Singing group in Northcote for pregnant women

Ten Moons is a singing group for pregnant women. It provides a creative and safe space for women to come together and sing music that is all about feeling good. Experience some of the incredible health benefits that singing can offer during pregnancy and meet with other women in the community over song and a cup of tea.

For more information contact Gabby 0425 774 543 or email tenmoonsong@gmail.com

Medicare funding from 1 November 2010 ?

Some midwives and maternity consumers are waiting eagerly for the ability to claim Medicare payments for private midwifery services. A previous post gave the link to the Medicare fee schedule, and discussion on the required signed collaborative arrangement with one or more doctors that must be in place for a midwife to apply for a Medicare provider number.

To search for the legislative instruments go to the Commonwealth Government site.

This is a brief status update. With only a week until 1 November, we are wondering how it's progressing.

It appears that Medicare is ready to give midwives provider numbers and to rebate midwives' fees, AHPRA is not. It appears that AHPRA does not yet have a process up and running to proceed with applications for notation as an eligible midwife.

The optimists among us suppose that women will be able to back-claim from November 1 for Medicare. We will be interested to see what happens there.

We have been advised not to use the application form for notation as an eligible midwife on the AHPRA website as it needs to be amended – does not fit the criteria for eligibility. Will be re-loaded in a few weeks …


Remember the signed collaborative arrangement between an eligible midwife and one or more doctors, which is a mandated part of the provision of Medicare for midwifery services. Many midwives believe this law (Determination) denies the midwife's right to practise on her own authority, and potentially allows a doctor to veto the professional agreement between a midwife and a woman in her care. See the Australian Private Midwives Association (APMA) statement on the Collaborative Agreement.

Much more could be written, but it's Friday afternoon and my mind is tired. I hope this update is of use to some of our readers.

Midwives wishing to apply for a Medicare Provider Number can access information and forms at the Medicare website.

Letters to public hospitals

Members of Midwives in Private Practice (MiPP) are sending letters on behalf of MiPP to public hospitals with maternity services, requesting a process that will enable midwives to achieve visiting access to provide private midwifery services for our clients in the hospital.

This is the pro-forma of the letter:

Director of Maternity Services
XXX Hospital

Dear XX
I am writing with reference to the recent health practitioner registration reforms, particularly in relation to eligible midwives being insured for the full scope of midwifery services including attending birth in hospital. The changes include the availability of government supported professional indemnity insurance for midwives, and being able to access Medicare provider numbers and limited prescribing and ordering of tests.

We understand that the reforms that impact on primary maternity services are intended to be consistent with the key principles developed by Australian Health Ministers Advisory Council (AHMAC 2008) “Primary Maternity Services in Australia – A Framework for Implementation. (Attachment 1). Midwives in private practice support each of these key principles, and look forward to being able to provide quality primary care for women who plan to give birth in hospital.

Members of Midwives in Private Practice (MiPP) and Australian Private Midwives Association are contacting all public hospitals to request details of how eligible midwives may proceed to apply for visiting access/clinical privileges. Would you please inform me of how your hospital is proceeding with implementation of the relevant changes, and the process for application and implementation of visiting access for midwives who are not employed by the hospital.

Yours sincerely


XXXX
On behalf of MiPP

ATTACHMENT 1

KEY PRINCIPLES
“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.

AIMS for a better birth

AIMS is the Association for Improvements in the Maternity Services.
AIMS has been at the forefront of the childbirth movement for more than forty years.

* Working towards normal birth
* Providing independent support and information about maternity choices
* Raising awareness of current research on childbirth and related issues

Although AIMS is based in the UK, many of the challenges in maternity services are the same in Australia, and globally.


excerpts from AIMS Informed Consent
An analysis of enquiries to the AIMS Helpline reveals that almost without exception women who intend to birth at home are given a long list of the ‘risks’ the staff perceive them to be taking. We have yet to hear from any woman who was also given a list of the risks of a hospital birth, so we have produced our own and suggest that this should be handed out to all women who intend delivering in hospital.

INFORMED CONSENT FOR GIVING BIRTH IN HOSPITAL

This Trust supports the view that women have choice and in order properly to exercise that choice they need to be fully informed of the risks in association with childbirth.
The following are the risks of a hospital delivery:

This hospital operates a shift system which means it is unlikely that you will be attended by the same midwife throughout your labour.

Because [the hospital is] short of staff you are unlikely to have the continuous support of a midwife as she will probably be trying to attend to at least two other women.

