PROTECTING WOMEN?

"The Brumby Government recognises the importance of registering independent midwives in order to protect women who choose this maternity care option."

This statement appears in letters that are currently being received by people who write to the Victorian Health Minister, Daniel Andrews, with reference to the package of health 'reforms' applied to maternity services. Readers of this and linked blogs will appreciate the complexity of the changes that are only months away now, and the devastating impact these changes will have on midwives' ability to practise midwifery in our own right, and on women's ability to employ a midwife privately.

When I received a letter from Daniel Andrews with this statement in it, I paid little attention to it. I agree with statutory regulation of health professionals, including ALL midwives. The mantra, "protecting the public", can not be dismissed. Noone wants to see a health professional abuse their position of trust through either commission or omission. The various Acts and Boards that register and regulate health professionals' practice and education are an accepted and valued part of our society.


It was not until I saw another letter from Mr Andrews (attached - click to enlarge), dated 6 November 2009, in which the same sentence appears, that I considered it in another light.

It's not about registering midwives; it's about "registering independent midwives"

It's not about protecting the public; it's about protecting women who choose this maternity care option.

It's not about the general notion of statutory regulation in the public interest (which is what "protecting the public" means); it's a new level of government control in relation to "this maternity care option".

"This maternity care option" is homebirth with a privately employed midwife.

It is becoming more clear as time passes that "this maternity care option" will not exist lawfully in Australia after 1 July next year. The reform that is progressing through federal and state parliaments will not "protect women who choose this maternity care option"; it will protect the public FROM this maternity care option.

As has been demonstrated time and again, the outcomes related to planned homebirth with a midwife in this country and in other developed countries are exemplary. This fact seems to have been missed by the Minister. What is it about "this maternity care option" that he thinks he ought to protect women from? Is it the caesarean rate of under 10% for all women planning homebirth, compared with approximately 30% in the mainstream? Is it that women planning homebirth VBAC are very likely to safely achieve vaginal birth, compared with 20%-30% VBAC rates in private and public hospitals respectively?
[click here for more detail]


When the reform dust has settled it seems possible that a new hybrid "private midwife" may emerge. The Health Ministers have promised that their reform package will usher in a new era. This midwife is likely to resemble the obstetrician's handmaiden of the past: she will be required to work in collaboration with a doctor or doctors.

Collaboration with doctors is reasonable if a person (a midwife in this case) is supporting that professional in carrying out their professional practice. Collaboration with a doctor is reasonable if a doctor requires midwifery support in the care of an individual woman - as happens because doctors are far too busy to attend a labouring woman throughout the labour: that's the midwife's job.

A doctor is not educated in midwifery. It is not possible for a midwife to collaborate with someone who is not skilled in midwifery. It would be like requiring a dentist to collaborate with an orthopedic surgeon.


Readers who think I am being alarmist are welcome to leave your thoughts in the comments column. Joy Johnston

dear Ms Roxon

dear Ms Roxon
you have more than dampened expectation
you have sold out!
the agent of institutionalization
birth homogenization
increasing medicalisation
you have sold out!

you have sold out on women, responsible women,
rolling in their souls as they’re told to turn over
face to face upon the threshold of fate
in perfect season shall mothers move
instinctual as the sea, rising in swells

you have sold out on babies, innocent babies
stamped on arrival and sent to a future therapy
when life could begin with connectivity,
an hormonal shake, a firing of self
the triumphant love of making it!

you have sold out on fathers, husbanding fathers
bewildered by machines and expertly confusing jargon
men could march from history’s darkness
allied like earth to the clouds of their ladies
chest out upon a 3D engagement of the sacred

you have sold out on midwives, timeless midwives
subordinate to those with 15 minute timelines and pre-determined roads
when midwives could do the good work by just being there
‘women centred care’ is not an answer in a test
it’s what works best!

dear Ms Roxon
you have more than dampened expectation
you have sold out!
the agent of institutionalization
birth homogenization
increasing medicalisation
you have sold out!

dear Ms Roxon
our mobilization will not lie down.
the stirrups do not fit us.


[Viktor, November 2009]

birth statistics

I have looked at the new site mybirth.com.au.

It’s a furphie to think that looking at the statistics enables a person to make informed decisions. The data must be interpreted and applied to the individual in order to contribute to decision making.



I do not support informal collections of birthing data. I’m happy for a site like this to link others to the sites where reliable data collections are accessible, and I’m happy for people to write their analyses of this data, but always giving reference back to the initial source. No data collection is perfect, and we need to scrutinise it carefully.

When I go to a website I am concerned about the reliability of the information and the accountability of the people who manage the site. I need to know who is behind it, and what processes the owners have committed to to ensure that the information is correct and timely. It's a huge task, with the potential to be either very useful, or to contribute to misinformation.


