Wednesday, December 23, 2009

homebirth with public hospital funding in Victoria

This news appears in The Age thismorning.

Home-birth boost for expectant mothers

December 23, 2009

VICTORIAN women will be able to give birth at home - with hospital back-up for the first time - under a pilot project starting at three hospitals next year. [... continued]

"with hospital back-up for the first time" NO! Victorian women planning homebirth have had hospital backup arrangements for as long as anyone in the business can remember.

with hospital/government $$$ (Mother does not pay any fee) for the first time YES

* Some women who have previously not been able to afford the cost of homebirth with a private midwife will now be able to access this service through their local hospital, if they live within reach of Sunshine in Melbourne's Western suburbs, or Casey, in Melbourne's outer South-Eastern corridor.

* Some midwives who have not been able to work independently in private practice will be able to access this service, and extend their practices, providing primary maternity care for individual women (caseload) through their local hospital, if they live within reach of Sunshine or Casey hospitals.

This homebirth service is a pilot scheme, which means the scheme will be evaluated before a decision is made to continue it or cancel it. The newspaper article (I haven't been able to find a press release from the Department yet) tells us that it's a one-year pilot, that would provide services for about 50 women at each site. That's a caseload that two midwives could easily cover, working part time for the pilot, and taking some private bookings at the same time.

"A regional health service will also participate, but the Government has yet to decide which one." - we will let readers know as soon as the news is available.

Thursday, December 17, 2009

A quiet backflip

A letter from the Health Minister, received only yesterday, has been posted on the Senate Community Affairs Committee site. Click on the image to enlarge it, or go to the committee site.

While many readers will be pleased to read this message from Nicola Roxon, that " ... I am persuaded that it is not necessary or desirable to proceed with the collaboration amendments.", there are many questions that remain unanswered in this botched attempt at maternity reform.

"However, after further consideration of the issues raised by stakeholders in relation to access to professional indemnity insurance and subsequent registration under the National Registration and Accreditation Scheme, I am persuaded that it is not necessary or desirable to proceed with the collaboration amendments to the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009."

Senate hearing today

The Senate Inquiry into the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills is being undertaken today.

To listen to the live webcast from 9am click here or here if that doesn't work

Submissions are online

As a result of stakeholder pressure, Health Minister Nicola Roxon has informed inquirers that the amendments will not proceed. In a letter dated 8 December 2009, Minister Roxon states:
“However, after further consideration of the issues raised by stakeholders in relation to access to professional indemnity insurance and subsequent registration under the National Registration and Accreditation Scheme, I am persuaded that it is not necessary or desirable to proceed with the collaboration amendments to the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009.”

This fact has been reported on by Family First Senator Steve Fielding in a press release

The silence of the government, prepared to do a quiet backflip, and hoping that noone in the media will pay any attention, is noted.

Tuesday, December 15, 2009

19 midwifery academics speak out in Crikey

Midwives damn AMA-induced amendments to maternity reform
by Professor Lesley Barclay and Professor Sally Tracy

Senior midwifery research academics, including 19 professors and associate professors of midwifery, have signed an open letter raising serious concerns about the newly proposed amendments to Health Legislation (Midwives and Nurse Practitioners) Bill and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill.
... Crikey

Friday, December 11, 2009

Report on Stakeholder Forum

MiPP was represented at the meeting in Canberra yesterday, as a stakeholder providing input to the National Health and Medical Research Council (NHMRC) in its task of developing multidisciplinary guidance for collaborative maternity care arrangements.

The 'guidance' is to support the new legislation enabling midwives to access MBS and PBS in November 2010. I am not sure what's the difference between guidance and guidelines.

Questions put to the invited stakeholders were:
1. How does collaboration work now?
2. What does/can collaborative maternity care mean?
3. What are the essentials?
4. How do you create and maintain collaboration?
5. What are the opportunities to review and monitor collaboration?

This meeting was funded by the taxpayer through NHMRC. Celebrity host Norman Swan acted as facilitator. The 'guidance' that will be produced as an outcome of this meeting will not have any power in the laws governing midwifery practice.

Participants were seated at round tables. Places had obviously been carefully appointed. Midwives, consumers, obstetricians, academics, GPs, paediatricians, and bureaucrats were mixed and matched in an interesting way. I was positioned next to a previous head of RANZCOG, and a young female GP Obstetrician from Tasmania. Also at my table were a couple of very articulate consumers, one of whom had a delightful baby with her, the CEO of the Commission on Safety and Quality in Health Care, and a privately practising midwife from Sydney. Ann Catchlove, who was representing Maternity Coalition Victorian Branch was placed next to Dr Andrew Pesce, also known as Mr 3am.

Many conversations ensued about the questions of the forum, as well as other issues. Although the 'h' word, 'Homebirth' was not the topic of the day, it was mentioned frequently. So many people giving their time to discuss a matter that affects a tiny proportion of midwives and births.

A large Discussion Paper had been distributed for pre-reading. This document attempted to tease out the arguments, and referred to its review of the literature, without quoting references, and its 'consultation comments' some of which could have come from the DoHA tea room or corridor.

