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;

Pondering the profession of Midwifery:

I have spent the weekend away from the email and work to try and recuperate from a really bad dose of the flu..... I must be run down, I have taken the opportunity to ponder my future..........The recent months have created much, discussion, passion, excitement, lobbying, stress, anguish, disillusionment, tension and more recently a more pronounced division within the profession of midwifery; even to the point of a midwife reporting the Australian College of Midwives to the ICM (International Confederation of Midwives) which I find extraordinary, I would of thought this would be saved for something so terrible; not here a modern, young progressive country such as ours with excellent maternal and infant outcomes however not so good midwifery services.... I am lost for words at this dissatisfaction within the ranks.....from what I can determine there is a strain of midwives that believe that no matter what the risk factor a midwife can provide the primary care without the necessary collaboration: I am particularly thinking of the twins, footling breach, high blood pressure, more than 1 caesarean at home type births; the homebirth that is not recommend at home. Any high risk category requires an obstetrician, this does not mean that you cannot have midwifery care but you have to collaborate with an obstetrician and birth in hospital.


Tawny Frog Mouth Owl (Male)

This has caused me to reflect on what my own vision is for midwifery within Australia as we are on the cusp of change or no change as it may be. Before I can discuss this it is important to say that I have only practiced midwifery in Australia for 7 years now after completing my midwifery in the United Kingdom and working there for several years, so my basic ideology of midwifery comes from my experiences in the UK. When I first arrived back to Australia as a Midwife it was extremely different and difficult to work as an autonomous midwife to the same level as in the UK, in fact impossible: I even tried the Birth Centre where I was told “no we do not do water births, you have to pull the plug out”, tried independent practice but the thought of no insurance and no support system was too much of a risk, I nearly gave up the profession several times as I felt it was a losing battle.

Nevertheless what kept me strong was the idea of being a change agent and influencing the public perception (namely women and not just the minority of women) of midwifery in Australia so I continued the journey for change and the freedom of midwifery from the medical model which is so prevalent in Australia. So how does one go about change in such a huge way, it seemed only right that you should join the peak professional body for midwives, which is the Australian College of Midwives; whose philosophy is.... “Our vision is to be the leading organisation shaping Australian maternity care for the benefit of women and their families”. The college’s work is to provide a unified voice for the midwifery profession, supporting midwives to reach their full potential and ensuring all childberaring women have access to continuity of care by a known midwife”....The College has grown significantly recently as the profession has gained recognition and respect. The numbers of midwives within Australia has been difficult to quantify.... and so too are the numbers of independent midwives; with nursing and midwifery being lumped together; However due to the new National Registration and separate registers for nurses and midwives, we will finally be able to separate nurses and midwives and determine the numbers of midwives etc;


Tawny Frog Mouth Owl (Female with baby)

Traditionally in Australia midwifery has been seen as a tack on postgraduate course to nursing....in recent years we have seen the introduction of the Bachelor of Midwifery course which will also improve the profile of midwifery as being separate from nursing; ....... ever since I can remember (20yrs ago) the reputation of midwives is that “they are outspoken/bossy women” “consider themselves better than the rest” “ a bunch of dykes or lesbians” “difficult women” ‘feminists” and I am sure you know more than me, you have to wonder who put these labels upon us? And as I ponder my future.... all these anecdotal comments about midwives are no different now to 20yrs ago..... I have to say I aspire to being a “feminists in the truest sense of the word” I have always valued and wanted equality for women and I firmly believe to be a high-quality midwife one of the qualities is to be a feminist or have feminist ideology.
There are three main facts that I think are imperative to where we currently stand politically: What is a midwife: Medical dominance in obstetrics; Private Health Insurance:


The leaning tree

The role of the Midwife: I was amazed on my return to Australia how very little was known about who a midwife is? What is the role of the midwife? Coming from a system where every woman sees the midwife at 6/8 weeks at the GP surgery to women not seeing a midwife until 19/20wks...... unforgiveable for a woman & midwife. Therefore the first trimester is left to the GP/Obstetrician......no wonder they don’t want to give this up now as it is money lost to them......I realise that funding is different here in Australia as compared to the UK, but this just illustrates that there are huge changes required for women and the medical profession in Australia; interestingly if you examine midwifery history you will see that the UK and NZ have gone through several battles similar to the ones we are going through on two fronts, that from outside midwifery (political/medical) and internally from the difference of opinion from the independent sector of midwifery.

The second main point is the medicalisation of childbirth; it seems to me that in Australia generally women take on face value what a doctor says and takes very little responsibility for their own health care or pregnancy.... they seem to have the notion that “Doctor knows best” “just do what you think is right” you are the doctor, however I think this is slowly changing, I am hoping women are changing and taking more control of their bodies and their pregnancy;



Thirdly is private health insurance; here in Australia the uptake of private health is far greater than in the UK, and women seem to think that private health equals better, higher quality health care, which is not the case. Most importantly women think that obstetrician means best possible care whilst pregnant, and this is definitely not the case; private obstetric care means higher caesarean section rates and longer stays in hospital. Yes you need an obstetrician when things go wrong or you have a high risk factor.... but there is no reason why a woman should not be seeing a midwife alongside the obstetrician....but this rarely happens.....



