Friday, December 23, 2011

"homebirthing is a sensitive and controversial issue"

The report said “homebirthing is a sensitive and controversial issue”.
The irony of this statement was clear when it appeared in Improving Maternity Services in Australia – The Report of the Maternity Services Review (2009). Homebirth continues to be both sensitive and controversial today.

Maternity Coalition's Summer 2011 issue of Birth Matters devoted significant space to the extremely sensitive and controversial end of homebirth; "high-risk homebirth". MC President, Ann Catchlove, wrote a deeply personal and moving column referring to the death of a baby in a highly publicised homebirth, that "I hope that we will have realised that the way to respond to "high-risk homebirth" is not by prohibition and persecution but by seeking to understand why women make decisions and giving them real options within the system. Meanwhile, in the here and now, a mother is being treated in a most unfair and unjust manner. We need to stand up and say that is wrong."

In an article published in the (UK-based) AIMS Journal Vol 23 No3 2011, Joy Johnston (who is also the author of this blog) wrote:
The constant recurring theme in Australian and international midwifery regulation is the public interest. The Australian medical profession considers obstetric supervision of all maternity care to be in the public interest, and assesses midwifery as incapable of delivering optimal and safe maternity care in settings outside obstetric surveillance. The issue of home birth is the pimple on the end of the maternity system’s nose. It won’t go away, it hurts when touched, and it’s a real nuisance.
The large 'Birthplace' study [click here for link and comment] looking at place of birth in the UK is to:
effectively be replicated in Australia from 2012 with a NHMRC funded birthplace study led by Professor Caroline Homer from the University of Technology, Sydney. Feeding in to the Maternity Services Review recommendations for more research and national data collection, the study will investigate outcomes from about 45,000 births across public and private hospitals including birth centres, freestanding midwifery units and homebirths, both publicly and privately funded. “We need to continue to grow the evidence and what has to be unpacked are the important pieces of information for women – their chances of a normal birth versus a caesarean section or their chances of good outcomes versus bad,” Homer said. “We haven’t had a big national study which clearly defined intended place of birth at onset of labour, not at 12 weeks. Smaller studies have also been a bit vulnerable because of their low numbers.” (quoted from Nursing Review, 21 Dec 2011)
MIPP is currently undertaking a REVIEW OF PLANNED HOMEBIRTH FOR ‘AT RISK’ WOMEN IN VICTORIA, 1999-2009. The data for this audit is being prepared by the Victorian Perinatal Data Collection team. Women included in this audit are those identified as ‘at risk’, having been recorded as planning to give birth at home in the care of a midwife, and that they have one or more of the following obstetric risk categories: Multiple pregnancy; abnormal presentation (especially breech); preterm labour prior to 37 completed weeks of pregnancy; post term pregnancy 42+ weeks; and previous caesarean birth. It is anticipated that at least one paper for publication in a professional peer-reviewed journal will come out of this review, and it is hoped that valuable information will be highlighted.

Monday, December 12, 2011

Hospital back-up bookings for planned homebirth

Midwives practising privately in and around Melbourne have, for many years, used the booking and emergency referral arrangements provided by the Women's hospital. The process has been simple: the midwife can fax the woman's details to the hospital, and the woman is given a hospital record number confirming the booking. The midwife provides copies of any blood test and other investigations relevant to the pregnancy, and contacts the hospital if and when obstetric referral is required.

In the past two years, after the Women's hospital relocated from the old Carlton site to its present site in Parkville, and, coincidentally as the numbers of births increased with the recent 'baby boom', restrictions have been placed by the hospital on which women are able to make bookings. For women who are experiencing uncomplicated pregnancies (which is usually the case for women planning homebirth), only those who live in the Women's local area are able to make a booking.  The hospital was apparently bursting at the seams.   Midwives who had previously brought women transferring from planned homebirth to the hospital from distant locations are now referring women who need medical attention to the nearest public maternity hospital.

Some midwives objected to the change.  Transferring to the Women's had been a well-managed matter, that the midwife could confidently navigate.  Professional respect between the independent midwife and the hospital staff, and vice versa, was generally upheld.  This of course tends to reassure the (labouring-birthing) woman, who is at the *centre* of the care.  [The good relationship between Midwives in Private Practice (MIPP)s and the Women's has been written about previously in this blog - eg see July 2008]

The Women’s hospital is now undertaking a review of ‘Services provided by the Women’s hospital in relation to women who choose to give birth at home’. A letter to participating midwives states that The Women’s “has identified a number of issues associated with its existing homebirth backup arrangements and, in recent months, significant concern regarding the clinical risks has heightened.” The Women’s Executive “has decided to review the current arrangements in order to clarify the Women’s role and responsibilities in this area and to determine the most appropriate processes for supporting women who choose to give birth at home.”

