The ACM's draft Water immersion for labour and or birth

Well it has been a while since I have written, and this is due to being very busy with four units of study, work and family life.
I am looking forward to the semester finishing so that I can have some free time to blog, play and have some fun...... However I have taken some time out of my study plan today to write this blog, as I am very frustrated about this issue.

Firstly yes I think water is a fantastic source for women to use for pain relief, and if I had my time over again I would have a water-birth - so I am no opposed to this concept, in fact I am highly supportive of it. But equally so I think it is important to maintain a safe environment for both mother and fetus (baby).

Please have a look at this draft position statement on the ACM Website: Water immersion in labour and / or birth:

Here are some excerpts:

Position Statement on use of water immersion for labour and birth

"The ACM supports the choice of all women at term to have the opportunity to access water immersion for labour and/or birth."........

 This opening creates a problem for me as not 'all' women are suitable for water immersion - and I think that this statement is a potential problem because it could be seen as encouraging 'all' women even those with a know high risk factor to use water immersion (in the bath/pool) - this in fact could work against the college if there was an adverse outcome.
However equally the problem arises when such tight restrictions (the current policy for water immersion states only low risk women) are placed on women who don't necessarily fall into the 'high' or 'low' risk category......

The other major problem I have is in the achieving best practice.......all maternity services to be encouraged to provide telemetry... for water immersion ( that is CTG monitoring in the bath/pool)

To achieve best practice use of water immersion for labour and birth, it is necessary for:
 all maternity services to be encouraged to provide women with access to water immersion in labour and/or birth including telemetry as required;

My concern with this is two fold, one if a woman needs a CTG (fetal monitoring) then it is considered that she has a risk factor that should not necessarily be in the water - and are we putting her more at risk?
Second issue is that but stating this point even the low risk women might end up having monitoring in the water...will we be opening Pandora's box?


What I really like about the position statement is the following excerpt....because this tells women that they can so 'NO' and have the right to say "NO" to any treatment they do not want.

Informed decision-making, informed consent, and right of refusal are accepted legal principles in Australia. Each and every woman has the right to make informed decisions, including consent or refusal of any aspect of her care. Women must be respected in the choices that they make.

I also think that the College is compromising the position of midwives on this issue, because most state-wide hospital policies all state that 'water immersion for labour/and or birth is recommended for low risk women'.
We have only recently taken the step to have water immersion in labour and/or birth accepted as a part of the childbirth care options.....and some hospitals are still not offering this to 'low risk' women let alone 'all' women.....lets take some baby steps first....otherwise we will lose the lot.....all it will take is one bad outcome and it's gone.........

Take some time out and give some feedback

DEADLINE FOR SUBMISSIONS: 5pm (Canberra time) 21th December 2012: Submissions received after this date will not be considered.
Submissions (and any questions about this consultation process) may be sent by email to: sarah.stewart@midwives.org.au



picture ref :http://watersongline.com/wisdomcorner/waterways/

Freedom for Birth - One World Birth

Take some time and have a look at this website: http://www.indiegogo.com/freedomforbirth
Take back birth - pregnancy is not a medical condition - question your Medical Practitioner, be empowered take back childbirth:
Make birth better,1000 premiere movie's at one time; Check out where the film is showing in your State /  Country;

For WA see:

Premiere screening of Freedom for Birth
When: September 20th, 7pm
Cost:    $5.00 or donation
Where: Boulevard Centre, 99 The Boulevard (next to Floreat Forum shopping centre)
RSVP: To get an idea of numbers please RSVP on:
admin@ccbcwa.com.au or call 08 61960463 to guarantee a seat.

Lobbying pays of.......

Picture ref:http://safetyatworkblog.com/2012/02/06/the-lobbying-for-control-impedes-corporate-and-ohs-growth/

If you have followed this blog you will know that with the maternity reforms came the Determination, which on the one hand gave midwives access to a Medicare provider number and with the other hand effectively tied both our hands together by demanding that we have a collaborative arrangement with an obstetrician, this seemed an unfair advantage to obstetricians..... Now this might of worked if the obstetricians agreed to collaborative with midwives however this proved difficult for one reason or another and only a hand full of midwives were able to obtain a collaborative arrangement. Midwives wanted collaborative arrangements to be with a Health Service rather than with an individual doctor….. hopefully this system would be a fairer option.

