Privacy Act: patient consent to collect and disclose information:

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

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

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

Don’t leave Privacy to chance:

10 steps to protecting other people’s Personal Information:

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

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

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

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

Community Midwifery Program AGM

My day started with some housework.....watching my grandson play his first game of tee-ball, they look so cute and little, wow Dylan at 5 hit the ball quite well and I was impressed; It did remind me of when my children started playing tee ball, the weekends of sport; As for Miss Bella she has just learned to play tag.... so spent my time watching and then playing tag... it was fun; I had enough time to stop and look at a school fete and couldn't’t resist buying a snoring teddy bear... I thought the grandkids would enjoy it when they come and visit....


The afternoon was spent at the CMPWA AGM; it was a delightful meeting, relaxing, it is so good to go a meeting and see mums, babies, (mums breastfeeding) midwives and yes a politician; Rachel Siewert Greens Senator for WA; it was refreshing.... you cannot go to many meetings in the current political climate and not talk about “the determination”; Rachel was a dynamic presenter, she outlined the history of the Maternity Services Review and the enormous progress that has been made in terms of maternity reforms; and the greatest voices are that of women with their babies..the march onto Parliament House the success of the mother of all rallies, in which the government realised what an error was made by not including homebirth in the Maternity Reforms which then lead to a retraction and a two year exemption on homebirth; which I might remind everyone that we have 18mths left and we need to be formulating a plan to include homebirth; one thing was evident for me and that is the power play of the AMA, politicians and midwives; I have said this before that we need to be focusing on the choices of women, the right to choose where and how to birth..The right to refuse treatment... the right to self determination of women.....not just about homebirth; we need this legislated as they do in the UK and NZ: then it is not about the AMA or midwifery, it is about women:


Rachel also discussed the views of many stakeholders, the many varied views on the determination; she gave some detailed background about the process of allowing and disallowing the determination and the possible way forward; she also acknowledged that in the mean time it was important to collate all the evidence of collaboration not working and forward this information to her office; the Australian College of Midwives is also collating this information so you could forward instances of collaboration not being effective to members@midwives.org.au


It was time for a bite to eat a cuppa, mingling & networking..... I was fortunate to meet Dr Ralph Hickling who is a retired Obstetrician; he is launching his new book entitled; “Childbirth today: Too many caesars, not enough joy?” a very interesting man... the book launch will be on Thursday 28th October at 6pm in the Fremantle Town Hall; if you are free come down and buy a book.....I can't wait to read it....


The AGM followed the break; Debbie Slater gave the Chair’s report eloquently and speedily, elections were conducted, no new business and the meeting was done.... the quickest AGM I have been to in a while... fantastic..... Then there was cake and more chatting....every midwives dream.....

It was late afternoon by now, I had enough time to call in to see a friend on the way home before dinner with my sister-in-law and an early night.... ah but the blog needs to be written...... so maybe not so early to bed, but its Sunday tomorrow sleep in day;

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.

Great news for Australian Midwives:

This is great news for midwives, read the full report;

THE HON NICOLA ROXON MP Minister for Health and Ageing:
Maternity Services Report:

Recommendations in a nutshell:

Improving choice for Australian women by supporting an expanded role for midwives

Consideration of the expansion of access to Medicare and the PBS for midwives – but only if accompanied by stringent professional requirements for midwives

Consideration of support for professional indemnity insurance for midwives

The development of new national cross-professional guidelines to support collaborative multidisciplinary care in line with best practice

Consideration of the establishment of a single integrated pregnancy-related telephone support line

Improved data collection and analysis, and further research

Providing increased support for the maternity workforce, particularly in rural Australia

The release of this report has generated many different responses: here are a few:

Rural doctors welcome maternity review
The Rural Doctors Association of Australia (RDAA) has welcomed the Australian Department of Health and Ageing’s Maternity Services Review Report. The association has said it provided a strong way forward for improving access to maternity services in the bush.
For a long time now maternity services in rural areas have been under increasing pressure and at least half of rural maternity units have been closed down over the past decade.
It is a well known fact that pregnant rural women are increasingly having to travel great distances to give birth as there is limited maternity services available for them.

