No Collaborative Agreements: No equality or justice:

12 months on and I still do not have access or a collaborative agreement:

As a private practice midwife I have not been able to secure a written collaborative agreement or access to hospitals to facilitate the care of my private clients; Unfortunately for the women of WA, there is only one Tertiary hospital and to date this hospital has not supported the role of the 'eligible midwife' or women's choice to be cared for by a private midwife within the tertiary hospital setting. This is totally unacceptable and goes against the governments National Maternity Plan initiative.

There have been many obstacles to try and implement midwifery reform within Australia: To date as far as I am aware there are a handful of collaborative agreements and no credential pathways for access to hospitals for private midwives:

If you remember the National Health Collaborative Determination July 2010 outlines the requirements for private midwives to work within the community; This Determination is clearly not working; for whatever reasons, personal or professional 95% of Obstetricians / GP Obstetricians are not choosing to enter into a formal collaborate agreement with midwives; There has to be a better system in place that does not require midwives to be reliant on Obstetricians who clearly do not want to collaborate -this effectively puts a midwife out of business, and gives women little or no choice. This will not stop women, they will just birth without a midwife.

I have written to over 50 Obstetricians, receiving only 3 responses (negative): the latest response being:

"I do not intend to enter into one of these agreements...... Planned birth at home is clearly associated with higher rates of both perinatal morbidity and mortality and I cannot support it"

.... he went on to wish me well in my venture..... Just how well does he think I am going to do with no hope of getting a collaborative agreement? Maybe that is the plan! This appears to be the general attitude of Obstetricians in WA. The evidence clearly supports homebirth for low risk women, however my request was for continuity of midwifery care not homebirth.

The Determination has to be changed or rescinded to stop the monopoly and control of doctors over midwives, this system is clearly not working;

Just taking a step backwards;

From November 1 2010, women receiving midwifery care could claim a Medicare rebate for services rendered from an eligible midwife:

On 12 November 2010, the National Maternity Services Plan (the Plan) was endorsed by the Australian Health Ministers’ Conference.

The Plan recognises the importance of maternity services within the health system and provides a strategic national framework, as endorsed by state, territory and Commonwealth Governments for the five year period 2010-2015

Within the first 12 months the plan's priority 1 was to:

1.2.1 Australian governments facilitate increased access to midwifery-managed models of care for normal risk women, e.g. midwifery group practice or birthing centres, while maintaining support for choice of, and access to, medically managed
models of care. Australian governments facilitate increased access for public patients to midwifery and medical practitioner continuity of carer programs

1.2.2 Jurisdictions develop consistent approaches to the provision of clinical
privileges within public maternity services, to enable admitting and practice rights for eligible midwives and medical practitioners

NOT ACHIEVED - the first year has passed and we are no closer to achieving these outcomes;

It is apparent that women are not being offered true choice within maternity services and Health Services are required to be more flexible. The evidence is clear that midwifery continuity of carer affords better outcomes for women; it reduces intervention and provides for improved parenting. This includes homebirth as an option for uncomplicated pregnancies. Therefore it is imperative, to achieve the strict intention of the National Maternity Services Plan, to protect mothers, babies and achieve best outcomes in maternity care, the Australian Health Ministers need to provide PII insurance for Intrapartum care at home for uncomplicated pregnancies, rescind the current Determination requiring written collaborative arrangements with an obstetrician and compel local Health Districts / Services to provide clinical privileges for eligible midwives, as a matter of urgency.

Ref: picture: http://www.ontheissuesmagazine.com/2010summer/2010summer_Ross.phpA Feminist Vision: No Justice-No Equity by Loretta Ross - My mother always asked the question, "Why would I want to be equal to men, when I've been superior to them all my life?"

Inspired.....

It's been a difficult week and I am sure next week the news will be all about Homebirth and midwives... so brace yourselves: Today I rekindled my passion, after a hard week.