Midwives began to collect data,that is evidence that collaboration was not working. Private midwives have been actively seeking collaboration for two years and there are only a few arrangements within Australia. We began to lobby the government for change…and finally this has happened. There was a round table consultation in July with key maternity stakeholders including the AMA and RANZCOG to discuss indemnity insurance and collaboration or the failure of the Determination in its current format…. hence the announcement after the Health Ministers meeting 10 Aug…..

Professional Indemnity Insurance for Privately Practicing Midwives.

 Ministers agreed to an extension of the professional indemnity insurance exemption for privately practising midwives until June 2015.  This will mean that privately practising midwives will continue to be covered by the national registration and accreditation arrangements. 

The Commonwealth agreed to vary the determination on collaborative arrangements to enable agreements between midwives and hospital and health services.

Ministers agreed that WA would develop a paper on longer term arrangements and that this would be presented at the November meeting of Ministers

http://www.ahmac.gov.au/site/home.aspx

comments made in the Canberra times: 

The health ministers also agreed yesterday to change the existing rules which require midwives to work in collaboration with doctors.

They'll now be able to enter agreements with ''hospital and health services'' as well. That move will be welcomed by midwives who have long argued the current determination effectively gave doctors a veto over midwives.

But doctors are outraged, with the Australian Medical Association labeling the decision ''dangerous and unexpected''.

''If the Commonwealth proceeds with today's decision it will be essentially allowing independent practice by a midwife,'' AMA president Steve Hambleton said in a statement.

''When the collaborative care arrangements were being developed it was agreed the midwife could have an agreement with a doctor in a hospital who would ensure appropriate care arrangements were in place.

''This decision is transferring sensitive patient care and management from a doctor to a bureaucrat. It must not proceed.'' AAP

Read more: http://www.canberratimes.com.au/national/midwife-exemption-gets-extension-20120810-240a3.html#ixzz23FsqH6gN

It is not surprising then to see that the AMA is not happy with this outcome…however to say the "decision is dangerous and unexpected"…is unacceptable and scare mongering…..Midwives are heavily regulated through legislation, (AHPRA) Registration, Quality and safety framework, policies, guidelines and Professional Standards….. this is about implementing the maternity reforms, offering women more choice and allowing midwives to practice as autonomous practitioners……midwives are always willing to collaborate..

Private midwives want access to hospitals to enable women continuity of midwifery care…. putting women at the centre of their care.

Improve access to maternity care by midwives known to women

A colleague of mine Beth O'Neil started a petition on change.org, the aim of the petition is to get 3000 signatures: what is the petition about? its about Improving access to maternity care by midwives known to women. 

Currently GP's will only refer to obstetricians and midwives are finding it difficult to get a collaborative agreement with obstetricians. What we need is for GP's to start referring pregnant women to midwives who are experts in providing continuity of midwifery care - what is continuity of care - it is the same midwife caring for you throughout your pregnancy, labour, birth and postnatal period.

We need women to be asking their GP to refer them to a midwife for continuity of midwifery care.... take a look at the petition have a read and then sign it..... pass it on to your friends, lets get it moving get the word out Midwives are here to offer you continuity of midwifery care.... shared care with your GP and or Obstetrician... we can all work together to give women what they want.... that is different models of care with informed choice and the same midwife throughout their care......

Change.org|How to Start a Petition

Integrity, principles and veracity - Food for thought!

The ups and downs of life, yes we all have them hopefully there are more ups than downs. I have so many blogs to write, this blog is going to be about ethical behavior; integrity, principles and veracity it seems to be foremost in my mind, it is my attempt to be philosophical. It is to get you thinking about the people, jobs, organizations and activities you are involved in..... stop and take a breath, and remember the basic principles of life, integrity and veracity. Abraham Lincoln said "Important principles may, and must, be inflexible". 