I’m not trying to support or bag the Victorian government for its data, but it’s not true that Victoria does not release information. If you go to http://www.health.vic.gov.au/maternitycare/ you will find enough to study for as long as you have time. It’s not the simple numbers/percentages for each hospital, but it’s still very useful.

Independent midwives put our data up on this blog from time to time, and for some years we have published summaries in Birth Matters, the journal of Maternity Coalition. All midwives who send homebirth data to the government’s perinatal data collection unit receive a copy of the annual homebirth report, so you can ask any independent midwife to show you, and you can make copies. Each hospital also receives one of these reports that compares its own statistics with the data from the whole of the State.



The Victorian Maternity Performance Indicators are an amazing comparison between public hospitals – private hospitals are not given the same scrutiny, but are lumped together. We had a performance indicator analysis of planned homebirths for the past 5 years of data, and the outcomes are brilliant. Have a look at this blog.

One of the reasons the Victorian health department has not gone down the path of publishing simple outcome data is a concern that statistics can be skewed - not comparing like with like. So when the all planned homebirths in 5 years are analysed under performance indicator 'rules' the results become much more reliable and significant. This is the sort of result that should be trumpeted from the rooftops.

Joy Johnston

More from the rallies

Brisbane

Sydney

Our message is clear:

Midwives and the women who employ us CANNOT ACCEPT the medical dominance over childbirth that is now being written into the laws of this country. The requirement that was last Thursday slipped into an amendment to legislation before the Senate, to require midwives to work at all times in formal collaborative arrangements with doctors as a condition of insurance, is thereby a condition of professional registration. It is very likely that this amendment will pass through the Senate without resistance.

Midwives do consult, refer, and transfer care to doctors when clinically indicated, and with the permission of our clients. This is the essence of professional collaboration.

The problem here is that when legislation makes it a legally mandated requirement for one profession to collaborate (midwives) and there is no requirement on the other profession to participate (doctors) we essentially have one hand clapping. (thans Liz for that word picture!) That will enable doctors to say which midwives can be insured, register and practice and that isn’t acceptable. It will also enable a medical veto of women’s choices that doctors do not agree with.

The passing of this legislation will effectively extinguish the right of ANY midwife in Australia from practising to the contemporary scope of a midwife's practice, as defined by the International Confederation of Midwives, and accepted internationally by health and obstetric peak bodies. This means that midwives can only exist in a restricted practice zone. Apart from concerns around workforce and professional career options, the safety and efficacy of such a model of care cannot be assumed.


We understand that our PM, Kevin Rudd, is "unmoved by protests". Until this outrageous situation has been fixed, we must continue to:
WRITE LETTERS TO POLITICIANS
WRITE LETTERS TO EDITORS OF NEWSPAPERS
SPEAK ON RADIO CALL BACK
TALK TO ANYONE WHO WILL LISTEN
USE THE INTERNET EFFECTIVELY - EG COMMENTS ON BLOGS

RALLY at Werribee

[also see villagemidwife blog]

APMA Media Release

Australian Private Midwives Association
Contact: National President Liz Wilkes 0423 580585



Medical veto impacts women’s access to care: Women Rally.

The Federal government may stall on the blocks of its first major initiative in health as the reform of maternity services hits stumbling blocks and criticism. Women will rally around Australia tomorrow to ensure choices are not lost in the wash up.

Liz Wilkes, National President of the Australian Private Midwives Association, will join women and midwives outside Kevin Rudd’s electorate office in Brisbane. Women are seeking assurances that new legislation around private midwives registration and practice will not reduce options for care.

“Midwives are educated and regulated to provide care for pregnancy, labour and birth on their own responsibility under the International Confederation of Midwives definition of a midwife,” Ms Wilkes stated “Suddenly we are told that doctors control the ship and that doctors will be able to decide who can do what.”

Legislation due before the Senate was amended on Thursday by the Government to require midwives to work at all times in formal collaborative arrangements with doctors as a condition of insurance. Doctors will be able to veto these arrangements effectively giving the medical profession the ability to control which midwives can be insured and register.

“The reform of maternity services is the first test of the Governments health reform agenda. It looks like the medical lobby may stall these reforms before they even get started.” Ms Wilkes said today “Placing one profession at the complete mercy of another for registration makes a mockery of professional regulation in this country.”

Women at the centre of the scuffle are concerned that the amendment may erode rather than expand choices as doctors make decisions about what types of care to support. Many choices such as homebirth, vaginal birth after caesarean and care in rural areas may be lost if doctors do not form the formal agreements with midwives.

“For the midwives who are currently self-employed it is no longer a matter of referring a woman who needs care to the appropriate person. Formal agreements with doctors will determine which of these educated, experienced and skilled midwives can actually register.”

