Thursday, August 28, 2008

conferences coming up in October

Here's some free publicity for a couple of reasonably-priced conferences in Melbourne, that midwives should enjoy. I haven't worked out how to attach a .pdf file to the blog, but you can follow the link or contact by email.

Having a baby in Victoria to Future Directions and beyond
Friday 31 October, organised by Maternity Coalition (follow this link for brochure and bookings) Presenters include midwives Liz Chatham, Pat Brodie and Nicky Leap; sociologist Kerreen Reiger; researcherRhonda Small, and obstetrician Euan Wallace.
Note: Consumers who would like to attend this symposium can apply for a specially reduced fee, made possible with a grant from the Department of Human Services.

Emerging issues in pregnancy, birth and postnatal care
Thursday 9 and Friday 10 October, organised by The Women's. To request a flyer, contact Tel: 03 8345 2147
This two-day seminar has many of Melbourne's leading maternity academics and midwives presenting the current evidence and debate on topics including caseload midwifery, diabetes, breastfeeding, caesareans, postnatal care, length of stay, and much more.
Note: Homebirth is notably absent from the list of topics. Victoria is a little behind other States.

Saturday, August 23, 2008

"But whose art frames the questions?"

In light of the recent discussions around guidelines, I was reminded of Maggie Bank's article "But whose art frames the questions?".
Maggie writes:
Midwives need to be vigilant to ensure the defining of appropriate midwifery practice has not been colonized by obstetric thought. Any guiding must reflect the essential Midwifery Model of Care in the evidence amassed and the way in which it is applied. ...

Whilst the discussion is centred around the NZ scene, it is applicable to our conditions also. Maggie's thoughts are well worth considering.


Gaye Demanuele

Saturday, August 16, 2008

Looking for a homebirth midwife

[Photo: MIPPs meeting with Shared Care coordinators at the Women's]

We received an email from a mother who I will call Tammy (not her real name), who was trying to find a midwife who would attend a homebirth from 35 weeks gestation. Tammy explained that her first child was born at about 35 weeks, weighing 2.3 kilos, after spontaneous onset of labour. The baby had no difficulty breathing, and fed well at the breast, and maintained body temperature well (three of the possible challenges that premature babies face). The only treatment the baby required while in hospital was phototherapy for jaundice, with "lots of love and care from mummy in nursing __'s poor bruised heels from all the blood tests".

I expect that anyone who reads this blog will recognise that the accepted range for 'Term' or maturity is 37 to 42 weeks. A baby born at 35 weeks is 'premature'.

Midwives who ignore well established standards do so at their own (professional) risk, and are possibly also putting the mother and baby at extra risk. The safety of homebirth internationally has been established in the normal birthing population. If homebirth midwives are holding themselves out as being practitioners in prematurity, twins, breech, and other clearly complicated births we are on very thin ice. A baby born spontaneously at 35 weeks may actually be mature, and this will be recognised soon after the birth. But even an apparently minor intervention such as blood tests and phototherapy for bilirubin are in many of these little babies considered essential for the baby's wellbeing.

By definition the midwife's duty of care includes "preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other approtpriate assistance and the carrying out of emergency measures." (ICM 2005

The Australian College of Midwives has recently undertaken a review of its National Midwifery Guidelines for Consultation and Referral (see blog posting 20 July 08). We (MIPP) have engaged in that review, in seeking to achieve a document that
will enable "the midwife to integrate evidence with experience (clinical judgment) in providing midwifery care; and to assist midwives in their discussions with women." (from the draft)

Following Tammy's email several MIPPs replied, seeking the opinion of their peers on this matter. The clear consensus from those who replied to the group was that we state that from 37 weeks is the usual time after which we are happy to attend birth in the home, and would consider the individual situation in the 36-37 weeks period. Of course in this instance the midwife could say yes now, knowing that it's likely that this baby will not be born pre-term. They may even have to have the discussion about postmaturity!

There is no fixed protocol for independent midwives in attending homebirth. We are independent in professional decision-making, and we are accountable for all decisions we make.

The ACM Guidelines are a guide, but should not be seen as prescriptive. Some independent midwives will agree to plan homebirth that carries a degree of potential complication with the belief that the woman will be better attended than unattended, or forced into a potentially harmful situation. That level of decision making requires an understanding of the responsiblities and rights of both the mother and the midwife. It is not a simple matter of booking a midwife who will agree to a particular issue, such as homebirth for a premature baby.

The midwife's selection criteria and guidelines for referral do not prevent the woman from making an informed decision, for her own reasons, which contradicts the midwife's advice. That's a very different situation from the one in this instance, when the mother is seeking a midwife who will agree from the start to working outside standard guidelines.

A wise midwife will encourage Tammy to talk about what she wants, and will use the discussion as an opportunity to explore informed decision making, personal autonomy, and the responsibilities of the midwife. Independent midwives may have greater scope than those employed by hospitals to work in a partnership with each woman, but a midwife cannot simply ignore basic guidelines or professional standards.

Joy Johnston