An attempt was made to identify principles that define collaboration in maternity services. The principles, which will probably be further refined, include (not necessarily in order of importance):
[comments and discussion are welcome]
1. Care must be woman-centred, culturally responsible, acknowledging a woman's right to autonomy, as well as the rights of professionals, and be coordinated according to the woman's clinical need.
2. evidence informed care appropriate to the local environment.
3. enable women to make informed decisions by providing evidence-based information, agreed to and endorsed by professional and consumer groups.
4. communication strategy
5. safety and quality framework to support all clinicians in it, including data monitoring, regular multidisciplinary audit (a process inclusive of consumers) and public reporting.
6. requires participants to respect and value each others' roles, provide support to each other in their work and provide education to meet those ends.
7. committed to joint education, trainign and ideally research focussed on improving outcomes.
8. provide to women continuity of care through pregnancy , birth and the early postnatal period as well as clear description of the roles and responsibilities of the person they identify as their primary maternity care coordinatior.

Some statements in the discussion documents were, in my opinion, plain group-speak eg "... the overarching principle that pregnancy, birth and the postantal period are normal physiological processes ..."

In many cases birth particularly, and subsequently the postnatal period, are not at all physiological. In fact, physiological births are not common in our world. The statement would have been more acceptable if "can be" replaced "are", and the document acknowledged the importance of the physiological process for health and wellbeing of mother and child. World Health Organisation (1996) states "In normal birth there should be a valid reason to interfere with the natural process."

A suggested draft definition of collaborative care is (in the discussion document)
"Collaborative maternity care involves collaboration with the woman and for the woman ..."
I disagreed with this statement. The relationship of a professional with a client, in this case, a midwife or other maternity care provider with a woman, is not collaboration. The midwife needs to collaborate with other professionals, while acting in a professional partnership with the woman. The woman has the right to disagree with the individual or collective wisdom of professional care providers, and the care providers have responsibilities to accept and respect the woman's decision. This is woman centred care. We can't place the woman as part of a collaboration with professional care providers, then place the collaboration at the centre of the care. There is no equality either in position or power in that relationship. The woman's rights and responsibilities are separate from professional collaborations.

There was no mention of the RANZCOG position that the obstetrician is the ‘designated clinical leader’ in all collaborations. The heirarchial nature of the obstetric model appeared to be overruled by the group, with the phrase "primary maternity care coordinator" being applied to the one professional person who provides care for the woman throughout the episode of maternity care, and who the woman identifies as her leading carer.

Discussion took place about the ACM National Midwifery Guidelines for Consultation and Referral, particularly with reference to the RANZCOG refusal to adopt these Guidelines. It was indicated that RANZCOG objected to what it considered a lack of consultation in the development of the guidelines, rather than the guidelines themselves. Interesting!

There was too much idealism, and too little factual reality in the room. In the discussion on continuity of carer it seemed that everyone wanted to jump on the bandwagon. Someone suggested that obstetricians, registrars, residents and even medical students would like to get to know the pregnant woman. Never mind what that would mean to the woman! How many prenatal visits would she need? Would everyone then commit to being with her when her time came to give birth, and also commit to working in harmony with her natural intuitive processes, unless there was a valid reason to intervene? I don't think so.

The facilitator had no idea of the extent to which midwives collaborate, nor did he seem interested in knowing what happened. He had an agenda - to get this mob to collaborate. And he was 'gunna' make it happen 'by hook or by crook'.

In this reform process a meeting like this one can be used as evidence of consultation with stakeholders. It can also be a box ticking exercise - yes, stakeholders have been consulted.

A further comment on insurance and practice issues can be found at Joy Johnston's blog.

Sunday, December 6, 2009


[Letters and emails, Sunday Age]
Midwives as well as mothers are facing an umprecedented attack on freedom and equity in maternity care. Nicola Roxon cannot be allowed to proceed with her plan to require, in law, a written collaborative (read supervision) arrangement between a private midwife and a doctor. Roxon's madness seems to be a special mix of listening to advice from those who have the most to win, while ignoring logic, good sense, mainstream professional advice, and the pleas of thousands of ordinary Australians.

In one way it's an extreme version of socialist health policy (the nanny state), for anyone who needs 'public' maternity care, while turning a blind eye to the absolute privilege (license to take what you want from the public purse) that has been extended to the obstetric profession for the provision of 'private' maternity care. The other provider of 'private' maternity care, the private midwife, is being bullied out of existence. The person taking responsibility for this 'achievement' is an obstetrician, who now heads the doctors' union, the Australian Medical Association.

Maternity issues don't usually get much press, but as you will see from the attached scan (click to enlarge), the Sunday Age has recognised Home Birth as THE BIG ISSUE - at least for today.

Tuesday, December 1, 2009

YOUR submissions are needed AGAIN!

To all the readers of this blog, no matter what your interest, please write to the Australian Senate (upper house of Parliament) and tell them why midwives must be free to practise MIDWIFERY, and women must be free to give birth under normal physiological conditions with a midwife in attendance.

The amendments to the legislation before the Senate will effectively prevent midwives from practising on our own authority, as it will mandate that a midwife has a collaborative arrangement with a doctor in order to practise privately.

Midwifery is a profession in its own right. Doctors do not practise midwifery, do not have any duty of care to promote and protect normal physiological processes in birth. That's what will be lost if this legislation passes.

We must all send submissions to the new senate inquiry.

For details click here.

Read through the instructions, and systematically comment on any discussion point that you consider important.

If you prepared submissions or calling cards previously you can rework these and email them to the senate committee before the cut off date 11 Dec.

Write to the Committee Secretary
Senate Standing Committee on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600
Phone: +61 2 6277 3515
Fax: +61 2 6277 5829

Please everyone, give this priority. Your letter is important. Ask your friends and family to make submissions too.