practice that makes perfect.... doing it just once or twice is not going to make it happen... it is something that you are going to consistently do over a few days or so...ensuring that everyone is safe and you can feel the fetus moving...

Formal Induction of labour: starts with prostin gel or Foley Catheter; artificial rupture of membranes, Syntocinon drip.....epidural? however this needs to be a blog all on its own....

We are waiting for contractions to begin....passing of a mucous plug, waters breaking.... all signs of the beginning.....the deadline is looming...

The art of being patient: Centred Midwifery Group Practice:

The Centred Midwifery Group Practice....it's interesting for me,in my mind the vision of the practice is a complete success, it flows smoothly and seems easy.... however the reality is somewhat different there are so many other variables involved to which I have no control. Yes that might be naive of me or it could be that the vision I have is so strong that it propels me to do the things I do... However the truth is that this is going to be a long slow process and I need to rethink the way forward in terms of my sustainability and how we are going to get collaboration working.... as my friends, colleagues and family keep telling me that “Rome was not built in a day” and it has taken us 20 years to get Medicare rebates for midwives.... a valued colleague said yesterday “ you are going to fall on your bottom and few times...the trick is to get back up and keep going,” “why are you surprised?” ......The answer is that I have a vision and the vision doesn’t have the stonewalls..........

The story thus far: The Group Practice has a brilliant dedicated team or midwives/consumers working to build the practice: We owe Berry Digital Design(Cass) an enormous Thank you she has done all our logo designing flyers, business cards / letterheads/invoices/receipts etc, printing and all pro bono...I highly recommend her so check out her website: if you want any designing or printing done. We have our email x6 is setup secretary@centredmgp.com and director@centredmgp.com the website and blog is coming as I type... so watch this space.....Our rooms are at the Conscious Conception and Birth Centre and we are now setting up the office with equipment: if anyone has a phone fax and photocopier/computer they would like to donate please let me know: Medicare provider number obtained, Insurance paid, pathology and diagnostic rights have all been secured and we are working on collaborative arrangements with the local Health Service..... this will take time: Most importantly we are starting to get clients and this is what keeps us going.... our practice is about offering women choice the choice to birth with a known midwife.... continuity of midwifery care....it’s about having time to talk to women, engage and build trusting relationships with women and their family throughout pregnancy birth and the postnatal period...


It is an exciting process setting up a new midwifery group practice in WA....
The next step is to go and visit the local hospitals, MP’s and GP surgeries to introduce the Practice and rally up support.... go to consumer meetings and get the word out there.....and last but not least advertising for clients....... it really is very exhilarating watching it all coming to fruition.
We need more midwives to pick up eligibility..... if you are an experienced midwife and want to work with women in the community, that is at home and hospital births please consider this option....contact me for more information about the process that is required for eligibility it’s not difficult you just need three years post registration working across the continuum of midwifery: or visit the AHPRA website and follow the links to eligibility:

As for me.... it is practising the art of patience’s....slowly, slowly, slowly..... Diplomacy and political lobbying; continue meditation... this has really proven helpful in slowing my mind chatter and keeping a calm demeanour...
Watch this space for our grand opening...... date coming soon......

Centred Midwifery Group Practice Inc (CeMGP)

Wow it is official….this has been a dream of mine for some time and became a reality today when the Dept of Commerce called me today to confirm our application for incorporation was successful. We are the first private Midwifery Group Practice for WA this is a huge step. I am so proud this is a fantastic achievement. We are a fantastic team of dedicated Midwives;

This idea has been mulling around in my head since returning to WA 7 years ago… however it is only since the Maternity Reform has the idea become a reality…. Women being able to access Medicare Rebates for midwifery services.

In July 2010 I talked about the idea, shared with a few people and in August asked a group of equally passionate women to come on board with this concept…..We met at my home for a day workshop and nutted out some key ideas…. One of which was the name Centred Midwifery Group Practice (CeMGP). I will not blog today the story from then till now I will save that for future blogs…. This is to share our fantastic news and say we are here….. watch this space…..for our Website, Facebook page and blog...all being designed as I type....

