Monday, June 29, 2009

Maternity Service Core Competency Model

The public (that's you and me) have been invited to respond to a national draft document, 'Maternity Service Core Competency Model', which is being developed by an expert team described here.

There is a 20 page document pdf that sets out the core maternity competencies.
We are invited to complete a survey form which has nine questions with two areas for text entry.

The closing date for feedback is Tuesday 30th June.

Here's a comment left by the manager of this blog (Joy Johnston), in response to question 9. Would you like to make any other comments about the Maternity Service Core Competency Model?

The document explains collaboration (p3) from a service perspective - that no maternity service provider can work in isolation. This is true.
Yet the point that is not made is that primary maternity care for many women can be achieved, and is safely completed, within the competency and capability of the midwife who is primary care provider. In these cases, from a woman's perspective (woman centred care is the first over-arching aspect of the framework), the experience of maternity care is uniquely within the midwife's scope of practice.
I recommend that a statement to this effect be included.

This point may be obvious to many people, especially mothers who have experienced physiologically normal pregnancy and birth. Birth is not an illness. Pregnancy, birth, and nurture of the newborn infant are beautifully and wonderfully within normal healthy natural life processes.

The document under review states that "The underpinning philosophy of primary maternity services is that childbirth is a normal but significant physiological event and that different women have different needs in relation to pregnancy and childbirth." (p2) It continues, "One guiding principle of primary maternity services is to maximise "the potential of midwives, obstetricians, general practitioners and where appropriate other health professionals' specific knowledge, skills and attributes to provide a collaborative, coordinated multidisciplinary approach to maternity service delivery for women with normal pregnancy risk (reference given)." [emphasis added]

Discussion on midwife led models of care has frequently become bogged down over the meaning of collaboration and multidisciplinary approaches to maternity care.

The independent midwife who provides primary maternity care, employed privately by individual women, practises autonomously withing the midwife's scope of practise will collaborate with other maternity service provides if and when a complication or condition which is outside her competence or capability arises.

An midwife who provides primary maternity care as an employee of a hospital or health service is frequently required by the service to send women in her care for routine review by an obstetrician at intervals in the pregnancy. This is supervision, not collaboration.

This protocol has been introduced as part of a "collaborative, coordinated multidisciplinary approach to maternity service delivery for women with normal pregnancy risk" as recommended by the Australian Health Ministers Advisory Council 2008 (full reference in document under review p2).

The requirement for routine obstetric review in pregnancy of women with normal pregnancy risk is not based on evidence, and therefore does not meet the over-arching criteria (p5) for core competencies in maternity service provision.

Readers who have completed the survey form, or who wish to discuss issues raised above, are welcome to add your comments to this blog.

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