As far as childbirth goes, Australia has a history of being medically led, midwives and midwifery is starting to gain some recognition, up until this point there has been no funding to support the profession of midwifery; the AMA is very strong and with its blanket rule of no support for homebirth this clearly indicates there is no support from that front. The independent midwives feel that the ACM is not supportive enough because they choose to take the safe route which will benefit many women & midwives rather than a few...and this is not to say that the few are unimportant, absolutely not, but small steps of change need to occur in order for greater change to follow; therefore working towards changing a medically dominated system that cannot be changed overnight and made to accept midwifery led care when this is a whole new way of thinking, in this country....... I have always thought it is best to take small careful considered steps to success rather than giant steps trampling on people to get the same result.

My vision is similar to that of the College in that I think that every childbearing woman should have access to continuity of care by a known midwife and that

I would like to see the ACM have its own industrial arm and legal support for its membership

(separated from the ANF)...... however in saying that.....I do despair for the future of midwifery in this country with such fragmentation within the profession........ As for me I am still pondering..... Shall I stay or shall I go? Is there a point to all this?


Isabella 2yrs old, her expression says it all!

Would you throw out the baby with the bath water?

Currently midwives particularly homebirth private practice midwives are up in arms (and rightly so) about the recent Determination where Midwives are to be virtually signed of by doctors. That is as a privately practicing midwife (independent) you need to collaborate with an Obstetrician or GP obstetrician before being able to claim a Medicare rebate for the midwifery services provided. I might add that there is nothing in the Determination to make doctors collaborate with midwives or any benefit for doctors to collaborate.... so I am not sure why they would even consider it as we (midwives) would be competition for them in terms of financial remuneration therefore less money in their pockets..... emm not sure this will work?

If you are a midwife this seems a sort of sellout, Medicare for collaboration; However the woman is able to recoup some funds with this system therefore allowing more women this option of care....that is continuity of midwifery care and also midwifery led care;

Now as I see it there are two schools of thought......

1: If the government does not change the wording of the current determination; you go all out and say no to collaboration as it stands therefore we lose the right to a Medicare rebate and the legislation falls over; and we maintain the status quo as in the past which is no funding or rebates for women choosing private practice midwifery led care.... and it does not go before Parliament again for three years.... and if the government changes we may never have this opportunity for a long long time.... we will still have insurance requirements and regulations, that will not change.

or

2: we say yes to the collaboration as it stands, work to make it a viable option and see how and if it would work and if it does not work we then collate the evidence and go back to the politicians to lobby for changes to the determination knowing it does not work, rather than speculating that it does not work....therefore whilst we are battling for change women are able to claim a Medicare rebate for midwifery services? and Midwives are recognised for the profession that it is... which should have a medicare provider number.....and be recognised as autonomous clinicians.

Once the system (Medicare) whether it is effective now or not would be beneficial as we can work on changes....but if we never get it in place it will be years before we get back to this position and all our work up to this point would be for nothing as would of achieved nothing and the status quo remains.

What would you do in this situation?

"Greens Will Act to Help Midwives Media Release"

Read what the Greens have to say about “the collaboration determination”

Greens Will Act to Help Midwives Media Release | Spokesperson Rachel Siewert Saturday 24th July 2010, 10:01am

The Australian Greens said today that midwives are furious with the Federal Government over recently released regulations governing the way they practice. Greens spokesperson for Health, Senator Rachel Siewert has committed to immediate action on the regulations upon the resumption of Parliament.

“As soon as the Senate next sits, the Greens will move a motion to disallow the collaborative arrangements regulation,” Senator Rachel Siewert said today.

“This regulation puts doctors in total control of midwives and makes a mockery of the Government's $120 million “Medicare for Midwives” reforms,” said Senator Siewert.

“The government released its definition of collaborative arrangements for midwives out of parliamentary session, and it’s easy to see why- their approach is unacceptable and demeaning to midwives and they didn't want to draw attention to them during the last week of sitting.

“Midwives are concerned that this determination effectively means that if a doctor does not agree with a woman’s choice of midwife, they do not have to participate and will withdraw their collaboration.“Midwives will have to work under the control of a doctor in order to access Medicare payments.

They must have a signed agreement with a doctor who agrees to the way they are providing care or have all elements of care planning acknowledged at every step.“We’re speaking about trained and regulated professionals who have been insulted by the reforms put forward.

“If the government does not trust regulation of health professionals to ensure that practitioners are working safely, it is a very sad indictment of their own health care system.

“The government has failed to deliver anything like the promises they made for midwifery reform and at the same time have given power of veto of one medical profession over another.

"Women are outraged that they have been told that Medicare rebates will be available for private midwifery care and now the reality is that this will be limited to those employed in an obstetric model which many women have said over and over again that they don't want," concluded Senator Siewert

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

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

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

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

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.....

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?

Who will be the next American President? My view!

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

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