Our Philosophy: “We put you at the centre of your experience”. We are group of committed midwives, dedicated to providing safe, competent, continuity of care, individualised and professional midwifery care and support to the well woman and her baby throughout pregnancy, birth and early parenthood.

I am so excited I can hardly contain myself.... this is so huge it is a dream come true......more to come in the coming days.....this is just the beginning...... of a wonderful fruitful experience with women and birth.

Homebirth in the news again.......negative press: when will it stop?

Homebirth is never long out of the news: strangely enough it is usually in the negative; When will doctors learn that it is not an issue of HOMEBIRTH it is an issue of CHOICE; Choice for women not doctors;

The Weekend West's headline was "Ban pleas on 'risky homebirths' now it is hard to openly discuss the leaked draft report - yesterdays front page of the West "Two quit as row over homebirths escalates" relating to the same leaked report, now calling for the Government Funded Programme supporting homebirth for low risk women:

I can not tell you how many midwives have quit due to lack of choice for women and lack of autonomy in the work place.....it never makes the front page of the newspaper this is doctor driven against the choice for women to have midwifery led care;

It is time again for women to stand up and be counted even if you would not choose a homebirth....this is far more than having a baby at home it is about how you as a woman make choices about your body..... most women will choose what is best for their babies....and do not have to be dictated to by the medical profession about how to do it...it is our bodies, our choice our life...... this is paternalism at its best... there is no grantee in life... and unfortunately babies do die....Babies also die in hospital.....there are many iatrogenic injuries that are caused in hospitals.... women are and have been traumatised in hospitals by the health professional... so don't try to say that having a baby in hospital is any better, in fact for the low risk women it can be devastating and equally for the high risk situations,.......

I cannot respond to the draft report because it is published yet, this is scaremongering at its best; Now midwives have the right to Medicare and can provide more options for women...the doctors are playing dirty........I wonder who leaked this information?

Things you can do...is write to your local Member of Parliment... with your concerns about lack of choice.....

Remember this is about choice for place of birth....not just homebirth...making the issue about homebirth is scaremongering.....watch this space.... for the release of the report.

Picture from Bring Birth Home: http://bringbirthhome.com/about/ have a look at this website... and read her story:

A bottle of Red......frustration of midwifery;

I had a bottle of red...with my husband, I am trusting him to proof read this blog as I feel positively tipsy ; I have had a bad day....a meeting from hell ego’s present in the room; I feel disempowered in my current position... people not being honest with their intentions.... all it takes is open honest discussion; and a colleague received some bad news that is really unfair.... why does life have to be so unfair; I really feel that we as a profession get the rough end of the stick.....I pride myself on integrity and honesty... I get so frustrated with women who do not stand up for women’s rights (but I guess this is dependent on your point of view) and maybe everyone thinks their point of view is correct...it truly is a man’s world and when we get women in power they seem to think the most important thing is to be accepted by men...that means playing by the man’s rule..... I am really feeling for a colleague of mine who I have grown to know on a intimate basis and trust her judgement and skill as a midwife I am really saddened that situation has not worked out for her as I had hoped and with my knowledge and expertise I have not been able to help her and for that I am truly sorry. All I have to say is as long as midwives are not protected by law we are open to the rules of nurses and we are very different.

Midwives need legislation to protect them to truly ‘be with woman’. Managers who are managing midwives need to be a midwife to really understand the issues that midwives face.... ideally they also need to understand what homebirth is about and the reality of choices women make at a homebirth; this problem highlights that nurses do not understand the autonomy and bond midwives have with women....... I guess a bottle of red will allow you to say almost anything I am distressed for my colleague that life has turned out this way... and even after a bottle of red it doesn’t stop the pain of what she is feeling... and there for the Grace of God go I..... here I am about to embark on a huge adventure for women and midwifery and I wonder if it is all worthwhile, because in one instant it can all be gone...we work so hard as a midwife to advocate for women.....to facilitate their choice.... but alas in Australia there is no protection for the midwife if things go wrong...and yes babies do die.. ..often despite our best efforts and for reasons beyond our control...errors are made because we are human but they are made every day in a hospital and babies die in hospital .....that is the process of life... we do our best to reduce the errors or mistakes;

We know that we are medically dominated that it is really unacceptable....however for this to change...it needs women to stand up and be counted... if you want the birth you want then you need to say so.... stand up and tell the medical profession this is what you want.... it is only in women’s voices will you be heard and midwives can then facilitate what you want; women have the power......you only have to say....