“Courage is going from failure to failure without losing enthusiasm.” – Winston Churchill

I was delighted when I was asked to talk to a group of midwives who wanted more information about becoming a eligible midwife, we certainly need more: I was greeted by approximately 10 wonderful midwives and a consumer, all keen to learn more about setting up their own business and eligibility: we spent the next two hours discussing the current issues for midwives and some of the difficulties that we are facing as a profession. Whilst I acknowledged that we have some difficulties, I do think that we need to continue to put pressure on the government to follow through on the Maternity reforms; issues such as visiting rights for eligible midwives, so that continuity of midwifery care is an option for all women.
What I found fantastic about today was the interest and that it was younger midwives who traditionally have worked in a hospital who are embracing these new challenges and thinking about working in a different model of care, being more autonomous and wanting to work in the community...which is best for women, and what we all strive for...they were looking for ways of making it work within their current settings....it was really exciting to work with them to suggest the best ways forward for change... it is very important to have change agents spread out to inspire and encourage these changes; change is about knowing people, its about being passionate.... change sticks when people embrace it..and that is what we have to do... I see such potential in midwives being able to set up antenatal clinics....working side by side with Obstetricians, shared care - and six weeks postnatal care that we can provide in the woman's home, how brilliant is that? once a few people start doing it...the knock on effect will be phenomenal.... the issue is that the doctors are fearful of losing control ...and we all know when people are fearful they do things they would not normally do:

Yes we are currently experiencing some issues and that's because this whole concept is new, there is much change and not just small changes they are all huge... National Registration, new Act, insurance, Medicare provider numbers: no wonder we are all reeling with fear.... these are catastrophic changes - independent midwifery has never been so regulated... and this all creates an atmosphere of mistrust: we have to work together...

I found it refreshing today to meet so many midwives that were keen to begin to think about working within a different model of care and this gave me great hope for the future...we need to embrace the changes and work together to implement different models of care...and challenge the medical model, with this comes a word of caution.... the consumer demand has to be present; women need to want 'continuity of midwifery care'.

We still have some major hurdles to overcome with the maternity reforms: collaboration, indemnity insurance, visiting rights and more midwives to take up eligibility.

“The greatest barrier to success is the fear of failure.” – Sven Goran Eriksson

Who is the 'eligible midwife' - jumping through hoops

Well here it is the Nursing and Midwifery Board of Australia has released a draft of what 'eligible midwife' may look like.....

The Key points are as follows;
1. Current general registration as a midwife in Australia with no restrictions on practice - having as it does all the requirements for eligibility for registration under the Act.

2. Practice for at least three years across the continuum of midwifery care (ante-natal care, intrapartum care and post-partum care of women and their infants), within the previous 5 years.

3. participation in an additional 20 hours per year of continuing professional development relevant to the continuum of midwifery care.

4. successful completion of a NMBA approved professional midwifery practice review program for midwives working across the continuum of midwifery care.

5. compliance with the collaboration requirements for eligible midwives- that is the requirements for midwives to work collaboratively with other health professionals as outlined in regulation and national health policy instruments.

6. successful completion of an accredited and approved program of study determined by the Board to develop midwives' knowledge and skills in prescribing, or a program that is substantially equivalent to such an approved program of study (at midwifery post graduate level and designed around the flour components of prescribing - information gathering, clinical decision making, generation of medication order and monitoring the review.

As the model of care for eligible midwives is across the continuum of maternity care, eligibility is contingent upon all requirements being met..... therefore once a midwife has been endorsed as an eligible midwife; and authorised and provided with the necessary provider number by Medicare Australia: READ the full document Guidelines & Assessment framework for the recognition & endorsement of eligible midwives

2 Endorsement to practice as an eligible midwife (to read the full document click the hyperlink)

To be entitled to endorsement under section 98 of the National Law an applicant wishing to be identified as an eligible midwife must be able to meet all the requirements including being a currently registered midwife in Australia; being able to demonstrate through professional review of practice at least 3 years experience across the continuum of midwifery care within the 5 year period preceding the application, comply with the collaboration requirements for eligible midwives; and have an approved qualification to administer, obtain, possess, prescribe and supply scheduled medicines required for practice across that
continuum of midwifery care.

