Monday, November 23, 2009


"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

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