As for my colleague I am sorry.... you have to fight to the end degree... ..For what you believe in.... as for me...I will strive to be the best I can... I am thankful for my family that supports me...even though it takes so much time away from them and to my friends...thank you for keeping me on the straight and narrow... I have to learn to stop wearing my heart on my sleeve...feeling the pain of others: Also take more time out from all these pressures;

....I will continue to do the greater good for women and midwifery.... the end result is a Midwives Act to support the choice of women and protect the midwife.....well the bottle of red is finished my husband my lovely husband has stopped me from the second bottle.... wow he is wondering what has hit him........ I have to say drinking does not solve any problems but hell, I sure felt good for a short while;

It is the next day; I have substantially edited this blog... and am very thankful I did not post it last night.....surprisingly I did not sleep well, my liver was objecting to the alcoholic abuse it received; Today I have drunk a litre of water with two paracetamol. I have to say that this is a rare occurrence drinking a bottle of wine, usually it is only a glass or two on the weekend.

I am reflective and still wondering how to take this issue further; and my husband cannot stop laughing at me:

A new day begins and the journey continues;

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?

Court ordered medical treatment for pregnant woman in the US

Informed consent and right of refusal are accepted legal concepts. The woman has the right to make informed decisions, including consent or refusal of any aspect of her care. The courts have consistently affirmed that the autonomy of the individual prevails, even when a patient refuses to consent to life-saving treatment.

Autonomy; Even when his or her own life depends on receiving medical treatment an adult of sound mind is entitled to refuse it. This reflects the autonomy of individuals and the right to self determination........as you will read from Judge Butler-Sloss in the St George’s Healthcare NHS Trust case where a woman was forced by a court order to have a caesarean section against her will...... You could liken this to the current issues surrounding women making a choice to have a ‘Homebirth’..... and doctors applying pressure and creating a ‘fear’ culture to ensure that women choose hospital as opposed to homebirth.....

Judge Butler-Sloss in St George’s Healthcare NHS Trust v S (1999) “...while pregnancy increases the personal responsibilities of a woman it does not diminish her entitlement to decide whether or not to undergo medical treatment. Although human and protected by the law in a number of different ways..., an unborn child is not a separate person from its mother. Its need for medial assistance does not prevail over her rights. She is entitled not to be forced to submit to an invasion of her body against her will, whether her own life or that of her unborn child depends on it. Her right is not reduced or diminished merely because her decision to exercise it may appear morally repugnant.,....”.

Now in the US where the fetus has arguably had more rights than its mother in some states, which in my opinion is outrageous the State of Florida has recently ruled that a woman who refused medical treatment was ordered to comply with her doctor’s orders. The woman a mother of two who was experiencing complications during her pregnancy was ordered to hospital, made to receive medical treatment and have a caesarean delivery.

“The trial court ruled that the woman's refusal of medical treatment placed her pregnancy at high-risk and created a "substantial and unacceptable" risk to her fetus. The trial court said the state's interests in protecting the fetus superseded the woman's privacy interests, and she was ordered to comply with her doctor's orders. The woman submitted to hospitalization, medical treatment and a caesarean delivery, although the fetus was delivered stillborn.”

The case went to appeal and the decision was overturned......

“In its ruling, the appeals court said the state's interest in the life of the fetus becomes compelling only when the fetus reaches viability, as outlined in the 1973 U.S. Supreme Court ruling on Roe v. Wade. The court added that there was no indication of viability when the trial court ordered medical treatment and that even if viability were shown, the trial court applied the wrong legal test. The "test to overcome a woman's right to refuse medical intervention in her pregnancy is whether the state's compelling interest is sufficient to override the pregnant woman's constitutional right to the control of her person, including her right to refuse medical treatment," the court said in its ruling. It added that the state also must show that its method of pursuing the compelling state interest is narrowly tailored to protect the woman's rights”.

However for this woman her rights have been totally obliterated..... mind you this case now becomes another precedent and hopefully some other woman does not have to go through the same ordeal. We have to remember that women have the right to self determination; because they are pregnant they do not lose that right.