The Maternity Services Review Report provided an opportunity for all stakeholders including consumers, doctors and midwives, and government to focus urgently on getting much-needed maternity services back into the bush.

The next question that has raised debate is that of indemnity insurance for independent and private midwives. I think that it is fantastic that the Commonwealth government is considering indemnity insurance for midwives. National Registration will be introduced in 2010 and all midwives will be required to have indemnity insurance to be registered. This will prove difficult if we do not have government assistance and we will lose many midwives.
Women are intitled to choose where, who, how, they will be assisted with their birth.

6 Minutes.com.au, reported this story:
GP obstetricians will be angry

if they have to foot their own medical indemnity insurance while midwives received government help, a leading obstetrician says.
The federal government’s new Maternity Services Review says subsidies for indemnity insurance would help private midwives who risk financial ruin by being sued.

The Age.com.au reports:
Furore over midwife report as doctors go on the attack
THE Australian Medical Association has accused Federal Health Minister Nicola Roxon of being "gung-ho" about the role of midwives and misrepresenting the findings of the Government's maternity services review.

It will be interesting to watch what happens and what the expectation will be relating to " expanded role of the midwife" "advanced level of professional education and experience" that will be expected of midwives.
In 2007 some Midwives in WA completed the 'expanded role of the midwife" course in preparation for this role.

Will UK & NZ trained midwives have to complete the expanded role of the Midwife when they come to work in Australia? they already work to this level, autonomously and independently.

The Age also comments

this could potentially allow midwives to prescribe medicines, open private group services and contract their services to hospitals. Midwives would also be given access to the Medicare system, although the report did not recommend Commonwealth funding for home births.

"

It is about time this happened - Women already pay for private services for independent midwives, why should they be disadvantaged for the informed choice they make - why not allow them to claim from the Medicare system.

Specialist doctors argue that Australia's strong safety record for mothers and babies shows that the current system is working, while advocates of home births have accused doctors of being responsible for soaring surgical delivery rates.

It is interesting to use the strong safety record for mothers and babies, however this also works in favour of midwifery, also, I feel it does not indicate the current system is working, if that was the case we would not have women choosing unattended births or freebirth occurring. Why are they happening, because women are not being listened to by obstetricians they feel they have no choice.

It is sad but no surprise that Dr Capolingua uses that "F word" "Fear" to reinforce the medical model in childbirth instead of working together with midwives in a collaborative way.
It was also disappointing to see very little or no support of homebirth via funding.
Another good aspect of this report was to see increased funding and maternity services for Indigenous women.

The report also discusses workforce issues, such as; aging GP's, Obstetricians, and Midwives, the average age of midwives being 45.6 years.

I am delighted to see that finally a Health Minister is listening to what WOMEN want, and that is CHOICE and to recognise that childbirth has become so medicalsied with high intervention, cesarean sections and the poor breastfeeding rates.

Cyber Talk and Midwives

Tonight I presented a lecture about Cyber talk: The presentation was a brief introduction to the Internet, focusing mainly on blogging. The aim of the presentation was to raise the awareness of midwives about the internet, who blogs and why, also to highlight the legal and professional responsibility of cyber mediums such as Facebook, MySpace, Skype, YouTube, Twitter and blogging. Currently there are approximately 22million blogs online. Blogs are becoming one of the fastest growing mediums for discussions relating to marketing, legal issues, health, political activism and social change.1


So, what is a blog? It’s a journal, reflection, diary, newsreel or a newsletter. However you describe it, it is something you write that is personal and informal for the world to read. Blogs are designed for the public forum – they can be updated daily, weekly, monthly or whenever the writer chooses. Blogs are very easy to set up – any of the major search engines will direct you to a site of your choice and you simply follow the instructions. 2

Major legal issues surrounding publishing on the Internet relate to: defamation, copyright, trademarks, moral rights and confidentiality. I am sure there are more but for now I will concentrate on these relating to midwifery.