Wording to appear on the register
Endorsed as an eligible midwife working across the continuum of midwifery care and qualified to provide the associated services, order diagnostic investigations and administer, obtain, possess, prescribe and supply schedule 2,3,4 & 8 medicines in
accordance with relevant State and Territory legislation, required for midwifery practice.

If you wish to provide comments on this paper, please lodge a written submission in electronic form by email to natboards@dhs.vic.gov.au by close of business on Wednesday 27 April 2010.

My point of view is that a Midwife is a Midwife....and a Midwife should work across the continuum of maternity care....this in its self will make you an eligible midwife... but not according to the Government... we have to jump through all these hoops to be able to claim MBS & PBS..... in order to be a eligible midwife we have to be insured and complete everything stated above......

I will be putting in a submission to say that a midwife is a midwife once you have completed your course....no other country puts extra constraints on a midwife to make them so called 'eligible'..... if anything I could concede a year post registration... a graduate year before a midwife chooses to work in the community.... please anyone using maternity services can submit a comment to the NMBA... be proactive and have your say.....

lets see what transpires.......watch this space.......

Sunday Night Channel 7 -did a story about Homebirth and the Rally

Seeing RED with Dr Pesce

It was good to see that someone covered the Homebirth "Mother of all Rallies" story - however there is nothing like seeing red when Dr Andrew Pesce Obstetrician and head of the AMA categorically states that "he does not support homebirth".

" why fix something that is not broken - Australia has one of the best safety rates" well little does he know about women - then to infuriate women more he states

"why fix something that is not broken, why give people choice just because they want it"

How arrogant, how dare he disregard people, I could pull apart many of his comments, but this one takes the CAKE!

That in its self tells you that there is no respect for women and their ability to choose what they want - it is about being paternalist and thinking he knows best! and that is not the case.

Secondly to respond to Dr Pesce comments "My colleagues and I have seen things that would make the hair stand on end" referring to decisions that some homebirth midwives have made. Well Dr Pesce I and my colleagues have seen decisions made by Doctors in the hospital setting that would make your hair stand on end, some very late bad decisions - no one is perfect - so don't throw stones if you live in a glass house.
Have you heard of the word collaboration - working with Midwives as equals?

Thank you Sunday Night for presenting the story, however it would of also been appreciated if you had sort the view of the Australian College of Midwives / or some Midwifery input to respond to the AMA - equal for equal - not medically dominated by the AMA.
Those who want to view this show "Homebirth who chooses?" go to Sunday Night Channel 7 yahoo.com

HOMEBIRTH IS A CHOICE NOT A CRIME

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.

The Homebirth debate!

I'm a homebirth baby and I am not happy if my mummy does not have choice about my birth!



There is much debate around Australia amongst midwives and women, what’s it about? Homebirth! Now what brings about this discussion, yes it's National Registration: which means by 2010 all midwives in order to be registered with the Nurses and Midwives Board need to have indemnity insurance to conduct a homebirth.
It is interesting to note that within the profession of Midwifery there are many differing views on this subject. Historically nursing has been fractured and governed by the medical model; therefore this has carried forward into midwifery. You have midwives that consider themselves nurses as well as midwives who still follow a medical model. Then you have the midwives who consider themselves purely as a midwife. I do believe that the Bachelor of Midwifery will help change this perception within Australia. Try as it may midwifery battles with the medical model regarding health issues. We as a Nation hold a very medical model mentality; this is another reason why so many women choose obstetricians as opposed to midwives. However now with the proposed changes being made by the government which allows for midwives to have a Medicare provider number this is a huge step in the right direction. The introduction of the Nurses and Midwives Act 2006, further confirms the separating of the two professions, Nursing and Midwifery. Of course with every carrot there is a price to pay and in this case it is that the government will not provide indemnity insurance for private practice midwives (independent).