We in Australia have to be mindful that this does not happen here, that women’s right to self determination is not eroded such as this.

“The American Civil Liberties Union, which filed a friend-of-the-court brief in support of the woman, said in a statement that the ruling is "an important decision for the right of women to make their own medical choices." Diana Kasdan, a staff attorney with the ACLU Reproductive Freedom Project, said that women "do not relinquish their right to determine their own medical care when they become pregnant."

Ref:.http://www.medicalnewstoday.com/articles/197902.php

St George’s Healthcare NHS Trust v S [1999] Fam, 26’ [1998] 3 All ER 673

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.

Legal issues? Homebirth again!

The Medical Observer writes Homebirths GP's new legal dilemma.... "If your patient decides on a midwife-led home birth and asks for prescriptions, could you be legally liable if something goes wrong?"
sometimes I am still amazed at what the AMA will come up with next..... really it should be no surprise that this tactic would be used.....
"Midwives are able to legally administer Syntocinon but cannot prescribe it, until 1 November when changes to federal laws mean nurse practitioners will have limited access to the MBS and PBS."
Giving syntocinon has always been part of a Midwives role, this drug is not new to the profession....it is part of our job, however the drug is only used if there is postpartum hemorrhage.
Part of a midwives course is a detail pharmacological unit, which entails knowing about the drugs used within midwifery there use and contraindications of drugs..... the way this article reads is as if this is a new drug that midwives have no idea about.....midwives are trained professionals.

According to Homebirth Australia spokesperson Justine Caines, the group has had reports of women in the ACT, NSW, Queensland, Victoria and SA who have been refused scripts for Syntocinon, vitamin K and ultrasound referral by their GP.

She says there is a steady growth in home birth as more women become what she calls “refugees” from the hospital system, reluctant to return for another birthing experience of “substandard or unsafe care”.

Ms Caines condemns the decision to refuse women these scripts and believes GPs are being unnecessarily cautious.

“I think [GPs] have less to fear than when they normally prescribe, as in this case the woman is in the care of a registered midwife,” she says.
Indemnity insurers are not so confident. There are legal risks for GPs if they do choose to prescribe painkillers, vitamin K or Syntocinon to patients wanting a home birth, they say.
Cheryl McDonald, medico-legal manager at MIGA (which will handle the new Midwives Insurance Scheme) says GPs are quite within their rights to refuse to write scripts in the case of home births, where they have no control over the medical outcome.

This really makes a mockery of the Collaborative arrangements Determination 2010....and really begs the question, how well thought out was the collaborative arrangements....? and did the AMA plan this all along knowing that these arrangements would not be workable. I am all for good collaborative arrangements that are workable, fair and equitable, not power orientated.

As midwives we have to be as proactive as the AMA..... we need to be allowed to practice our profession just as they are......this is about monopoly, money and power.
We need to be considering "women's choice" fairness and equity and right to refuse....

ref pic: littlekanga-roo.blogspot.com

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.

Empowering women - not as easy as you think

Thoughts to ponder on!

There are times it is difficult empowering women.... there is a fine line that you walk and the only way I find to walk it is to be true to yourself, let go of your ego and just state the facts and what you see.

As any midwife knows there are always two sides to a treatment and this is where the fundamental problem arises, because you can have several responses from the woman, and you as the midwife have to know which way the woman wants to go.....and often you will sense that...

Often women only get one side of the treatment, often a paternalistic point of view. Not that a doctor consciously chooses that, it is what the doctor feels is in the best interest of the woman... now how he puts across that treatment option is often to sway or dis empower the woman to his way of thinking rather than giving the woman the complete facts and allowing her to make that decision. Now why is that?

The second option of course is that the woman does get the compete treatment option from the doctor and then says "I don't know what to do, you make the decision"? now I understand this option and I can live with this option.... it is the first option I have problems with...here is an example....