The fact that "significant concern regarding the clinical risks has heightened" in recent months, in relation to homebirth, is a matter that midwives who attend homebirths care a great deal about. Has there been some change in the way midwives practise, or in the way midwives and women planning homebirth proceed through their decision-making processes?  Is there a problem specific to the Women's, or ...?

MIPP leaders have also been aware of some issues that would come under the heading of 'clinical risk'.  During the past couple of years, with the federal government's Maternity Services Review; the passing of new legislation requiring professional indemnity insurance which was not accessible; the 'exemption' for homebirth; and the Medicare provisions for participating eligible midwives - this has been a time of unprecedented stress and concern for midwives practising privately, attending women for planned homebirth. 

An application was made some months ago to the Victorian Perinatal Data Collection Unit (VPDC) by MIPP for retrospective information on the birth outcomes of women identified as ‘at risk’, having been recorded as planning to give birth at home in the care of a midwife, and that they have one or more of the following obstetric risk categories: 

  • Multiple pregnancy; 
  • abnormal presentation (especially breech); 
  • preterm labour prior to 37 completed weeks of pregnancy; 
  • post term pregnancy 42+ weeks; and 
  • previous caesarean birth. 

  • There has been an unexpected delay in obtaining the data requested, as 2009 data cannot yet be publicly released. We understand that the delay has been related to the change from manual data entry to electronic data entry at some sites.  We will inform our members and readers as soon as something becomes available.  The VPDC publishes data on actual homebirths (and outcome data for each hospital providing data to the system) each year.  The MIPP audit is seeking information on outcomes specific to 'at risk' pregnancies and planned homebirth.

    Thankyou to anyone who has read this far.  We will keep you updated on matters of interest to the private midwifery community, as information becomes available.

    Your comments are welcome.

    Thursday, December 1, 2011

    Safety of home birth - the UK Birthplace study

    Birthplace study 

    Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: The Birthplace in England national prospective cohort study. 

    This new cohort study from the UK reports on birth outcomes for healthy women with low risk pregnancies.

    As with all research, statistics can be interpreted differently by different people.  In this post I want to give a general overview of the research, and provide links for those who are interested in reading more.

    The first point to note is that the title 'Birthplace' may be misleading.  The outcome data was sorted according to PLANNED [not actual] place of birth.

    Readers may remember a study from South Australia (Kennare et al 2010) which received considerable press coverage as it claimed huge increases in adverse outcomes for planned homebirths. For more comment and links relating to that study, click here.

    Although there are major differences between planned homebirth in the UK and planned homebirth in Australia, valuable lessons can be learned when we review and critically consider the meaning of results of research.  

    Births at home or in hospital: risks explained is an article at the NHS Choices: your health your choices website.  The explanations given are well considered: compare with the titles and subsequent content of newspaper articles listed and linked at the end of the piece.

    Links to the headlines

    First-time mothers warned over home birth risks. The Daily Telegraph, November 25 2011
    Home births three times more risky than hospital, says study. Metro, November 25 2011
    Women with low-risk pregnancies 'should have birth choices'. The Guardian, November 25 2011
    First-time mothers who opt for home birth face triple the risk of death or brain damage in child. Daily Mail, November 25 2011
    Home as safe as hospital for second births. The Independent, November 25 2011
    Home birth risks up for new mums. The Sun, November 25 2011

    Another commentary worth reading is at the Having a baby  blog.  The writer Marina Colville concludes:
    This study supports government policy to offer choice in place of birth to all women.  However, there remains a severe lack of viable community midwifery services with associated expertise which means most women do not have a realistic choice of where they give birth despite a potential claim to the contrary by a range of Trusts.  This issue should be addressed by NHS managers who have so far largely not implemented this long standing government policy particularly in the face of extensive evidence from this study showing the cost-effectiveness of it.
    Make no mistake, any attempt to change the maternity service following this study will be as tortuous as the previous years of inaction but this study is vital fuel for the fire making the case for better birth experiences for women and babies.