Ms Wilkes added “Regulators should control midwifery professional standards, not how a doctor feels about a particular midwife. This takes midwifery back 50 years.”
Women are worried about the choices in birth and are calling on the Prime Minister to make sure that in implementing this first serious reform in health, options for choice are not lost.

Women rally at 10.30am November 9 at electorate offices of Kevin Rudd Brisbane, Julia Gillard Melbourne, Tanya Plibersek Sydney and Stephen Smith Perth.
Contacts: Liz Wilkes 0423 580585 (Brisbane and national) Marie Health 0407266004
(Sydney)Sally Westbury 0422 894 496 (Perth) Clare Lane 0416 130291 (Melbourne)

MIPP Calling Card to Julia Gillard

Deputy Prime Minister, Minister Roxon is not listening!!!

Midwives ALREADY provide safe care yet she continues to submit to the AMA demands.
MIDWIVES do not need medical supervision or permission to care for homebirthing women!

Babies born at home had similar Apgar scores to babies born in hospital. Less than 3% of babies born at home required admission to the special or intensive care nurseries compared to hospital born babies at > 15%.

Medical Observer, 6th November 2009:
"The amendments to the nurse practitioner legislation will come as welcome relief for doctors…AMA vice-president Dr Steve Hambleton, who sits on the Government’s Nurse Practitioner Advisory Group (NPAG), said the crucial amendment would ensure nurse practitioners were not supported to work in competition with doctors."
The amendments to the legislation will also apply to midwives.

The safety of women & babies is clearly not the Health Department's or the AMA's main priority. They care more about the perceived potential loss of income & loss of control over a woman’s basic right to choose how, where & with whom she gives birth.
[Calling Card prepared by Andrea Bilcliff]

Reminder: RALLY ON MONDAY

Monday 9 November 2009 from 10.30am (local time)


Rally points:

Brisbane:
Prime Minister
Kevin Rudd’s office
630 Wynnum Road
Morningside Qld 4170

Werribee:
Deputy Prime Minister
Julia Gillard’s office
Shop 2, 36 Synnot Street
Werribee Vic 3030

Sydney:
Minister for the Status of Women
Tanya Plibersek’s office
111-117 Devonshire Street
Surry Hills NSW 2010

Perth: at 11.10am Perth Only
Office of Stephen Smith (most senior Gov member in WA)
953A Beaufort Street
Inglewood WA 6932


If you are unable to attend, please prepare your 'calling card' - a letter to Kevin, Julia, Tanya, or Stephen (or another member of the government), telling them who you are and why you can not accept maternity reform which prevents midwives from practising midwifery in their own right, and prevents women from giving birth in their homes with their chosen midwife attending them. Please email your letter to your midwife or someone else who is going to the rally, and ask them to give it to the MP concerned.

Anyone who would like their calling card to appear on this blog, please email it to joy@aitex.com.au

NOTE:
I want to encourage midwives to go to the rally, and to make sure your banners and calling cards state clearly that you are not happy with what this reform is doing to you – as a midwife.

The midwife’s livelihood is at stake, and we need to be heard. The whole profession of midwifery stands to lose our right to practising on our own authority in any setting.

Excerpts from Julia Gillard's speech to midwives in 2005

I hope you will enjoy hearing the Deputy PM saying that she is concerned that midwives have:
“limited opportunities to practise as primary carers and provide continuity of care to women”
and
“Unless and until the Government is shocked and shamed into realising that Australian women … blahblah”
and
“I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system”

Sounds familiar, doesn’t it! Perhaps Julia needs to be reminded of what she said before the Australian people voted Labor into office.

Joy Johnston


Midwifery By The Sea - Riding The Waves Of Change

Speech - ANNUAL CONFERENCE OF NSWMA

20th October 2005


Julia Gillard

[These are excerpts from the speech]

Thank you very much for your invitation to join you here today at your annual state conference by the sea.

…

The best start in life

It will not surprise this audience - I'm sure you will all agree - if I now say that I see the pregnant woman as the best focus for early intervention.

Between us we could draw up an impressive list of perinatal programs that would boost the health of the mother and her baby, and improve outcomes, and give all our kids the best start in life.

Obstetric services and workforce shortages

In the middle of this is the big event - the birth.

I know that midwives - as a group and individually - have strong ideas about what should be provided in terms of birthing services.

But shockingly, it is increasingly the case that for some women the idea of having a choice of birthing services and having continuity of care throughout their pregnancy, the birth and in the post-natal period is an impossible luxury - not just unaffordable, but unobtainable in their local area.

…

The shortage of midwives is also a problem. The Australian Health Workforce Advisory Committee estimates a current national shortage of 1850 midwives, and this is expected to increase over the remainder of the decade.

…

Midwives face additional concerns about the lack of professional recognition as well as limited opportunities to practise as primary carers and provide continuity of care to women.