A woman comes in with a query rupture of membranes...40/40 (she is due) not a convincing history of her waters breaking...she was lying in bed, knowing she wants to go to the loo.... gets up and feels a gush of fluid but she is unsure her waters have broken.... she waits several hours.. and then calls the hospital.... she is asked to put on a sanitary pad to see if any water leaks and come in to be assessed. She arrives several hours later, her pad is slightly wet so she is asked to lay down for 20 mins to see if any water is leaking (amniotic fluid)... the woman has an assessment...the fetal position is LOA, presentation-longitudinal, position-cephalic (head down) head ?3-4/5 palpable..(a high head) and a speculum examination is performed to see if there is any water pooling.... there is none...she then has a real time scan (ultrasound) which shows reduced amniotic fluid.... and on reviewing her notes it is noted that she is GBS positive... which means she needs IV antibiotics in labour... the woman is contracting irregularly 1:10..it is now 9 hours since query rupture of membranes....and early evening... the doctor recommends induction of labour (IOL)due to GBS positive, high head, and irregular contractions..... the woman is unconvinced... but her questions are dismissed by the doctor.....when the midwife attends the woman and asks what are we doing for you this evening... the woman is hesitate about the upcoming procedure... when she is asked to explain what is going to occur...she states "the doctor wants me to have the drip"...language is very important... if you are listening to women you hear the unspoken question or the resentment....the next question needs to be... "is that what you want?" she replies " what are my options, I would prefer to wait until the morning to see if I can go into normal labour", she was asked, did you discuss this with the doctor....she said yes.... but he said this is the best option, "you will not go into labour with the baby's head so high".....I would still like to wait said the woman... the midwife discussed it with the doctor and he repeated, his reasons as already stated..... now here is where the conflict lies..... how far do you push for the woman? yes I hear you say all the way.... but how many times do you do this and then the doctor walks in and speaks to the woman and she says to him ok do it......

In this instance the midwife sat and spoke to the woman asking what did she really want and why? and gave the woman the pros and cons for having the IOL now or waiting until the morning.....presenting all the evidence including information about her GBS status & ruptured membranes including the option not to accept (refuse the treatment option) the doctors treatment option and that all this information will be documented in her progress notes. The midwife left the woman to discuss her options with her family, the woman then made the decision to wait until the morning before having the drip. The doctor was notified and the information was documented in the clients progress notes. The woman had some dinner, was happy with her decision and went walking around the hospital for the next two hours.... when she returned she was contracting every 6 minutes... and they were lasting about 45 seconds... it was great......everyone was happy..... the woman went on to labour all night and birth in the morning... it was a vacuum extraction.... there was no induction....in this instance it all worked out well.... the empowering of the woman was because she was given all the information and the woman made her own choice knowing all the risks... she just wanted to wait until the morning..... it really was not a lot to ask... she was being monitored.... that is, pulse, temperature, IV antibiotics 4/24,she did not want to go home... just wait until the morning... to have her baby the way she had planned....

Sometimes I think as a midwife you need to choose the battle.... read the woman's Birth Plan, and most importantly listen to what the woman wants......

picture ref:http://mdean.tripod.com/justice.html

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.....

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.

This is inspiring...... Randy Pausch "The last Lecture"

I have watched the You Tube video and read the book.... and I have found it sad and inspiring so much so that I thought I would share it.... I also show my students this clip and when i feel that life is not going to plan, or I get despondent, I play it again to remember what my dreams and passions are so that I can continue and achieve them.
Randy Pausch Last Lecture: Achieving Your Childhood Dreams

An Ethical question, "my sisters keeper"

I went to the movies to see "My sisters keeper" with my girlfriend, we had a superb night. The movie does raise ethical questions about genetically created babies, or babies created for 'spare parts'.

The movie is based on Jodie Picoult's book - the opening I thought was brilliant and quiet true, in that most babies are created by accident, where as Anna Fitzgerald (Abigal Breslin) was conceived by means of invitro fertilization. She was matched genetically so that she could provide stem cells etc for her sister Kate (Sofia Vassilieva) who stars in "Medium".

The long and the short of the story is that Ann 11yrs old sues her parents for the control of her body. This is an interesting concept because I believe that children who are sick or have a major illness are very well informed and have a good understanding of the disease process. Therefore, I also credit these children to having a greater awareness, understanding and depth about their illness. It stands to reason then that these children will a greater comprehension of the consequences of the illness and treatments.