I have been contemplating veracity, principles and integrity and how is it that people make decisions - I was conducting Health Assessment exams with students as I was intently watching the student go through the process of auscultation (listening) of the heart sounds - aortic area, pulmonic area, ebbs point, tricuspid and mitral (apical).... her actions and explanations were good, then she listened with the stethoscope to detect the different sounds, here the student has to listen with the diaphragm (wide bit) firmly on the chest, then lightly with the bell (with our stethoscopes you have to turn bell around so you can hear. This student listened with both the diaphragm and bell without turning the bell, therefore she would not be able to hear the heart sound. I asked the student to explain what she had just done and could she tell me what the heart rate was using the bell - and she did. I was surprised that the student would lie outright - when I asked her to listen with the bell of the stethoscope and tell me what she heard - her eyes met mine, then her head drop, she held her breath and then said sorry -  it was the moment of realisation - its the oh F___K moment....her eyes dropped, the moment of shame. There was no need for me to say anything.... the student knew the impact and we all felt the disappointment. 


My question is whose principles are correct - I demand from you in the name of your principles the rights which I shall deny to you late in the name of my principles....Walter Lippmann.

So we are all on the same page, I'll start with Integrity - according to dictionary.com it means; adherence to moral and ethical principles, soundness of moral character and honesty. Ralph Waldo Emerson said "A little integrity is better than any career" and Oprah Winfrey said " For me real integrity is doing the right thing, knowing that nobody's going to know whether you did it or not".

This then leads nicely on to Principles again dictionary.com states an accepted or professed rule of action or conduct a person of good moral principles. Franklin D Roosevelt said "Rules are not necessarily sacred, principles are".

Finally veracity as per dictionary.com, means conformity to truth or fact, accuracy., such as, honesty, truthfulness, credibility and many more. Thomas Henry Huxley said, “veracity is the heart of morality”. I just love the word veracity..... it's not used much these days.

I wonder how many people get disillusioned with the lack of these very important principles in life? yes we all know the meanings of the profound words and probably all profess to abide by them, but do we truly do that? I challenge you to think about it.... why do people particularly leaders known for integrity and leadership engage in unethical activities?

Is it they think they won't get caught or believe that the elevated status puts them above the law? was this the first time they did something inappropriate, or have they been on the slippery slope for years and no one knows.....is it as simple as being in a situation where you have to make a choice between what is right and what is easy? remember the famous words from Martin Luther King Jr “The time is always right to do what is right”. 

Sometimes it is just much harder to do what is right, no one knows that better than Toni Hoffman the senior nurse who put her career on the line to expose killer surgeonJayant Patel in one of Australia's worst medical disasters - Queensland Health and the Bligh government had treated her "like a leper" since she blew the whistle.

Another person that springs to mind is Tiger Woods, no one expected his life would unfold to the public and expose such a degree of infidelity "Gone is the mystique that once surrounded him. His aura of invincibility has evaporated, leaving only the very human man where the red-clad, club-twirling superhero used to be".

John Edwards  former Senator of North Carolina  During his presidential run and wife's cancer battle, Edwards had an affair, fathered his mistress’ child, and lied about the mess. Sadly the list is endless.

Do you think it is ever justified to tell a lie? This is a question I always ask my students in my ethical lecture, and as usual its a split class, sometimes I have majority that say its OK to lie and other times the decision is reversed. Most students will agree they should not lie and it is good practice not to lie, but in reality this does not happen, often it has been a split second decision to lie.... and this can be detrimental as the domino effect of the lie takes place together with the inevitable consequences of the lie.. However most students also seem to accept that lying is a fact of life, and that there are many degrees to lying.

This attitude is highlighted in a A study in the Uk that showed  Lying, adultery, drug taking, breaking the speed limit, drink-driving, and handling stolen goods are all seen as more acceptable than they were at the turn of the century. Prof Paul Whitely,..... “It appears Britons are growing more and more tolerant of low level dishonesty and less inclined to sanction activities which would have been heavily frowned on in the past.” 

