Wednesday, January 28, 2009

Inquiry into Public Hospital Performance Data

The Victorian government's Standing Committee on Finance & Public Administration is undertaking an Inquiry into Public Hospital Performance Data

Terms of Reference
"To inquire into and report on the capacity of hospitals to meet demand, standards and quality of care, resourcing and access levels, and the accuracy and completeness of performance data for Victorian public hospitals."

Submissions are being made available via
(Link to submissions)
Public Hearings are proposed for early 2009.

A submission has been made, applying the questions of this inquiry to homebirth, and particularly the need for Victorian publicly funded materntiy services to offer the option of planned homebirth. For further detail of the submission see
In summary:

• The capacity of hospitals to meet demand, standards and quality of care (TOR#1) for women planning homebirth is a matter that is not difficult to manage. In fact, the introduction of homebirth programs into public hospitals will free up staff and beds for those who need to be in hospital.
• The resourcing and access levels (TOR#2) of public hospitals to provide back-up arrangements for women planning homebirth can readily be managed within normal resourcing arrangements.
• TOR#3: there is a high standard of accurate and useful data in respect to the performance of midwives attending home births, and for hospitals to which women planning homebirth (approximately 20% of the group) are transferred.

A copy of the submission has been sent to Shadow Minister for Health, Hon Helen Shardey.

Thursday, January 22, 2009

A woman's choice???

The following message has been shared with the permission of the (unidentified) midwife who wrote it.

"Just to let you know that I received a first and final warning for the waterbirth that occurred at [hospital] in December. Knowning in my heart that I had done nothing wrong, and the woman is rapt with her birthing experience, is reassuring but I am just left sooo angry at how the whole ordeal was conducted.

"A number of comments that were made to me which have left me hurt and offended. The Don and our unit manager are not midwives so I FELT I had little support. I was told that our governing body and codes and competencies were "airy fairy". When I asked about the woman's chioce I was basically laughed at and said that in an institution we can't afford to be led by what patients want.

"They mentioned homebirths three times in both interviews, which made me cross. In the second interview I stated to the DON that I started to think that this was a personal attack as I know that the obstetrician knows I do homebirths, and she said that they quashed that theory very quickly! So unfortunately there were no congrats in the office. What makes it soooooo good though is that woman is rapt with her birth experience. She came up to me afterwards, gave me a big hug and said that she and her husband had been talking and he mentioned about the amount of money they had spent on the obstetrician and she said that it was all worth it just to have you, []. I have one rapt woman, who is empowered, feels great and intact!!! I just wanted to tell you what had happened."


Midwives who attend homebirths should have received the new updated version of the Parent Pack.
There are important changes to the Newborn Child Claim form and other information.
Midwives who have not yet obtained copies of the updated version can order them (in boxes of 15) through Centrelink's telemarketing office.

Thursday, January 15, 2009

National Registration for Health Professionals

[From Australian College of Midwives Member e-bulletin, January 2009]

There is not a more exciting time to be a Midwife in Australia. On 1st July 2010 National Registration in commencing for all midwives in Australia. This will mean that you will register with the soon to be formed Nursing and Midwifery Board of Australia body instead of your local state nursing and midwifery Board. There is going to be a lot of written communication coming your way about the processes involved, so stay tuned.

Details of the new scheme are still being worked out by state and federal government officials. But it seems likely at this stage that there will be some new requirements associated with the national registration scheme for all health professionals. These include:

· Providing evidence of Continuing Professional Development- MidPLUS provides a framework for you to do this.

· Completing a minimum number of hours of Continuing Professional Development - again, MidPLUS helps you to keep track of these hours.

· Participating in an annual professional review of some kind - Midwifery Practice Review can be an option that you choose.

· Signing a Statutory Declaration stating that you are competent to practice

· Completing a minimum number of Practice Hours - exact number to be confirmed.

The Nursing and Midwifery Board of Australia will be responsible for managing all of this for midwives. It is being created on 1 July this year. The Board will make decisions before the scheme gets underway on 1 July 2010 about all of the above details. It will also have responsibility for managing a separate register or division for midwives. It will become possible for the first time for midwives to register as midwives and not as nurses if they wish to do so. It will also be possible for individuals to maintain registration on both a nursing and a midwifery register, but people who do this will need to meet both sets of competency and other registration requirements (but will probably pay only one fee).

Sunday, January 11, 2009

Opposition to maternity reform

The Australian has published Doctors firm against role of midwives, written by Adam Cresswell, Health editor | January 10, 2009.

"OBSTETRICIANS have stepped up their counter-attack against a push to give midwives a bigger role, claiming dire consequences will result if a federal review recommends allowing midwives to practise with inadequate medical supervision.

"With the federal health minister, Nicola Roxon, already on record as indicating some sympathy for the midwives’ pitch, specialist doctors say the Government should first consider what they claim are the ‘‘harmful effects’’ experienced in New Zealand, which moved to a midwife-led system in 1990.


Please follow the link to this article.

