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.

Ethical question: should we be encouraging octuplets?

Has the idea of fertility gone mad, eight babies to a family who already have six children what is the point or have I missed something? The chances of eight babies being conceived naturally are inestimable. I thought the idea of fertility treatment was for couples who could not conceive naturally.

I would argue that the doctors concerned in this case are negligible on ethical basis, why? Because they knowingly put this woman at risk and high risk is what doctors should be avoiding.

What do you think? Do you think there is any responsible reason why octuplets should be conceived?

To read the complete story click here

Midwives opinion disregarded by doctor

Trust to pay millions after brain damaged boy's 'mismanaged birth'
This story was reported in The Independent UK, it is a sad story of a mother’s (Kristi Riches) labour & subsequent birth in 2001 that went wrong and resulted in her child (Oscar) being born with catastrophic cerebral palsy, severe cognitive deficit, impaired vision, epilepsy and painful muscle spasms. The midwives involved in the care of Kristi were very troubled and tried to influence the doctor’s course of action, to no avail.

Oscar Riches would have been unharmed and grown up to live a normal life if he had been born swiftly by emergency Caesarean, Mr Justice Holroyde heard at London's High Court.
But the delay at Eastbourne District General Hospital had left the now seven-year-old with catastrophic cerebral palsy.
Oscar's counsel, James Badenoch QC, said that East Sussex Hospitals NHS Trust had admitted liability because of the behaviour of the locum obstetric registrar - an overseas doctor who has now left the UK - who "grossly mismanaged" his birth. Mr Badenoch said that before Oscar's birth, the heart-rate trace showed that he was in great jeopardy but not yet damaged.
But the locum "inexplicably" insisted that Mrs Riches should continue in labour and then failed in a ventouse delivery. Eventually extracted by forceps, Oscar was severely asphyxiated with the umbilical cord tightly around his neck and did not breathe spontaneously for 20 minutes.

"It was effectively an admission of negligence against the doctor - it was not a system failure... and we are happy to acknowledge that the midwives were very concerned and did seek to influence the doctor to take prompt and effective action."

Mr Badenoch said that the locum refused to speak to the midwives, hummed and whistled while attending to Mrs Riches after the birth and wrongly recorded the amount of blood lost when she suffered a potentially dangerous haemorrhage.

"It was effectively an admission of negligence against the doctor - it was not a system failure... and we are happy to acknowledge that the midwives were very concerned and did seek to influence the doctor to take prompt and effective action."
Mr Badenoch said that the locum refused to speak to the midwives, hummed and whistled while attending to Mrs Riches after the birth and wrongly recorded the amount of blood lost when she suffered a potentially dangerous haemorrhage.
It was also reported that as a result of the trauma of Oscars’ birth in December 2001, Kristi (mother) suffered stress and anxiety that she could not contemplate having any more children.
It was not believed that he had worked again in this country but his present whereabouts were unknown.
Oscar is totally helpless and would require constant care long as he lived, which was likely to be into his 20s, funded by an agreed lump sum payment of £1.118m plus annual payments.

Mrs Riches who, with her husband Clive, cares devotedly for Oscar at their home in Glenleigh Park Road, Bexhill-on-Sea, East Sussex, has reached a further undisclosed settlement with the authority for her psychiatric injury.

It is interesting to see the CTG submitted as evidence relating to the fetus’ well being; however there was no mention of any fetal scalp sampling or cord bloods. Also the midwives documentation and concern were duly noted, it would be good to examine this case further to see what other options the midwives may of had in relation to the doctors who were leading this case.


Reference:Posted by The Independent
Friday, 30 January 2009 at 06:54 pm
Published: 2009-01-30 14:18:38
Author: By Jan Colley, Press Association

Should nurses & midwives be allowed to work as a health professional once they have committed a criminal offence?

Nine msn reported on an interesting story in Victoria, regarding nurses found guilty of serious offences. This information was found through The Freedom of Information,the offences included manslaughter, sex offences and torturing animals.

Nurses in Victoria found guilty of serious offences including manslaughter, sex offences and torturing animals have been given approval to care for sick and vulnerable patients.

Nursing authorities in Victoria have in the past three years approved registration of more than 100 nurses who had admitted being found guilty of crimes including stalking, drug trafficking, possessing child pornography and manslaughter, News Limited newspapers said.

This raises several questions, what was the crime? have they repaid society for the crime? and are they now trustworthy?

Have they by the very nature of the crime, forfeited the right to work as a nurse? one could also argue,that the nurse has bought the profession into disrepute therefore should not be allowed to work as a nurse again.
Would you like this person looking after your mother, father, son, brother etc.

Off course there is the other side of the coin - they have paid the price to society for the crime, whether it be a fine or goal time and they have proven to be trustworthy. Is it then unreasonable to allow them to work as a health professional again? However, It does seem bizarre that a nurse convicted of sex offences and torturing animals would be allowed to work as a nurse again?

Do we allow policeman who have been convicted of a crime and gaoled to be re-employed as a policeman?

What do you think? should nurses & midwives who have committed a serious criminal offence be allowed to re-register and work as a nurse?

Out of action

Well it’s that time of year as a lecturer, preparing for the new semester to begin, changing unit outlines and assessments to correlate with the student’s evaluations from the previous year. I am very excited about the semester beginning a whole new group of students all eager to share and learn experiences.


