Saturday, July 24, 2010

Safety and Quality Framework for Privately Practising Midwives attending homebirths

This document has now been circulated, pending final endorsement/modification and adoption by the Nursing and Midwifery Board of Australia.

Readers who would like to have a copy of the document emailed to them may request it by email:

Key Principles [Attachment]

“Primary Maternity Services in Australia – A Framework for Implementation (AHMAC 2008)” articulated the following principles which underpin the range of models of maternity care available to women in Australia. These principles involve:

· ensuring services enable women to make informed and timely choices regarding their maternity care and to feel in control of their birthing experience

· ensuring that maternity services and care are provided in a culturally appropriate and responsive manner according to the individual needs of each woman

· maximising the potential of midwives, obstetricians, general practitioners and where appropriate other health professionals such as paediatricians and Aboriginal health workers specific knowledge, skills and attributes to provide a collaborative, coordinated multidisciplinary approach to maternity service delivery

· offering continuity of care, and wherever possible continuity of carer, as a key element of quality care

· ensuring that maternity services are of a high quality, safe, sustainable and provided within an environment of evidence ­based best practice care

· ensuring continued access to best practice maternity services and care at the local level, while recognising that the benefits of local access must be considered within a quality and safety framework

· providing the right balance between primary level care and access to appropriate levels of medical expertise as clinically required

· working to reduce the health inequalities faced by Aboriginal and Torres Strait Islander mothers and babies and other disadvantaged populations.

The Safety and Quality Framework

The framework is consistent with the principles underpinning provision of primary maternity care (Attachment 1) and recognises the full scope of midwifery practice.

The framework also recognises that women will make the final choice about their care and birthing choices in most circumstances. It is incumbent upon privately practising midwives (PPMs) to provide balanced and contemporary clinical advice to ensure that informed decisions are able to be made.

PPMs are expected to adhere to recognised consultation and referral guidelines developed by the Australian College of Midwives (ACM) and to have processes and relationships in place to demonstrate compliance with the guidelines.

The ACM guidelines were developed to guide midwifery practice more broadly and do not specifically to cover homebirths. Distance and time to travel to an appropriately staffed maternity service should be considered when assessing suitability for this option of care. These factors are in addition to undertaking an assessment of risk for this birthing option.

Women with a singleton pregnancy, cephalic presentation, at term and free from any significant pre existing medical or pregnancy complications are those identified in the ACM guidelines as clearly meeting criteria for midwifery led care.

When PPMs are the primary carers for women who fall outside of these criteria, the consultation and referral pathways must be documented and followed. Clearly articulated and documented plans of escalation and collaboration are integral to provision of safe high quality care leading to positive outcomes for mothers and babies.

PPMs are required to document advice provided to women in their care about midwifery scope of practice, risks and escalation processes.

In addition they will enlist the services of another registered maternity care professional to provide a second opinion in situations where the woman chooses not to follow clinical advice about the need for interventions or transfer. A written record of these processes is essential to verify adherence to the framework in the event of any adverse outcome and /or subsequent legal action or professional investigation.

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