In order for a minor (usually under 18) to be able to give consent to treatment they need to meet certain criteria and generally that is to be "Gillick competent". The other issue is that it is in the child's "best interest".

An important issue here is the right to self determination, the right to choose what happens to your body. This is particularly important for women, making decisions when pregnant. Who's body is it? the woman's, the doctor or the babies? do you force a woman to have a cesarean section to have her baby?

Imagine that a member of your family needs your kidney and you do not want to give them your kidney, for whatever your reasons and that family member dies because no one else is compatible, you can not make anyone give you a kidney because you are going to die - then think about a woman choosing not to have a cesarean section to save her baby? for what ever her reasons, providing she is mentally well. Do you force her to have c/section? I think not, this would be considered "assault and battery". Food for thought!

This movie was good in highlighting these types of ethical decisions, which I think we will see more of in the future - because these issues are not always thought through to the end, and certainly it all begins in Amercia.
Lastly, the book ends differently to the book, this was disappointing, however I think I prefer the movie ending!

The movie is worth seeing, just take some tissues!

Would love to set something like this up in Perth!

The illawarra Mercury reported a feel good story about a "Midwifery Group Practice" that is doing well.

The Midwifery Group Practice, where the same midwives work with expectant mums before, during and after birth, is made up of nine midwives whose intake is supposed to be capped at 40 clients at a time.

The program is booked out for births until March 2010.

It is so good to read positive stories about homebirth and respecting women's choices about where and how women want to birth.

I would love to set up this sort of practice in WA and have it funded by the government and with the new legislation looming it is doubtful that we would get indemnity insurance to protect both the midwife and the woman.

Any ideas of how to make it work?



Reference:
First for home births
BY ANGELA THOMPSON
18/07/2009 4:00:00 AM

Homebirth rally! Canberra September 7th 2009

In my last blog, I forgot to add the Homebirth website (Homebirth Australia) for the Rally in Canberra when is it:

WHEN: Sept 7th @ 11.30am
WHERE: outside Parliament House, Canberra

You can register your commitment to attend on face book
http://www.facebook.com/profile.php?id=1641140582&v=feed&story_fbid=9419...


Unfortunately I can not attend, however you can be part of this rally by being a Virtual Rallier what a great idea!

Be a ‘virtual rallier’. For every person who is unable to attend we are organising a virtual rally in conjunction with our ‘live’ rally. Pledge $25, send us a head shot, your name and location and 25 words or less that you want the politicians to hear. We will mount your head shot onto a cardboard pregnant belly with your message, which will be attached to bamboo and will be placed in the ground outside Parliament House. Your pledge will go towards the cost of your cut and our continuing campaign.

see you all at the Homebirth rally, virtual or real.

Time for Bunbury Midwives to respond!

The Bunbury Mail headline written by Kaitlyn offer reads "More women risking Bunbury homebirths"This headline is just purely 'scaremongering' and in light of the recent release of the governments Maternity Services Review Report, which suggest that women should have improved choice, and expanding the role of the midwife.

I think the article endeavors to present a balanced view, however, it does not at any point have the view of 'the midwife' it does consider that of the obstetrician. In light of the Maternity Review I think it is time the media recognised the value of the profession of 'midwifery'(hence we have the Nurses & Midwives Act 2006) and sort the opinion of the Southwest midwives or the Australian College of Midwives to further balance this article. It is sad to see that an obstetrician is negating the woman's' right of choice and slamming this as 'putting her baby at risk'. This woman has made an intelligent, informed choice of how she would like to birth her baby and this choice should be respected not criticised.


The article goes on to say that

"Between 2003 and 2007 there were 70 homebirths recorded in the South West by the health department, up from 13 performed in 2003 to 20 in 2007.....and that there were no deaths from homebirths in the South West between 2003 and 2007". Did the Dr quote the amount of traumas associated with a birth in the hospital?

So please explain to me why then have these women put their babies at risk? oh that's right

Bunbury's gynaecologist Dr Ron Jewell said mothers were putting themselves and their babies at risk.

With what evidence is the Dr basing this statement on?
“People are looking at their choice rather than safety,” Dr Jewell said. Dr Jewell has not once commented on the services or the ability of the very professional midwives of the Southwest, where is his attempt to be collaborative with his colleagues?
All midwives are trained to be able to recognise the abnormal and deal with any emergency that may arise.