However it’s also a good time to have some urgent minor hand surgery. It really is difficult being the recipient of care especially me being Ms Independent. It’s about giving up your control, trusting and letting others do things for you and for me this is a difficult lesson. I feel sorry for my husband and family trying to keep me down – however ‘pain’ is a good indicator, it certainly makes you stop!
I am usually a touch typist, but alas now with bandaged hands I’m afraid it’s finger typing, I am grateful that I am able to do that, otherwise I think I would go nuts.
Funny enough I had not heard of Trigger Thumb until 16 weeks ago when I developed incredible pain in the soft pad and left thumb area eventually not being able to bend it or use my thumb. I wore a splint hoping that would resolve the issue, alas it only got worse, driving me to go to the doctors and the diagnosis being trigger thumb.
After being referred to a specialist, ultra sound then the cortisone injection – I would not recommend the injection, it was the most painful experience and would not do it again, especially as it only lasted six weeks. The pain was back with vengeance, now my thumb would lock at the joint and had to be manually manipulated back into place – wow the pain. To make matters worse the right thumb was following suit, it was now very painful. Both thumbs are now splinted. It's surprising how important your thumbs are, no opening bottles, jars, door handles the list is endless.
It’s time for a ‘Google’ search to see what the cause & treatment options are: causes are repetitive use, which I can’t think of anything I have done, other causes are rheumatoid arthritis, diabetes, or simply being between the ages of 50-60, damn! getting older. Also pre-disposing factors are, suffering from carpel tunnel syndrome – which I have. Women are 4 times more likely to get than men. Treatment is, splinting, steroids and surgery, once the finger starts locking.
So it was time for surgery, now I am out of action for about a week or two.

Thank goodness I can still use my fingers. I now also have time to finish my book “How are we to live” by Peter Singer. Speaking of Peter Singer he is coming to Perth Writers Festival in February.

Baby Confiscation in Bali - Midwife in question

This is a very interesting story, one I had not thought of before. It just goes to show you that anything is possible in the name of money. We are very fortunate here in Australia.

This story was reported in the "Jakarta Post" "Baby Confiscation goes to police"

A couple whose baby was reportedly "confiscated" because they were unable to pay for its delivery have reported their midwife to the Bali Police, accusing her of human trafficking.

The couple have accused their midwife of "confiscating" their baby for financial purposes. The couple also felt that the midwife was not displaying ‘goodwill’ over the issue.
The parents could not afford to pay their bill of 1.5 million rupee (Rp) after the delivery so the father left the mother and baby at the clinic until he could return with the money to pay his debts.
He returned three weeks later with 1.Million rupee and hoped that this would be enough for his family to return home with him. However the midwife had added a further 4.5 million to the bill for expenses totaling 6 million Rp. He was forced to sign an agreement stipulating that he must leave one of his sons at the clinic to assure he would return to pay his debt or in order to be released from all his debts.

The midwife is defending the charges and disputed the amount of fees charged as only 2.5 million, and has a lawyer representing her.

The midwife is under investigation for Human Trafficking, possible adoption issues and child protection laws.

The human trafficking laws carries a penalty of between 3 and 15 years in prison and a fine of between Rp 60 million and Rp 300 million (US$27,000).

This is a sad story and certainly contravenes any Code of Ethics throughout the world.
I am thankful that I work in Australia as a midwife and do not have to deal with these issues.
What do you think?

Why is it so hard for Doctors to accept working in partnership with Midwives

January 10 The Australian published a story "Doctors firm against role of midwives".
We are all eagerly waiting for the release of the federal health minister Nicola Roxon's report on Maternity Services in Australia. During the process of review the obstetricians have stepped up their campaign against the MIDWIFE.
Lets look at the facts: Midwives want to look after low risk women - Midwives want to offer midwifery-led-care, which is a midwife-focused, woman-focused model of care for low-risk-women.
Women with medical problems, or in a higher risk category will see an obstetrician or the midwife will refer the women if it is required.
Is this so hard to understand?

Why are obstetricians so determined not to work collaboratively with midwives?

Dahlen (Australian College of Midwives) says obstetricians are incorrectly claiming or implying that midwives are seeking to be in sole charge of births.

‘‘We are not asking for midwives to be out there on their own — we don’t want that,’’ Dahlen said.

‘‘What we want, what we have always wanted, is collaborative models of care, where women can have a midwife who cares for her through her pregnancy and postnatal period.

‘‘It’s not about being ‘independent’ — this is about doing what midwives are best at, caring for women, particularly low-risk women, and having support from obstetric colleagues when that’s needed.

‘‘Part of the reason we have such a high intervention rate is because normal, low-risk women are being cared for by highly specialised surgeons trained in surgery.

‘‘We are not saying midwives are not going to work with obstetricians — we are asking for more choice, not less.’’ Dahlen says women are ‘‘marching with their feet’’ to seek better access to midwifery services, based on the number of women prepared to attend rallies and on the number of submissions from individual women to the federal Government’s review.

In December the Government revealed over 900 submissions to the review had been received, most of them from individual consumers.

It is about time someone started listening to what women want.....our maternity services are failing women and this is evident by the number of women who freebirth.
Also the submissions from women indicate that our maternity system has become to focused on medical intervention.

It will be very interesting to see the outcome of Nicola Roxon's report.....we are waiting with baited breath.