    Your comments are welcome.
    ps: for Sarah Buckley's comments on the question 'Is homebirth safe?' and links to her work, go to

    Friday, November 25, 2011

    Invitation from MAMA

    Celebrate with MAMA  

    As a way to say thanks for all of the help & support you have so kindly given to us, you and your family are warmly invited to celebrate the successful opening of our centre… 
    Sunday 4th December 2011 
    1pm – 4pm 
    at 38 Gatehouse Drive, Kensington 
    Champagne and Finger Food will be served throughout the afternoon 

    Please RSVP by 25th November 2011 
    to Kylie Tel: 03 9376 7474 

    Thursday, November 17, 2011

    Membership in MiPP

    A MiPP meeting in 2009

    MiPP is a collective of privately practising midwives in Victoria.
    MiPP meetings are usually by-monthly, in locations to suit members.  Communication is mainly by email, either directly or via the maternitycoalitionmidwives Yahoo! Group.

    MiPP welcomes applications for membership from registered midwives, who seek employment/income from private midwifery practice, and who are willing to provide primary maternity care for women and their babies across the continuum of pregnancy, birth, and the postnatal period. 

    Full members' entitlements include listing on the MiPP brochure, and on the MiPP page at the Maternity Coalition website. 

    Associate membership is available for midwives and midwifery students who are interested in private midwifery practice.

    It is a couple of years since MiPP published a brochure.  We are now preparing a new brochure, and asking members to indicate their desire to renew their membership.  Midwives who wish to join MiPP as new members are welcome to apply.  Applications are reviewed by MiPP on an individual basis.  A current full member of MiPP may be named as a sponsor to new members.

    Please note that a midwife who wishes to commence private practice, outside the hospital/acute healthcare sector, is encouraged to seek mentoring with an experienced independent midwife.

    Although the MiPP collective is based in Victoria, registered midwives from other parts of Australia are welcome to join our group.

    For more information, or to request a membership form to be sent by email, please contact joy[at], or phone 0411190448.

    MIPP is affiliated with Maternity Coalition Inc, as a 'Participating Organisation'.

    Maternity Coalition is a consumer and midwife advocacy organisation, committed to protecting pregnancy and childbirth as natural processes, and to supporting the role of the midwife as a primary maternity care provider.  All MiPP members are also members of Maternity Coalition, and receive a copy of the journal Birth Matters quarterly.

    Friday, November 4, 2011

    Collaborative arrangements with Medicare-eligible midwives for Victorian public hospitals framework

    The following communication to stakeholders has been distributed:

    November 2011
    Work has now commenced in Victoria on a framework for public health services that provides guidance on the appropriate mechanisms to consider, implement or review collaborative arrangements with [Medicare] Eligible Midwives (EM) providing midwifery care to women who are admitted privately and seeking to birth in hospital under the care of the EM.

    Monday, October 24, 2011

    An open letter to Bridget Lynch, past President of ICM

    This letter, written by midwife Robyn Thompson, is addressed to Bridget Lynch, immediate past President of the International Confederation of Midwives (ICM).  The Australian College of Midwives (ACM) is a member organisation of ICM.

    I was privileged to be introduced to, and speak with you Bridget at the Australian College of Midwives Conference on Thursday October 20th 2011 in Sydney. I was in the right place at the right time in midwifery history.

    Tuesday, October 18, 2011

    the reshaping of private midwifery practice

    Private midwifery practice is undergoing real changes, as midwives who have Medicare provider numbers are able to offer certain midwifery services for which women will receive substantial Medicare rebates. 

    There is scheduled fee for each item, from which rebates are calculated [variation in amount payable depends on a person's safety net]. For example:

    Friday, October 7, 2011

    Key issues for midwives

    Referring to the development of visiting access arrangements for midwives in public hospitals (see previous post), the following comment has been offered by a highly respected 'elder' of the midwifery profession, Helen Sandner, from Bendigo.

    I would just like to put forward a few key issues that I think are paramount for future discussions and consideration in the planning and implementation of a written document.
    • Midwives autonomy. In saying this I do not mean in a dictatorial way, but I believe that it is important to acknowledge that we are registered to practice as autonomous practitioners. It is only the Government that is putting us back under the auspices of the medical profession with the Collaborative Determination. 
    • Collaborative respect. We deserve equal respect and I would like to see this in writing. We are not underdogs or lesser professionals and this needs to be acknowledged and therefore we should be referred to in any document with the same level of professionalism as any other healthcare professional. 
    • Consent, informed decisions and right of refusal. All without saying the women should be the focus and these points should be acknowledged in any written document.
    Helen Sandner
    Midwifery Practice Coordinator
    Central Victorian Midwifery Group Practice

    Thursday, October 6, 2011

    mipps and public hospitals in Victoria

    Independent midwives in Victoria have for many years encouraged and guided women planning homebirth to make backup bookings with public hospitals. Those women who experience complications are referred to the back-up hospital. The midwife usually continues with the woman in labour, visits her in hospital postnatally, and picks up postnatal care after the woman and baby have been discharged. This process does not usually receive any special attention; it's just the way midwives work. Recent posts have discussed the midwife's role in hospital based intrapartum care.

