Sunday, July 20, 2008

Review of ACM Guidelines

The Australian College of Midwives (ACM) has published a draft of the revised National Midwifery Guidelines for Consultation and Referral (Guidelines)

Individuals and groups have been responding to ACM, and there has been discussion amongst midwives on email lists. In accepting the need for a systematic set of Guidelines, there is a hope that the professional identity of midwives will be enhanced, and that collegial relationships with other providers of maternity and newborn care (including doctors, nurses, midwives, and allied health), will be effective in providing the best options for each mother and baby. The need for Guidelines that deal with consultation and referral, and possibly transfer of care from a midwife led model to a collaborative, multidisciplinary team that is obstetrician led is clear in ensuring a seamless process for the woman and her baby when the need arises.

Anyone reading this blog will probably already realise that independent midwives are an endangered species. Midwifery in Australia is restricted to the point of near suffocation, and midwives who come to this country after working in other developed countries (incl UK, Canada, Netherlands, Denmark, NZ) are shocked at the lack of professional recognition in such basic matters as arranging routine blood tests, and access to oxytocic drugs. We face social and financial and professional exclusion. We can't get professional indemnity insurance. Although we are fully recognised as providers of maternity care, women who use our services have no public funding when a midwife provides the same service as doctors and hospitals provide. No equal pay for equal work!

Many midwives are paralysed by fear. It's not fear of adverse events in birth - it's a fear of what our colleagues may do if we dare to step outside the usual authoritarian system. It's a fear of being regulated and reviewed by people whose expertise is in nursing, not in midwifery. It's a fear of being misunderstood, and possibly losing our right to practice; our livelihood, over trivial disagreements with those who have power.

Our profession will never thrive until midwives are proud of our identity and our authority. The title 'midwife' is protected by law in all States and Territories in this country, meaning that a person who has not achieved and maintained a recognised midwifery qualification cannot call themself a midwife. Yet midwives themselves easily give away their unique identity, as the primary care provider who works in partnership with each woman, promoting normal birth, health and wellness for the woman and her family.

The following points have been made by a group of independent midwives, including several Victorian MiPPs, in our submission to the ACM.
  • We accept the Guidelines, with further ongoing refinement, as being a statement that guides midwives in decision making, particularly in the interface between primary maternity care, and collaborative care within a multidisciplinary team.
  • We accept the Guidelines as being a useful risk management tool for maternity service providers.
  • We express our concern at the potential for misuse of the Guidelines, affecting some models of midwife-led care. Midwives who are regulated and employed within authoritarian, medically dominated systems have experienced punitive action, apparently with the support of ACM Guidelines. We recommend that a statement be included in the revised Guidelines to protect the scope of practice of the midwife in all settings.
  • Although the revised Guidelines quote the ICM Definition of the Midwife (2005), we recommend that the Guidelines draw attention to the fact that the midwife’s duty of care now includes, since 2005, “the promotion of normal birth”. This change in the Definition is potentially useful to midwives who may consider that, in a particular professional situation, their advice and actions are consistent with the promotion of normal birth rather than strict adherence to a professional guideline.
  • We recommend that the phrase ‘evidence based’ be deleted, except where specific reliable evidence is quoted.
  • We recommend that the reference list be limited to papers or documents referred to directly in the document, and to current literature reviews that inform the midwife’s decision to consult or refer. If a paper is considered important enough to be included in the references, a referencing system such as footnote could be used to identify the reference, as in the Preamble.
  • We recommended that the word ‘support’ or ‘support person’ be removed from any ACM documentation referring to midwives as it devalues the midwife’s title which is protected by law throughout Australia.

[We welcome your comments on these points and recommendations. We will be meeting with ACM later this month to discuss our recommendations. Joy Johnston)

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