complaints and notifications against midwives

Midwives practising privately in Victoria face a high risk of experiencing complaints to the registration authority about their actions. 

Protesters rally outside AMA house in Melbourne, in support of private midwifery

The number of Victorian independent midwives with current investigations into compaints is seven or eight, out of a group of less than thirty. This rate of complaint is disproportionately high when compared with midwives in other practice models.  Midwives are asking "why?"

There are, of course, complex issues in any complaint about a professional person's actions or competence or ability to practise at an acceptable standard.  The statutory body with responsibility for investigating and making decisions about a midwife's professional actions is the Nursing and Midwifery Board (NMBA), which acts under the Australian Health Practitioner Regulation Agency.  The principle of acting in the public interest - protection of the public from unprofessional or incompetent or unscrupulous operators - is the reason for existence of statutory regulation of health professionals.

In recent months and years the defining of a midwife's scope of practice and even who is suitable for a midwife to accept when providing care have been further complicated by government bureaucracy, under what has been presented as 'reform'. While the 'reform' is offering the carrot of Medicare (public) funding for prenatal care and visiting access to hospitals for intrapartum care, the stick at the other end of the donkey is adherence to a high level of risk management that is dictated and overseen by competing medical interests. 

Without going into detail, independent midwives face the possibility of restrictions that go beyond anything we have previously faced. For example, is a woman who has had a previous caesarean birth a suitable candidate to be in the primary care of a midwife? What about a woman who has had two caesareans?
or a woman with a high BMI (too fat)?
or a woman who has twins?
or a woman whose baby is presenting breech?
or a woman who had a post partum haemorrhage with her previous birth?
or a woman who comes into spontaneous labour at 36 weeks?
or a woman whose baby has not yet been born at 42 weeks?
or ...


Now is a good time to go back to the question what is a midwife?

ICM Definition of the Midwife (2005) is a core document of the International Confederation of Midwives [http://www.internationalmidwives.org/ ]

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.

A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

[Adopted by the International Confederation of Midwives Council meeting, 19th July, 2005, Brisbane, Australia. Supersedes the ICM “Definition of the Midwife” 1972 and its amendments of 1990.]



Principles that provide a framework for midwifery practice

The ICM Definition of the Midwife (2005) establishes the following principles:

The principle of ‘partnership’: “The midwife … works in partnership with women …”
The principle of professional responsibility: “The midwife is recognised as a responsible and accountable professional …”
The principle of caseload – primary care: “The midwife … works … to give the necessary support, care and advice during pregnancy, labour and the postpartum period, …”
The principle of primary care – on the midwife’s own responsibility: “… to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.”
The principle of health promotion: “This care includes preventative measures, the promotion of normal birth,…”
The principle of detection of complications, consultation, referral, and carrying out emergency measures: “This care includes … the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.”
The principle that midwifery care has broad community health implications: “The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.”
The principle of ‘any setting’: “A midwife may practise in any setting including the home, community, hospitals, clinics or health units.”

I would encourage midwives who face complaints and notifications to come back to the principles outlined above, and to review our practices in the light of these principles. A midwife who can demonstrate that her practice was consistent with the ICM Definition has strong footing for defending her actions.