Midwives are highly skilled autonomous practitioners; however they may work in different ways. There are those who practice midwifery in every aspect, which is working with the women, antenatal, intrapartum and postnatal. You have midwives that only work in one area, so they choose either labour/birth suite or a ward area and only specialise in that area however they do know all aspects of midwifery care. When working within a hospital system (medical model) midwives can practice within a team model which is midwifery led care, referring to the medical model when a problem arises. Also midwives work providing high risk care in consultation with the obstetrician. Midwives always endeavour to keep labour as normal as possible for the woman. Even though midwives work within a hospital system there is also low risk normal labours and births with midwifery led care and without intervention.

As a midwife you can work in a birth centre and within the Community Midwifery Program which provides midwifery led care for low risk women. The only provision for Homebirth is in the community midwifery program. These midwives will be provided with indemnity insurance because they are attached to a health service. All other care is covered by Medicare or private health insurance.

Private Practice midwives (independent midwives) provide a homebirth service in which they will charge the women a fee approximately $4500.00. This fee will vary between midwives and is a reasonable fee as opposed to our medical doctors who charge much more, however the woman can claim this from her private insurance or Medicare.
Private practice midwives provide all facets of midwifery care and would refer to an obstetrician if there was a medical problem. The ideal is for private practice midwives to look after normal healthy women without any medical problems, therefore considered low risk. The Australian College of Midwives (ACM) provides National guidelines for midwives to assist them in which conditions are considered high risk. Remembering the definition of a midwife is to deal with the normal, anything abnormal is referred to an obstetrician for advice.
This is where some midwives differ in opinion; there are some who believe that all births should be in a hospital setting and those who believe anything goes. The most important point to remember is that it is the woman's choice as to where she wants to birth.
The conflict arises when a woman chooses to birth outside what is considered the ‘normal’ which is stated in the guidelines (AMC). A private practice midwife can choose to accept a woman even though she may be considered high risk. As long as the woman is well informed and has consulted an obstetrician for a medical opinion. The midwife needs to clearly document her discussion, care and plan of action; it is after all the woman's choice. However, the woman and midwife must accept the consequences of this action. The midwife has to remember to continue to work within his/her scope of practice as legislated by law. Fringe or radical midwives, whatever term you would like to call these midwives might accept any woman with what is considered a high risk pregnancy and this is where the problem lies. This is not an easy choice, because there are women that would go it alone rather than go to hospital. The question is who protects these midwives who choose to work with high risk women who are well informed and do not want medical intervention? Because the choice is that these women will go it alone.
I am pleased to work as a private practice midwife however I would not work outside the realm of 'normal' 'low risk' because that is what I consider the role of a midwife to be, anything that is abnormal is not considered for midwifery care within the home environment. There are midwives and women that would consider me to be conservative and not being ‘with woman’ because I choose only to take low risk women. I am happy to facilitate and care for a high risk woman within the boundaries of a hospital making her experience as much normal as possible.
I am sure that some women do not really understand the scope of practice of a midwife and that we are governed by legislation as to how we can work (Nurses & Midwives Act 2006). The big question is if the government does not provide indemnity insurance for private practice midwives, homebirths will no longer be allowed. This will surely push homebirth underground and more women will free-birth. This in fact will take us back to the dark ages, more women and babies will die. This is the last thing the government and society wants.
Change is slow - and maybe we need to take a step back to enable two steps forward. Medicare provider numbers are a step in the right direction; this will increase the visibility of the midwife and allow women to claim for the care provided by the midwife. Hospitals will give visiting rights to private practice midwives to birth women in the hospital under the care of the midwife and allow these women to go home a few hours later, continuing the care at home. Eventually the powers to be will see the value of birthing at home? 'It’s a nice dream'
I personally want to see women’s choice for homebirth being an option - by 2010 this may not be an option.


please contact your local politician and have your say!

Have your say! submissions due now!