As a society, if trust is eroded this will lead to economic and social consequences. I think its time to enforce these basic fundamental principles of integrity and veracity as essential elements to maintaining a cohesive society.

"Public confidence in the integrity of the Government is indispensable to faith in democracy and when we lose faith in the system, we have lost faith in everything we fight and spend for".

(Adlai E Jr Stevenson)

Next time you are going to tell a lie, think twice and choose not to lie.

Choices Women Make in Childbirth

This is a short blog about a few conversations with several women regarding the choices they made for the birth of their babies....I was  in a shopping center promoting midwifery and chatted to some pregnant women.....  I’m sharing some of these conversations for two reasons; because the choices these women made blew me away and in light of the vigorous homebirth debates after the release of the SA coroner’s report where he suggested that women who have a high risk factors should possibly consider a caesarean section rather than a homebirth or words to that effect...... (which will be my next blog).

I have to note that the women concerned all had private health insurance and wanted to birth in a private hospital. First two women were 35 and 36 weeks respectively, they were having repeat caesarean sections. When I asked how they felt about their impending c/section Mary said “look I have accepted that is my reality”, I asked was she happy to discuss her decision and she said she was happy to share and talk about it.... she went on to say “my first section was an emergency.... when I was pregnant again we saw the same obstetrician and we were told the risk of the scar tearing was high and its best to have another section. I then said I would get another opinion..... You know, I could not find another obstetrician that serviced the private hospital that would do a VBAC.....and besides my husband did not want to take the risk and I have to consider his wishes,” I asked “did she know the risk was really low...as in 0.04%” and she said “yes, but my husband did not want to take that chance, I wanted to have my baby in a private hospital and did not want to go to a public hospital, so I accepted the second section, now its baby number 3 and that’s the choice I’ve made, it would of been nice to birth normally, but that’s the choice I made, I wanted to have my baby in a private hospital”.

Janie who was her friend had a similar story.... except this was her second section...she also knew about the risks involved regarding a VBAC but really did not mind having a section, again her main reason was she wanted to birth in a private hospital as opposed to a public one....

Sally was an older professional woman, 39yrs old first baby and elected to have a caesarean section, currently she was 34 weeks and was not interested in a vaginal birth, she said ‘I never wanted to give birth naturally, I want to protect my pelvic floor and besides it took me longer to get pregnant than I thought, don’t think I could deal with all that unexpected stuff, now I know the date my baby will be born.....’ her mind was made up – we did go to talk about breast-feeding to which she was not interested in, however we did manage to talk about skin to skin at birth for bonding and the possibility of expressing for the first few weeks and bottle feeding with  breast milk as an option.... I asked had she ever spoken with a midwife, her response was ‘I have private health insurance therefore I have a very good obstetrician.... and he does have a midwife I see from time to time....but he makes all the decisions....”

The last woman was 35 weeks booked for her repeat section at a private hospital – first section was an emergency, no VBAC offered and she elected for a section because her husband is a fly –in-fly-out and she wanted to plan his time off for the birth and this was the easiest way....she also did not want to birth in a public hospital....”on no I only go to private hospitals, that’s why I pay for private health insurance...”

Out of the 10 women I spoke to 5 were having elective sections, 3 were booked in secondary hospitals and another two for private hospitals and hoped for a vaginal birth but all knew about the chance of a caesarean section.... “if all goes well, I will have a vaginal birth..... we have discussed if the need arises we might have a section”.....

I must say the aspect that surprised me most was the desire to birth in a private hospital even if it meant having a c/section as opposed to birthing in a public hospital.....that puts a different perspective on some of the issues.....what is it that the majority of women want and is this the expected norm of place of birth?

Again I come back to the point of education and informed choice..... these women wanted to birth in a private hospital and how that happened did not matter, their main issue was the place of birth.....food for thought.

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 One World Birth: take some time and have a look