The need for reform of maternity services throughout Australia has been well established. Midwives are not interested in competing with GPs or obstetricians for medical or obstetric-surgical work. We simply want to be able to practise midwifery. And we expect to practise midwifery without medical supervision. Doctors do not know midwifery; midwives do. We collaborate with doctors when appropriate, in providing the best package of care that is suitable for each mother-baby pair.

The spokesman for obstetricians is Rural NSW obstetrician Pieter Mourik. He has been the spokesman for NASOG for many years.

Dr Mourik, who has retired from his obstetric practice, has established a national locum practice for obstetricians. The need for obstetric services in rural towns is undeniable, and Dr Mourik's initiative must be greatly valued.

Yet the other obvious fact is that midwives are also a scarce and valued community resource. Midwives who can practise the whole scope of midwifery.

Calls by midwifery organisations, and individuals, for reform of maternity care in Australia have in no way devalued the obstetrician or GP. Doctors cannot provide effective maternity services without the support provided by midwives, nurses, pathologists, physiotherapists, and all the complex teams in hospitals. The group of women for whom these services are appropriate are those with complications - a minority part of the spectrum within maternity consumers. The larger group of pregnant and birthing women and their babies are well: they do not need medical intervention.

A midwife who is providing primary care for a woman is expected to be constantly vigilant, and to collaborate with doctors and hospitals when complications arise or are suspected.

Midwifery in Australia today is a profession that is at a watershed. Either we will continue within the stiflingly restrictive environment of virtual medical supervision, or we will move into a new and exciting era of professional freedom. The former option will, I believe, lead to continuing escalation of the rates of surgical management of birth. The latter offers the only hope for midwives to become confident in our professional identity; promoting physiologically normal birth; and collaborating with other maternity service providers to achieve the best outcomes for all mothers and babies in our care.

Joy Johnston

Saturday, January 3, 2009

Newspaper articles

Midwives and maternity consumers are welcome to forward any comments on these or other published articles, to appear on this blog.

SMH 3 January 2009, by Julie Robotham Public hospitals vs private: the painful truth about childbirth

An interesting piece has been published by the Daily Telegraph, NSW, from Sue Dunlevy, Canberra Correspondent 'Robbing Sick as birth fee rises'

My response has been sent to the Editor:
I am a self employed midwife, meaning that in order to make a living I compete with obstetricians and public maternity services, working in the most anti-competitive sector of public health. Midwives are fully qualified to be *primary* maternity care providers, as opposed to obstetricians who are *specialist* maternity care providers, and may not be skilled in promoting normal birth.

It is not easy to make a living this way, as there is no public funding at all for women who choose a midwife as their primary maternity care provider. A midwife's fees don't even get considered in the 'safety net'.

The inequity of Australian health funding through Medicare is so obvious, yet no government has been prepared to do anything about it. It's a huge con. The emperor HAS no clothes. We pointed the fact that obstetricians were "ripping off the system'' to Mr Abbott when he was health minister, without any apparent effect. I am hoping this anti competitive monopoly will change.

Joy Johnston

Friday, January 2, 2009


Midwives, it's time to plan some continuing education (if you haven't already done so). Excellent and reliable programs are available from both Capers and Birth International, and coming to Melbourne in March. Please check the links below for details, and for dates in other cities.

Future Birth 2009: "Making a difference"
26 March

Midwifery Update: Women, Midwives, Risk and Decisions 14 March

Thursday, January 1, 2009

New year's greetings, and some holiday reading

The New Year 2009 has come, and I would like to wish all readers of this blog a safe and wonderful year. As those who come to this blog are likely to be in the baby business, either as parents or practitioners, I also wish you many happy birthdays (and nights).

For good online professional reading material, as well as video blogs, you can go to the Medscape Women's Health site. Medscape is a free online service that includes the option to sign up for regular email newsletters. This week's articles include Vitamin D Deficiency Linked to Greater Risk for Primary Caesarean Delivery.

"December 23, 2008 — Vitamin D deficiency in pregnancy is associated with increased odds of primary cesarean delivery, according to the results of a study reported in the December 23 Online First issue of the Journal of Clinical Endocrinology & Metabolism.

"At the turn of the 20th century, women commonly died in childbirth due to 'rachitic pelvis,' " write Anne Merewood, MPH, IBCLC, from Boston University School of Medicine in Massachusetts, and colleagues. "Although rickets virtually disappeared with the discovery of the hormone 'vitamin' D, recent reports suggest vitamin D deficiency is widespread in industrialized nations. Poor muscular performance is an established symptom of vitamin D deficiency, [and] the current US caesarean birth rate is at an all-time high of 30.2%."

"The objective of this study was to determine the relationship between maternal serum 25-hydroxyvitamin D [25(OH)D] levels and the rate of primary cesarean delivery.

Is this possibly another contributing factor in the high, and continually increasing, rate of caesarean births in Australia?

Medscape also gives links to online journals such as J Midwifery Womens Health - a valuable resource for ongoing learning for midwives.