The aim of this blog is to disseminate this information to as many people as possible and for you to read it and make comment. This is legislation that is going to affect your clinical practice, choices for women and the way in which registration and complaints will be dealt with. So please if you have never been proactive now is the time to start. It is time for public consultation and the submissions close 17 July 2009.

This is how we have a voice, by making submissions. We need to find a way to save independent midwifery, there are some very good practitioners out there that want to work in collaboration with our medical colleagues.

The National Registration and Accreditation Scheme for the Health Professionals:
The Health Practitioner Regulation (Administrative Arrangements) National Law Bill 2008 received Royal Assent on 25 November 2008, giving effect to the new national law.

The council of Australian Governments (COAG) in March 2008 signed an agreement to start the ball rolling creating a single national registration and accreditation system for health professionals. To start with, there are 10 health professions; chiropractors, dentists (including dental hygienists, dental prosthetists and dental therapists); medical practitioners, nurses and midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists, and psychologists.

Now it is time for you to review the next phase of this process The Health Practitioner Regulation National Law 2009 (Bill B)
Exposure draft of Bill B released for consultation - submissions close 17 July 2009

The bodies in the new scheme: Ministerial Council, Advisory Council, National boards, State/Territory boards (committees of national boards), Accreditation authorities, and Australian Health Practitioner Regulation Agency (AHPRA).

What does this mean to you as a Midwife – in a nutshell this is what is important:

Independent accreditation will be independent of governments – the final decision on whether the accreditation standards, courses and training programs are approved for the purposes of registration is the responsibility of the national board.

National accreditation standard which exist prior to the commencement of the new scheme are to continue until they are replaced by new standards.

Existing external accrediting bodies such as the Australian Medical Council are expected to continue.

CHANGES TO THE REGISTER;
- There will be both general and specialist registers available for the professions including medical and dentistry

- Separate register for nurses and midwives

OTHER IMPROVEMENTS TO QUALITY AND SAFETY OF HEALTHS SERVICES;
- Mandatory reporting of registrants – who is placing the public at risk of harm
- Reportable conduct

- Criminal history and identity checks

- Simplified complaints system

- Students registrations – students will now have to register from 2011

- PRACTITIONERS WILL BE REQUIRED TO HAVE SUITABLE PROFESSIONAL INDEMNITY INSURANCE during the period of their registration. (see clauses 69, 73, 75, 80, 83, 101 and 125)

73 Professional indemnity insurance arrangements
(1) Professional indemnity insurance arrangements in force in relation to
individual are appropriate for the purposes of registering the individual
in a health profession only if:
(a) the arrangements will not expire before the end of the
individual’s period of registration, and
(b) the National Board established for the health profession
considers the type and level of cover provided by the
arrangements are sufficient in the circumstances.
(2) A National Board may accept as evidence that there is, or will be, in
force in relation to an individual professional indemnity insurance
arrangements:
(a) written advice from an insurer or insurance broker that an insurer
has agreed to issue a professional indemnity insurance policy or
that the premium has been received and accepted by the insurer
for the issue of a professional indemnity insurance policy, or

These are some of the major changes, but for independent midwives the death nail is the requirement to have indemnity insurance with registration. See the above clauses within the Bill. The second most important issue is that of complaints. From my limited understanding at this early stage is the there will still be an office in each state – I will update you all on this section when I have finished reading it.

Please visit the http://www.nhwt.gov.au/natreg.asp site and make a submission:

go one just hit the hyperlink and have a read!

Celebrating our Land, our People and our Profession.

International Day of the Midwife (IMD) was on May 5th. The Australian College of Midwives WA Branch, celebrated this occasion on Saturday 2nd May at UWA. It was a day of celebration to which approximately 60 Health professionals attended. It was nice to see familiar faces of the midwives that generally celebrate and come to the College events. This is a time for midwives to get together and network, gossip and generally catch up with colleagues that you have not seen since the last IMD celebration.



