Thursday, September 23, 2010

Why midwives can not accept the Determination

Readers of this blog will know that a piece of legislation, The National Health (Collaborative Arrangements for Midwives) Determination 2010 (the Determination), which has been discussed previously, was introduced by the Health Minister just prior to announcing the election.

Midwives who are members of the national professional body, the Australian College of Midwives (ACM) should have received an URGENT e-bulletin from ACM, which states:
"On the balance of information that we have to date, we feel that lobbying to disallow the Determination is placing the whole maternity reform package at risk. Although a compromise position is what some might call ‘incremental reform’ it is still an extraordinary time for midwifery in Australia and one we have been fighting to attain for many years."

Why can midwives not accept the Determination?

We believe that ACM should be calling for the Determination to be disallowed. It appears that ACM is putting financial considerations ahead of professional matters. I (Joy J) was an ACM Victorian Branch executive member in the 1990s when we fought to be freed from regulations which required that a midwife be supervised by a doctor. ACM is, by supporting the Determination, turning midwifery and maternity reform back a couple of decades.

In an attempt to defend the position I am taking, I draw attention to a list of so-called 'facts', in the ACM URGENT e-bulletin:

ACM claims that
"The Determination
1) Will not prevent private midwives being able to practise (they can still access insurance)

Midwives in private practice will, under the Determination, be required to choose EITHER medically supervised practice (with Medicare), with all births taking place in hospital (NO homebirth) OR continue private practice in our communities without the hope of government funding for any of our services, and without the hope of hospital visiting access.

ACM also claims that the Determination
2) Will not prevent women being able to make choices - if you are having a homebirth and choose not to access Medicare you do not need a signed agreement with a doctor.

This claim is nonsense. By supporting a two-tiered midwifery system (the homebirth midwives and the Medicare midwives), ACM is ignoring the basic scope of midwifery practice, in any setting.

ACM also claims that the Determination
3) Only affects midwives seeking to access Medicare and midwives can choose not to do this

Does ACM think it's reasonable that midwives should give up the defining features of midwifery practice, and accept supervision by the medical profession?

ACM also claims that the Determination
4) Is not included in the NMBA Quality and Safety Exemption framework supporting private midwives providing homebirth services

Of course not! The Determination is a piece of legislation.

ACM also claims that the Determination
5) Does not re-define the ICM definition of a midwife - it does not define the role or scope of practice of midwives in Australia. It only defines how midwives can access Medicare if they choose to do so. ...

Of course not! By agreeing to medical supervision of the midwife's practice, the ICM definition is OFF THE TABLE. The 'midwife' working under the Determination will become a new breed of obstetric handmaiden.

There are a couple more examples of SPIN under the heading of THE FACTS.

Midwives will be giving up midwifery if they accept the poisoned chalice of Medicare funding with this Determination. Change of funding mechanisms, as will occur when midwives are able to practise with Medicare rebates, does not equate to reform of maternity services. The Australian government's commitment to a $120 Million reform package is floundering because this government (in its previous state, and continuing through to the present leadership) has refused to listen to the very people who are intimately involved in maternity care (midwives and mothers), and has submitted to a 'doctor knows best' subservient mentality. The midwifery profession has an opportunity to stand up and take responsibility for ourselves, or cave in to the bullying that is seeking to force us into someone who is unrecognisable in current international midwifery literature.

Related posts:
NEW Maternity Coalition national blog
Homebirth Australia
Maternity Coalition
Lisa Barrett's blog


Emma Lund said...

I am a mum and Child and Family Psychologist and I cannot believe there are still people who dont see the link between the psychological state of our children and the way we have medicalised normal birth. Please let the midwives do their job and be autonomous. let the doctors look after mothers and babies in need

Joy Johnston said...

Posted by Beverley W
I am outraged by the seeming mistaken beliefs which are driving the current spin coming not only from the Government but also from midwives professional organisation ACM which does not appear to be listening to the members it is meant to serve. Driven by some in the medical profession our politicians are blinded by men of science whose objective is to play with womens lives using the latest toys for boys. These same 'men of science' through cultural practice (without evidence to base this on) traditionally made women lie on their backs to birth, with great difficulty, up against gravity for nearly 2 centuries. Both organizations government and the College appear to have fallen over for patriarchal dominance by means of the fear message.
The "determination" ought to have been an opportunity for female politicians to have stood beside and for the rights of midwives who have been denied access to Medicare since its inception by a blatant group of men who have then and now dominated its board since the 1970's.

So much for feminism and affirmative action for women in parliament. Midwives quite rightly want to run a business using their unique ability to enable women to give birth which results in an intact woman and a healthy baby.

Women who choose this option seem to raise the ire of a small percentage of obstetricians (some of them women) who blatantly state they disapprove of home birth.
I believe this to be a smokescreen to cover their own incompetence hidden behind hospital walls - where no one may, including governments, dare investigate.

If women realised how fast hospitals are becoming an unsafe place to be they would stay home for birth.

Justine said...

It is very clear that passing the determination will place Australia outside of the ICM definition and Glasgow declaration. Medical veto of a woman's decision making in pregnancy and birth contravenes Australia's commitment to CEDAW (Convention on the Elimination of All forms of Discrimination Against Women).
Our PM is our most senior Feminist (as she is a member of Emily's List). Where are the ALP feminists? The outrage is deafening. So much energy on termination and contraception but when it comes to supporting and honouring a woman's amazing capacity to create and nurture new life there is very little. Liberal feminists seem to be women acting like men! Crazy.

Joy Johnston said...

Message from anonymous:
"It's obviously an AMA-Health Minister agreement to anihalate private practice midwives. The truth is homebirth would not be available to more women if it were not for the private practice midwives keeping homebirth alive over the past 30 plus years. My argument is if the population want to exeterminate private and then every profession under the Health Practitioners Act should also have private services removed and the whole of the Health Services become a National (public service) that includes Chiropractors, doctors, chinese medicine, osteopathy, and so on."

Joy Johnston said...

Apologies to people who have tried to leave messages and found it difficult to sign in to a Google account. I have now changed the settings so that anyone can comment. JJ