    A multi-disciplinary reference group has been brought together by the Health Department, to inform and support a process under which eligible midwives (ie midwives who have a notation on their registration that they are eligible for Medicare*) will be able to attend women privately in public hospitals.

    Sunday, October 2, 2011

    Don't give up!

    An opinion
    Joy Johnston

    I wrote in a recent email to fellow independent midwives, "Don’t give up! Midwifery has survived darker days than this one."
    One younger midwife who received that post asked me what I meant. Was I referring to midwives being burnt at the stake, or similar historical atrocities?

    Those dark days certainly rate high in the shame file. But, realistically, it's a long way removed from any midwife today.

    Midwifery is the one health profession that challenges the medical/legal establishment at its core.  Midwifery enables women to get on with the job of being mothers without interruption, and will only seek treatments or interferences from outside sources (natural or pharmacological; alternative or mainstream) when complications present.

    Wednesday, September 14, 2011

    Australian midwifery's Position Statement on Homebirth

    MIPP and other midwifery and maternity consumer groups are preparing our responses to the ACM Interim Positon Statement on Homebirth. See previous posts at villagemidwife and an earlier post on this blog.

    It's a complex and important matter.

    Friday, September 9, 2011

    Is caesarean now the normal way to give birth and should we be worried?

    From theconversation: A hot topic: Is caesarean now the ‘normal’ way to give birth, and should we be worried? written by midwife academic, Professor Caroline Homer.

    We must remember that 'usual' is not necessarily 'normal'. The physiological norm for pregnancy, childbirth, and nurture of the infant will always engage the woman's and baby's sensitive hormonal systems and deep intuitive knowledge.

    Monday, September 5, 2011

    The Australian Private Midwives Association (APMA) has just launched an on-line campaign, called Mums Matter! 

    This is aimed at bringing the issue of women's rights back on the agenda (as it has slipped off many politicians radars!) We have 1 week before pollies are back in Canberra. By then we want 20,000 supporters sending emails sent to pollies across the country. It is super easy only takes 2 mins. Please pass on far and wide.

    We know different women make different decisions but the vast majority support each others' ability to make them. APMA is also asking for pledges of $20 to fund our campaign continuing. We don't need to all travel to Canberra this time we want to make it cheap, easy but still effective. Here's the link

    Thankyou for passing this message on.

    Sunday, September 4, 2011

    Role of the registered midwife in private practice when the woman is admitted to a health service as a public patient

    A new position statement has been circulated by the Nursing and Midwifery Board of Australia, concerning the role of the midwife who supports a woman admitted to a public hospital. Extracted from that position statement:
    ... The midwife may choose to withdraw when the care of the woman is assigned to the health facility’s health care professionals. However, should the woman request it, the midwife may choose to remain as a support person to the woman either as paid or unpaid as agreed between them.

    Wednesday, August 24, 2011

    Mandatory reporting

    There is a great deal of discussion and some dismay in the world of private midwifery, since we learned that a 'mandatory reporting' notification was made of a midwife who was deemed to be practising without insurance.

    We understand that this midwife was in a public hospital with a woman who had planned homebirth. After transfer of care to the hospital, the midwife continued in a supportive role with the woman: the usual practice in Australia when women transfer from planned home birth to hospital care.

    Saturday, August 6, 2011

    A scarred uterus

    The Australian College of Midwives (ACM) has released an Interim Homebirth Position Statement for comment.

    The ACM Interim Guidance for privately practising midwives providing midwifery care for a planned homebirth state:
    "There are some contraindications to a planned homebirth which women should be informed of at booking. These are:
    • Multiple pregnancy
    • Abnormal presentation (including breech presentation)
    • Preterm labour prior to 37 completed weeks of pregnancy
    • Post term pregnancy of more than 42 completed weeks
    Scarred uterus"

    Thursday, July 28, 2011

    A treasure-trove of literature

    Readers who are serious about understanding and discussing aspects of maternity care will find an excellent resource at:
    click here

    This is a listserve site for a discussion group of Canadian Family Physicians (the equivalent of the Australian General Practitioner), hosted by Dr Michael Klein.

