Monday, June 22, 2009

carrot and stick approach

It's a brilliant strategy - particularly when working with donkeys.

The carrot is the 'promise' of extended practice, namely Medicare and prescribing rights, WITH indemnity insurance - removing some of the big restrictions that Australian midwives have struggled under for as long as any of us can remember. There's no 'promise' of access/practising rights for independent midwives in maternity hospitals, although that is implied. My memory goes back far enough to remember our efforts in the 1990s, when we DID have indemnity insurance. The big doors at the hospitals were securely shut to us then, and I haven't seen anything that makes me believe it will be any easier next year.

The stick is the clear statement in the draft legislation (see the previous entry in this blogsite) that a midwife will face disciplinary action if she engages in professional activity for which professional indemnity arrangements are not in force.

[Anyone who wonders if they would not mind disciplinary action - would just speak the truth without fear - perhaps you should speak to someone who has experienced it. The time and emotional effort demanded by the process, even if the complaint does not go to formal hearing, can be very draining.]

In a recent email discussion forum an experienced midwife colleague suggested that a new group be formed: a grassroots group set up specifically to protect homebirth. A group of guardians of the birthing woman and child. Midwives who can no longer practise the most basic and legitimate form of midwifery.

It appears that those midwives who are currently self employed, as well as those who are on extended leave from midwifery (such as maternity leave) will be registered as ‘non-practising’ midwives until we have insurance, (or, get a proper job).

I don’t look forward to disciplinary hearings, and will do all I can to avoid them, but imho that’s better than handing it all over to the police. As noted above, I expect that the carrot that will make many midwives toe the line is the ‘hope’ of being ‘eligible’ for the insurance, Medicare and prescribing when that is brought in. This will be particularly significant between 1 July, when the requirement for indemnity is enforced, and 1 November next year, when we anticipate the government's new indemnity plan for midwives to be available.

Will some midwives engage in civil disobedience?

Going underground, even with the possibility of disciplinary action if someone notifies the registration Board, may be the best option for those midwives and women who choose to continue to plan homebirth. It's not the first time authorities have set unreasonable rules that cannot be accepted by people with integrity. A skilled midwife who agrees to attend a labouring woman in her home will advise the woman appropriately if complications arise.

Going underground is not a long term strategy. It does not offer a solution in any sense of the word. It simply delays the inevitable. Home birth with a private midwife faces obliteration - extinction - annhialation.

There is a great deal of apathy in the midwifery profession. It appears that many of the influential midwives and nurses in this country believe in their hearts that there is no place for home birth in Australia. Is this through fear or ignorance?

I am challenging all midwives to stand up for MIDWIFERY. It's not about standing up for homebirth. I believe that the profession as a whole (not just independent midwives) should be objecting to our government's uninformed intrusion into the midwifery profession’s scope of practice, as defined internationally by ICM, and agreed to by all relevant peak bodies. Midwives practise midwifery in all settings, including the home. Birth is part, but not all, of midwifery. The setting for birth is a professional midwifery decision, made in partnership with the individual woman, and is not open to government fiddling.

Get real! My colleagues remind me "If we had the support of the midwifery profession as a whole, this wouldn’t be an issue! Imagine if ALL midwives threatened action in support of protecting the rights of birthing women and their own right to practice as midwives. The Government would soon find a way to resolve the issue…"

And where are the midwifery students, young and strong, waving placards??? A student commented: "The student body should be threatening action, but aren't. There is such an apathy amongst the majority of midwifery students."

So what can we do right now?

Stay well informed - join email groups, read and comment on blogs, read professional emails, newsletters and journals

Keep the issues in the public press - call in to radio talkback shows, send articles to local newspapers, write your own blogs and websites

Plan to attend the HBA Homebirth Rights Rally in Canberra September 7th, where you will be able to wave placards and demonstrate how important homebirth is to midwifery.

1 comment:

Janie said...

Thank you Joy for your words of wisdom. I have forwarded this to my work place and will see if we can't rouse a response of solidarity. Unfortunately I do not expect there will be much, but for me I have to respond. I will be writing my angry letters, they reflect me and how I feel about this. I think any one who feels moved by this circumstance should not feel they need to be censored, I think we have been reasonable and played nicely for long enough. I will be taking the family to Canberra and look forward to standing up for what is every womans right and what is a midwifes capability to be a midwife.
Spirited and defiant
Janie