Thank goodness the the trusted consumer, Bunbury mother Megan Pelusey disagrees.

Mrs Pelusey gave birth to her first child Georgia at home in 2006 and with baby number two on the way her family is preparing for another homebirth with the help of a trusted midwife, her husband Marcus and Georgia, 2. “I’m a private person and it’s a nice way to have it in your home and this time my two year old will see it all,” Mrs Pelusey said.

Mrs Pelusey said she felt women with low risk of complications could have safe homebirths when supported by a midwife with the right equipment.
“I had continuity of care with my midwife, I had regular visits throughout the whole pregnancy, (the midwife was there) during the birth and I had after birth care and you still see a doctor anyway,” Mrs Pelusey said.
She said she was not nervous about complications.
“The midwife has all the right equipment like oxygen if it is needed and we are not very far from the hospital if something happens.”

I must say I am sadden by this article, the headline, could have been a more positive one, 'Homebirths successful in the Southwest', 'More women choose midwifery led care in the Southwest' - but I guess it just may not have the same impact.

I urge the media to give midwives a fair go! find out what it is we do? don't just take the word of an obstetrician, this is about collaborative work, we can and do work together, let midwives provide continuity of care, give women the choices they want!, it really is not to much to ask for.

Infomidwife

Is our Maternity system failing? A Freebirth gone wrong.

In NSW a newborn baby dies, after the mother birthed at home with her husband and no health professional, a freebirth. The woman attended a hospital three days prior to the birth and was told the baby was fine however that she was at high risk of complications, including the rupture of a scar from previous caesarean. They wanted to induce her labour immediately. The woman refused and return to her home in the Blue Mountains where she gave birth to a stillborn baby several days later.

Two doulas, who are not medically trained but provide emotional support for women before and during childbirth, and a qualified independent midwife were called but arrived too late.

The baby's father told The Sun-Herald the doulas had told him the baby was stillborn due to an infection contracted inside the womb.

This tragedy confirms the fears of maternity experts who are alarmed at the growing trend of women evading the health system in favour of unsupervised home births.
This begs the questions, what information did the hospital doctors give this woman to scare her away and make the decision she did? Why do women make these choices? Was this woman suspicious that she may be coerced into something she did not want, and made a hasty decision? did she feel she had "no choice"
The Australian College of Midwives supports homebirth for low risk women. Midwives are trained in the 'normal' and can recognise the 'abnormal' therefore refer when necessary to an obstetrician. However the College does not support "freebirthing" its too risky.

Associate professor Dahlen said in this case the woman had been traumatised by a previous hospital experience and fears she might be forced into induction or a caesarean. Against medical advice, she made a last-minute decision to leave the hospital and go home and soon after the baby died in the womb.

If we fix the system we won't have women resorting to a last-minute panicked decision like this......... The increase in women freebirthing is a symptom of a system that does not give women choice. We're seeing more and more of these concerning incidents in the last two years. It has to be addressed, and urgently.

The NSW Health Department spokesman said;

Patients have the right to decline medical intervention or treatment, as as the freedom to choose where, when and from whom they will receive medical advice and assistance

It is suspected that this baby died of Group B streptococcus, not as a result of the homebirth. This case is currently with the coroner, so watch this space........

As a midwife I have to say, that there are enormous risks associated with 'freebirthing' and it is not advisable. I am an advocate for homebirth in low risk women, that is with no risk factors. However it is important to talk about your concerns and collaboration is the key. I urge any woman considering the option of Freebirth to seek advice, from your doctor, midwife, someone who can give you appropriate advice.

Look at all your options carefully, be fully informed in the risks associated with your condition and your babies condition before you make a decision. Write the risk and benefits down so that the facts are clear and there can be no mistakes, get a health professional to read your list so you have a balanced view and you have not left something out, then make a decision.

Remember to act on the FACTS not the EMOTION, after all it is your life, dreams and aspirations that your are considering. Take the time to make that decision, there are always consequences to actions.

Ref: http://www.smh.com.au/articles/2008/09/13/1220857899000.html?feed=fairfaxdigitalxml