All Midwives be they; community, independant, hospital based are bound by legislation such as the Nurses and Midwives Act. Within this framework we are regulated by the ANMC Code of Conduct (2008),

Code of Ethics(2008) &

The Competency Standards for the Registered Midwife (2006). If midwives fail to meet the required standards of these Codes, then they can face disciplinary action as stated within the legislation. Therefore midwives need to know and understand what the Codes mean and how they work. It is important to remember when you are blogging to be professional at all times, being mindful not to bring our profession into disrepute. Once something is published on the web it is very hard to delete, it is passed around the cyber world like lightening creating lots of threads and being saved in different places.

There are many health professionals blogging, sharing stories, practices, education and reflecting care given. This increases the risk of breaking patient/client confidentiality due to the blogger or authors sharing too much information, such as subspecialties, names, places and content.

The Journal of General Internal Medicine published an article titled “STUDY HIGHLIGHTS RISK OF BREAKING CONFIDENTIALITY IN BLOGS” this was a study that examined 271 medical blogs and found that 56% of the blogs contained enough information to reveal the author’s identity. 3 The study found that blogging was a great way to reach both patients and health professionals so long as people were responsible about it. However “blogging does pose serious concerns about confidentiality and bringing the profession into disrepute. 3”

Defamation occurs when one person communicates material that damages the reputation of another. This can be verbal, written or pictures and the publication must reach someone else other than the person being defamed. However there are several defences to defamation such as: is it a ‘fair comment’ on a matter of public interest or was it simply an opinion, was it an honest opinion of the author 3.

ANMC Professional conduct refers to the manner in which a person behaves while acting in a professional capacity. It is generally accepted that when performing their duties and conducting their affairs professionals will uphold exemplary standards of conduct, commonly taken to mean standards not generally expected of lay people or the ‘ordinary person in the street’.

The moral from this evening's presentation is to know your ANMC Codes inside out, they provide you with a tremendous framework. As for my presentation, I must remember to have my cheat sheet with me, because once I start talking lots of new ideas come through and I forget the ones I was going to focus on. This is such a massive topic that I really just tipped the iceberg.

Happy Blogging - 'have blog will travel'



References:
1. Sylvia Mercado-Kierkegaard, Blogs, lies and the doocing: The next hotbed of litigation? Science Direct.
2.http://www.artslaw.com.au/legalinformation/LegalIssuesForBloggers.asp
3. BMJ 2008;337:a1043; Study highlights risk of breaking patient confidentiality in blogs.

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

National Caesarean Awareness Day (NCAD)

"Getting clear about fear"

I attended the NCAD conference yesterday and what a sensational day it was. It never ceases to amaze me the endurance of women. I was fortunate to meet many amazing women but in particular a women who had dreamed of having a vaginal birth, but unfortunately had quite the opposite. Amber shared her journey of first the joy of being pregnant then the horrendous pain of being rail-roaded into a caesarean, not once but twice and why, for the perceived ‘risk’. Amber for her third pregnancy employed an independent midwife to achieve the dream she wanted. ‘
This begs me to ask the question?
Why is our medical system failing these women?
This has been the theme of a few of my recent blogs and I have come to the sad conclusion that Obstetricians have what they perceive as the women’s best interest in mind, historically this comes from the Hippocratic Oath, however, they fail to hear or listen to what women want. They hide behind the fear of litigation and work in a defensive manner (consent forms for vaginal birth, refusal of epidurals etc).This also is a result of a perceived loss of medical power, in times gone by it was always ‘doctor knows best’ however now with ready technology and ‘google’ the consumer, woman is armed with information and therefore asking more questions. We fear risks that are hard to understand: doctors find it hard to understand why women make the choices they do. This then leads to the power struggle and the ‘fear’ tactic to regain the power and so the cycle continues. If the medical model continues to not listen to women, instead of women caving in to the ‘fear’ or the doctors pressure, they will seek help from other sources, be it, independent midwives or freebirth, they will do it alone.