The need for a concerted approach

Clearly this is no time for turf warfare between doctors and midwives, but it is time for all health care professionals involved in delivering obstetrics care to mount a combined attack on the Howard Government to force them into action to address this situation.

Unless and until the Government is shocked and shamed into realising that Australian women are now scrambling to find the birthing centre of their choice, and in some cases scrambling to find any professional who will deliver their child, the situation will not improve.

It seems to me that we need a variety of solutions to fit all the circumstances that arise. There is no 'one size fits all' way to solve the problems that present so differently in metropolitan Sydney, the isolated community of Wilcannia, the growing town of Byron Bay and the multicultural suburbs of Western Sydney. The one common factor is the pregnant woman and her child - they must be at the centre of the solution.

… I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system.



We need to realise that potential so that mothers have real choice in their birthing experience, and their babies have the best start in life.



This is one of the best investments we can make in the future of our nation.

Midwives/ Nurse Practitioner Amendment

THE HON NICOLA ROXON MP
MINISTER FOR HEALTH AND AGEING

MEDIA STATEMENT – 5 NOVEMBER 2009


Midwives/ Nurse Practitioner Amendment




The Minister for Health and Ageing, Nicola Roxon has today circulated an amendment the Government intends to introduce into the Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.

This amendment makes clear in the legislation something that was articulated both on introduction of the Bill to parliament and in the explanatory material tabled at that time.

Following requests for clarification, this amendment will simply clarify in legislation that collaborative arrangements with medical practitioners will be required to access the new arrangements.

The details of these requirements will be specified in subordinate legislation following the ongoing consultation with the professional groups.

These bills are a key plank of the Government’s 2009/10 Budget commitments which recognises for the first time the role of appropriately qualified and experienced midwives and nurse practitioners in our health system.

The Minister for Health and Ageing said today “I thank the doctors, nurses and midwives for their constructive engagement to date to ensure these new opportunities for nurses and midwives are implemented in an integrated fashion for the benefit of patients.”

For more information contact the Minister’s office on 02 6277 7220

NOT HAPPY KEVIN! NOT HAPPY JULIA!

RALLY - outside the offices of Kevin Rudd and Julia Gillard
Homebirth: My Birth, My Choice
Monday 9th November 2009 10:30am

As a result of the mess that maternity reform has become and the unclear but seemingly very poor options for homebirthing women, Homebirth Australia and Home Midwifery Association are hosting a rally outside Kevin Rudd's electorate office in BRISBANE, and outside Julia Gillard's office in WERRIBEE.

Other groups are invited to join the rally to make this the beginning of a very clear election campaign.

Homebirth: My Birth, My Choice

Kevin Rudd and the Labor Party is no friend of homebirth, not even midwifery it seems.

Kevin Rudd's electoral office
630 Wynumm Road
Morningside

Julia Gillard's Werribee Office:
Shop 2, 36 Synnot Street
Werribee Vic 3030
Email: Julia.Gillard.MP@aph.gov.au


Women, children, men, families, friends who support choice in birth, including homebirth with a private midwife.

Bring a 'calling card' to drop off, letting our Prime Minister and his deputy know that women want choice in childbirth and this includes the choice to hire a private midwife to birth at home - insured and funded. The calling card should be an A4 piece of paper (can be larger or smaller) with your name and address, concerns, experience, suggestions and a request for a response from Kevin Rudd and Julia Gillard about this important issue.

The rally and is supported by Homebirth Australia, the Home Midwifery Association (Qld) and Maternity Coalition.

More info

HBA: Justine Caines justine.caines@gmail.com 0408210273

HMA: Kirsten Adams adamskirsten@hotmail.com

Queensland passes national registration Bill

News article from the MEDICAL OBSERVER

Queensland passes national registration Bill
Elizabeth McIntosh - Monday, 2 November 2009

CONTROVERSIAL legislation that gives governments greater control over medical training standards has begun its national roll-out.

The Health Practitioner Regulation National Law Bill 2009 passed through the Queensland Parliament last week, and will now be used as a template by all other states and territories. ...

AMA president Dr Andrew Pesce said the Queensland Government had failed to take into account the association’s concerns.
“The AMA believes the Queensland Parliament is handing the other [states and territories] a flawed and ineffectual Bill,” he said.

Since it was first proposed, the national registration and accreditation scheme outlined in the Bill has generated much concern among medical groups. The AMA previously lobbied for the legislation to incorporate a ‘public interest test’ that health ministers would have to meet before altering standards, however the amendment was not supported by the Government.

The only concession given was that health ministers would have to consider the impact that any changes would have on the quality and safety of health care.


[NOTE: This is the Bill that has made professional indemnity insurance mandatory for all registered health professionals, at the centre of the threat to the very existence of private midwifery practice for homebirth. As has been discussed here and elsewhere, midwives have been granted a 2-year exemption from indemnity for attending birth in the home.]