As this hospital has a 25% [to 30%] caesarean operation rate this means that you have at least a 1 in 4 chance of having a caesarean. Please be aware that this is major abdominal surgery that:

• doubles the risks of maternal mortality,
• increases the risk of damage to other internal organs and blood vessels,
• carries a risk of infection, which may prolong a hospital stay,
• interferes with the establishment of breastfeeding and
• delays post operative recovery.

Research has also shown that this type of surgery:

• produces harmful side effects according to which anaesthetic is used,
• lowers fertility rates in women,
• may increase the incidents of post natal depression,
• adversely affects the baby because of the anaesthetic used,
• can accidentally cut the baby as the incision is made,
• produces babies who are less likely to breastfeed,
• results in babies with breathing difficulties because they haven't received the benefits of being squeezed through the vaginal canal,
• increases the risk of miscarriage in future pregnancies,
• produces a greater risk of childhood asthma and
• results in a greater risk of Sudden Infant Death Syndrome.

As the World Health Organisation has stated that there is no improvement to maternal or infant health when the caesarean operation rates exceeds 10% you should
understand that we are tr ying to reduce our caesarean rate.

...

You should understand that in this hospital, which is a high technology obstetric unit, only 1 in 6 women expecting their first baby and only 1 in 3 women expecting their subsequent babies will have a normal, straightforward, birth.

This hospital applies a time limit on the second stage of labour, this is not applied for your benefit it is imposed in order to ensure that you deliver as quickly as possible so that we can use your bed for another woman.

At this hospital the midwives will cut the cord as soon as the baby is delivered, this has adverse effects on the baby, but you need not worry we have resuscitation equipment at hand to help the baby breathe.

At this hospital the majority of women will give birth on their backs, despite the research indicating how this position increases the difficulty in pushing the baby out and causes trauma to both mother and baby.

This hospital prefers women to be quiet when they are in labour ... Therefore, in order to maintain a more subdued atmosphere, you will regularly be offered a range of opiate-based drugs ... Please be aware that this can lead to an increased chance of your child becoming a drug addict in later life and if administered at the wrong time during labour, will result in your baby being born in a dangerously stupefied state.

Do not worry, as the medical staff will inject the baby with an antidote as soon as it is born.

...

Source: AIMS JOURNAL VOL:19 NO:4 2007

Medicare funding from 1 November 2010

The Health Insurance (Midwife and Nurse Practitioner) Determination 2010 has been released. To search for the legislative instruments click here.

We will keep our readers informed as soon as we hear of any progress by midwives in incorporating Medicare into their private practices.

There are widely different opinions held as to what the Medicare-Midwife will look like, what she will be required to do. Here is a section from the piece of regulation, the National Health (Collaborative arrangements for midwives) Determination 2010
...

5 Collaborative arrangements — general
(1) For the definition of authorised midwife in subsection 84 (1) of the Act, each of the following is a kind of collaborative arrangement for an eligible midwife:
(a) the midwife is employed or engaged by 1 or more obstetric specified medical practitioners, or by an entity that employs or engages 1 or more obstetric specified medical practitioners;
(b) a patient is referred, in writing, to the midwife for midwifery treatment by a specified medical practitioner;
(c) an agreement mentioned in section 6 for the midwife;
(d) an arrangement mentioned in section 7 for the midwife.

(2) For subsection (1), the arrangement must provide for:
(a) consultation between the midwife and an obstetric specified medical practitioner; and
(b) referral of a patient to a specified medical practitioner; and
(c) transfer of a patient’s care to an obstetric specified medical practitioner.

...

This is legislative language that confuses many.

The Medicare-Midwife (medi-wife) will:

* have a close working relationship with a group of obstetricians (no doctors work 24/7 these days)
* provide prenatal checks in the community, possibly in 'rooms' shared with obstetricians or other doctors (it has been suggested that a new GP Superclinic could include medi-wives)
* attend births in private hospitals where she has visiting access, and where the 'senior' member of the professional team is always the obstetrician
* be able to order basic tests and prescribe basic drugs, such as oxytocics
* provide postnatal services for mothers and babies in hospital, and possibly at home.

It is not yet clear whether public hospitals, which currently provide obstetric backup for the clients of privately practising midwives who plan homebirth, will accept the new medi-wife as a practitioner with visiting access.

Midwives are at present contacting public hospitals and requesting details of the hospitals' processes and time lines in preparation for enabling midwives to practise in the hospitals with visiting access.

PRINCIPLES underpinning maternity reform

Key Principles

“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.

[This document is Attachment 1 to the draft Safety and Qualitiy Framework for private midwifery, a document which is currently being adopted by the Nursing and Midwifery Board of Australia]