Approximately 77 people attended the conference, what was exciting to see was women breastfeeding their young babies. It was sad to see that there were no Obstetricians at the NCAD conference, last year there were several and it made for good conversation and debate. Why did the doctors not attend? They would benefit from hearing Ambers story!
The word ‘RISK’ is communicated in many different ways and changes the birth plan enormously if communication is not a two way street. Maybe a solution is that we need to start at medical school to change the mindset of doctors, have consumer groups talk to medical students, about listening and informed choice.
Doctors are forgetting that most women are well informed and make choices. Autonomy is the single most denied option given to women who are pregnant. Women have the right to choose the care that they desire, despite the doctor not agreeing with them, as long as the women are fully aware of the implications of their actions. It is important to let go of control, develop a trust relationship and do not manipulate. “Listen more & insist less”.
I have to acknowledge the great presenters of the conference, Amber her story, The VBAC Dilemma: What the Evidence Tells Us - Henci Goer; Risk and Fear: The Best of Friends - Heather Hancock, Birth Beyond Fear - Lorraine Hale, Next Birth after Caesarean - Tracy Martin, Moving on after a challenging Birth - Lynne Staff and Initiating Change in the Operating Theatre – Caroline Dufton & Sara Bayes.

NCAD have achieved many things over the last year, more awareness regarding the rising rate of caesarean sections, the enormous help they provide to traumatised women resulting in caesarean section. Government recognition of the caesarean rate and the need to reduce this rate (through lobbying), advice on the National Maternity Plan, also the assistance with NVBAC (Next Vaginal Birth After Caesarean) clinic at a major tertiary hospital, and too much more to mention here.



This is only the tip of the iceberg; Birthrites do a fantastic job and continue to do so. They are a group of dedicated people who work very hard, a job well done.
If you require any further information regarding Vaginal Birth after Caesarean section: visit Birthrites - Healing After Caesarean Section http://www.birthrites.org/

The planing committee: Congratulations an Excellent program and day.

Homebirth: Angelina Jolie wants a homebirth: What sort of birth would you have if money was no object?

I was doing the obligatorily food shopping and as usual the queue was long, shopping trolleys laden with food, good, bad and indifferent. Alas I have to wait, the cover of the Woman's Day beckons me with its striking heading.

Brad and Angies SHOCK HOME BIRTH

Nothing like headlines about Homebirth to get you to buy a magazine when you are a midwife. I flicked through the magazine until it was time to unload my shopping, pack and pay for it.
I sat down at home with a cup of Earl Grey tea, kicked of my shoes and read the article.

Angie loves the idea of a home birth

How fantastic I thought, did no one tell her that having twins puts you in a high category in terms of obstetric risk factors and therefore a homebirth is really not ideal. Then I read further "a team of medics has been flown to the French hideaway in preparation for the twins' arrival"

A gynaecological consultant and midwife, are said to be staying with the family. Angie is looked after around the clock by an ob-gyn, a midwife and at least two nannies

Woh, how good is that, at least there is a midwife present. That shows our status is of some importance. I wonder if they have a portable ultrasound machine in the house?

Angie has a pilot, who has US Army training and a helicopter on 24-hour stand-by to fly her to a local hospital. She is taking no chances.

I wonder how much this is costing? the magazine did not elude to the cost however did say the property they are staying at belongs to Microsoft co-founder Paul Allen and is valued at $63 million US. It is clear that money is no object.
I would like this job as the midwife? over looking the Mediterranean and caring for Angie.
There are many questions about this case that we do not know, for instance what position are the twins? so it is really difficult to make any clear decisions regarding Angie's care.

I pondered on this for a while and thought if everyone had the money to do and have what ever birth you wanted, what sort of birth would you have?
Who would you have present? What resources would you have and use? does this mean that helicopters are an option?
The mind boggles at the thought. Now stop dreaming, the reality is you do not have to pay millions to have a homebirth.
Homebirth's are within the reach of every woman and midwives are recognised as the best professional to care for a woman within a low risk category - or normal pregnancy.
Every pregnant woman needs to know who her midwife is.


Perth WA, has a Community Midwifery Program which is government funded however we do need more places to be made available for the women of this State. The government is currently reviewing the homebirth policy................so watch this space.

The Community Midwifery Program (CMP) is a unique community based midwife-led service. The Program aims to meet the needs of women and their families by providing them with continuous midwifery care throughout their pregnancy, labour, birth and the early postnatal period. Continuity of care is internationally recognised as increasing satisfaction rates for women who utilise this care option. The CMP is the only government supported homebirth program in Western Australia. The Program is fully funded through Medicare for women eligible for this benefit.

http://www.cmwa.net.au/CMWA%20pages/program.html