This time I met an exceptional woman, a beautiful Cherokee midwife who has worked with the Inuit women of Canada, she had such long hair I just had to take her photo.



It is very important on these occasions to get the catering correct, because as midwives we like to chat, eat and have a nice cup of tea or freshly brewed coffee. UWA did a great job of the catering there was good food and beverages. The day started with an official Nyungar Welcome to Country and a traditional Nyungar dance - performed by Justine, it was breathtaking.



The rest of the morning was spent discussing Aboriginal Health, relating to mother and infant mortality and morbidity. Heather Hancock from SA University gave a riveting presentation on her work in the Northern Territory and Alice Springs. She also reminded us as Midwives to continue providing quality care, remember to be happy, joyous and passionate about our beautiful career. I couldn't agree with her more, we, as midwives need to be happy and joyous in our work providing women with continuity of care. You know the famous saying ' if you love what you do, you do it well' or something along those lines.


Fun was had by all in the Laughter workshop:




With the afternoon came the laughter workshop, some people like this sort of thing, me no, its not my cup of tea, however i did do it to experience something different. But can't say i am in a hurry to do it again.

I did enjoy the last session which was the panel discussion on the way forward for the maternity review report.



The nuts and bolts of this discussion was that we as midwives need to work together to achieve better outcomes for women. So that women can have the informed choice they so rightly deserve. This means, midwives becoming more politically savvy,find out who your local politician is and start emailing or writing to them saying what it is you want as a midwife. That is a medicare provider number, this is what will give us what we want, that is access to all pregnant women in the first trimester, from 12 weeks. This way the woman will get informed choice and all her birthing options, that is Midwifery Led care, Birth centre, teams, shared care, homebirth and obstetric care.



It was good to see so many midwifery students attending the study day. We need to encourage students to attend because they are our future, and need to become actively involved in the College.

Remember to watch out for information relating to National Registration & Accreditation 2010, the Maternity Review Report, Indemnity Insurance for independent midwives and the Complaints committee relating to National Registration; All this topics will be up for public discussion and this is when you need to make your comments, make your voice heard. If you see articles in the news papers or on the news, that are untrue or unjust, respond or send it to the Australian college of Midwives and ask them to respond, this is how we are noticed. However always remember to be professional.
Thank you to all those who attended the day to make it a success.



The time is now, for you to start being heard as a Midwife.

Happy International Midwives Day 2009.

Misleading headlines! Homebirths!

The phenomenon of Free birthing, Unattended childbirth whatever it is called, women who choose to birth at home with no medical or midwifery assistance. This phenomenon continues to happen and we knew it was only a matter of time before we started hearing about some tragic deaths. Now it has been reported that there have been 4 tragic baby deaths in the last 9 months. The web is full of sites of how to do your own birth (DIY) homebirth complete with what to do if things go wrong, even DIY u tube videos on waterbirth.
The Daily Telegraph has reported that AT least four babies have died during home births in Sydney in the past nine months, including the daughter of one of Australia's most vocal advocates for hospital-free deliveries. These are homebirths, but they are unattended homebirths or freebirths, without midwives or doctors.

Janet Fraser, national convener of Joyous Birth, which encourages women to shun hospitals, is dealing with the death of her own baby during a water birth at her Croydon Park home. Ms Fraser went into labour at home assisted only by her partner and a female friend when things went horribly wrong.

It is woeful that women are forced to choose this option of birth because our maternity system does not offer them a safer option, informed choice or support their option of birth without feeling threatened, bullied or patronised by the medical profession.

Now that independent midwives are under threat of being not allowed to practice if they do not have indemnity insurance, due to National Registration we will be forcing more women to do it alone. Already there is debate as to whether to outlaw or ban homebirth. Alison Leeman for the ABC reports

So as long as the AMA and RANZCOG are hostile to homebirth -ideologically, not evidentially - the government is not prepared to stare them down

– how deplorable is that, banning homebirth, what sort of democracy are we? What happened to choice and women’s right to choose? We certainly do not want to go down the same road as our American counterparts who are not permitted to do homebirths and the fetus has more rights than the woman who carries the fetus.

The Honourable Minister of Health Nicola Roxon’s report on Maternity Services stops short of supporting Homebirth and independent midwifery. However the report does acknowledge the need to increase the role of the midwife within Maternity Services and listen to what the women of our country want and that is informed choice about how to birth their babies. Without feeling intimidated by paternalistic obstetricians.

Even when reading this news story at no time is it reported that these are unattended homebirths, that is no midwife or doctor in attendance – they stipulate that the

dangers of homebirth need to acknowledge and that there are down sides to a homebirth’
Dr Pesce said it was time the increased risks of home birth were acknowledged and addressed.
"There are one or two extra deaths per 1000 deliveries and I wish people would acknowledge that," Dr Pesce said.
"It's often presented as if there are no downsides to a home birth only up sides."
He said obstetricians and the health system had to take some responsibility and try to attract women back to the hospital system.

Australian College of Midwives president Professor Pat Brodie said more was urgently needed to be done to avoid future tragedies.

"We are very concerned about a maternity care system that is so abhorrent that women choose to do this (give birth without a midwife),'' Professor Brodie said.
She said the maternity services system needed to be re-organised so women were assigned to a single midwife who they knew and trusted and who could provide continuity of care throughout their pregnancy.

'Home births in Australia represent just 0.25 per cent of all births.
Of the 277,436 babies born in 2006, just 708 were home births.
The majority of the home births are done with the assistance of a midwife.'

Surprise, surprise hospitals are now asking the question? Why are women choosing to birth at home without medical or midwifery assistance? Dr Pesce described it well when he said “ In the hospital system we need to get our act together rather than make them (women) refugees of the system” well said doctor.

It is all about informed choice, allowing the woman to know her own body and make the right decisions. Collaborative work with our obstetricians, we need to work together each one acknowledging that each profession has an equal place. Midwives specialize in the ‘normal’ obstetricians specialize in the ‘abnormal’

great show on SBS - insight 'birth'

It was fascinating watching insight last night - it was a great forum - pregnant women, more women, midwives, GP's, obstetricians and politicians.
So what real choices do women have, from elective Cesareans to
homebirth? What are the risks? And with the rising cost of health care, what can we really afford? A recent government review of maternity services found that women should have access to more choices as to how their babies are delivered.

The rate of cesareans is up 50% over the last decade. But why? Are women themselves opting for cesareans over a natural birth? are women truly informed?
What a great debate that is!I was excited to see such an open debate, I was so proud to be a midwife - the midwives representing midwifery were articulate, knew the research to quote, held their ground and put the hard questions out there to be answered by both the obstetricians and politicians.

Please click on the link and watch the show and comment: SBS Insight
http://news.sbs.com.au/insight/

I was disappointed with the opening of the show, in my opinion it does not truly reflect the attitudes of Australian women. I think often in a show like this extremes in both camps are provided to create discussion and sensationalism. I also felt that the presenter 'Jenny' was trying to insight rather than collaborate between the health professionals, by trying to insist that 'there was a turf war' - this is by no means the case, it is about working collaboratively together and recognising each professionals ability and place in the scheme of childbirth and woman centered care. After all it is all about informed choice and the woman's choice not 'paternalism'.
I was truly impressed with our midwifery leaders Jenny Gamble and Hannah Dahlen, they were always professional and inclusive wanting a collaborative approach in providing women centered care, choice and continuity of care.

It is also disappointing to hear that the Federal Health Minister Nicola Roxon is putting on hold the option of 'Homebirth' and National insurance for independent midwives. It is not a closed option just one to be considered later, this is something that we have to keep addressing and maintain pressure on the Minister so that is an option for women.

The SBS show will be repeated several times, go to the website and have a look. It is also interesting reading the comments from women - although sad that this is a forum for asking questions relating to childbirth.
Enjoy the show let me know what you think?

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.