    The site contains links to a huge amount of useful literature and debate.
    One example, which many readers of this blog will want to print out and review in some detail is Home Birth: An annotated guide to the literature (Vedam et al, May 2011).

    Wednesday, June 29, 2011

    Births after Caesarean

    Is spontaneous natural labour and birth a realistic option?

    The answer, in each case, depends on decisions made during the pregnancy and as the labour progresses.

    Most midwives, and many doctors, would encourage women to give birth vaginally. Unless there is a specific and valid reason to avoid vaginal birth, there is no safer way for mother and baby than spontaneous, natural, unmedicated vaginal birth.

    Wednesday, June 15, 2011

    Transfer to hospital from planned homebirth in the Melbourne area

    Midwives in and around Melbourne have received a letter from the Women's Hospital in Parkville, telling us that backup bookings for women planning homebirth will now restricted to the local area. Women outside the catchment area for the Women's, who require transfer of care, are to "present to the local maternity hospital closest to your client's home."

    Wednesday, June 8, 2011

    Update on private midwifery in Victoria

    If you are interested in the national private midwifery scene, or trying to locate a midwife outside Victoria, please go to the APMA blog.

    For links to websites of private midwives, scroll down this page to web links.

    To locate a midwife in Victoria, go to the MIPP list at Maternity Coalition. Alternatively, you can leave a comment at this blog.

    Thursday, May 26, 2011

    Professional Development options

    The Professional Development Unit (PDU) at Deakin University offers high quality flexible educational learning packages.

    Monday, May 23, 2011

    homebirth position statement

    Members of MIPP who are also members of the Australian College of Midwives (ACM) will be aware that "ACM is working with both the NMBA and the Commonwealth to develop a contemporary homebirth position statement within the next three months."
    (Australian Midwifery News, Autumn 2011 issue, page 3.)

    Tuesday, April 26, 2011

    Join the global webinar to celebrate International Midwives' Day 5 May

    Plans are set for the Virtual International Day of the Midwife on May 5th. The program, which spans the 24-hour period, with speakers from the various continents, has now been finalised, and it looks to be a very interesting and diverse program:

    Friday, April 15, 2011

    MIPP submission to Senate Inquiry

    Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency (AHPRA)

    MIPP has made a joint submission with Australian Private Midwives Association (APMA). To access all the submissions received by the committee,
    click here

    The matters addressed in this submission are in response to our experiences during the recent transition from individual State and Territory-based regulation of the midwifery profession to the national regulation of the midwifery profession under AHPRA.

    We draw to the attention of the Inquiry the following matters, which will be discussed in more detail in the body of this submission:
    1. AHPRA’s administration of the registration process for Medicare benefits
    .1 Midwives are required by AHPRA to provide a reference from hospital midwife manager or obstetrician when applying for notation as eligible for Medicare benefits. This is an unreasonable request for many privately practising midwives.
    .2 ‘Prescribing’ course. Midwives who apply to AHPRA for notation as eligible for Medicare benefits are required to sign an undertaking to complete within 18 months of recognition as an eligible midwife, an accredited and approved program of study determined by the Board to develop midwives’ knowledge and skills in prescribing ...” There is at present no such course available for midwives.
    .3 Some midwives have experienced unacceptable delays and a lack of fairness in processing applications for notation as eligible midwife.
    .4 We draw to the attention of the Inquiry the implications for consumers/ private clients of midwives whose applications have been delayed without good reason.
    .5 We assert that there is a strong potential for misunderstanding in the obstetric and hospital midwifery communities as to the meaning of collaboration. Legislation that privileges obstetricians, placing them in a supervisory role for midwives, must be repealed.

    2. The administration by AHPRA of complaints against privately practising midwives
    .1 A privately practising midwife’s registration had been suspended prior to the changeover to the new legislation. This midwife has been unable to work and earn a living, yet she has not yet been given an opportunity to present her case in person, or to have her suspension lifted.
    .2 At least two midwives have recently had conditions (supervised hospital practice) placed on their registrations without any investigation into the complaint. This is as effective as a suspension, with the midwife losing her ability to earn a living while the conditions apply.

    3. Professional Indemnity Insurance. AHPRA, through the Nursing and Midwifery Board (NMBA), is currently in the process of drafting requirements for insurance for midwives. We wish to draw this to the attention of the Inquiry, as midwives in private practice are the only professional group unable to purchase indemnity insurance to meet the requirements of the national legislation.

    Friday, April 8, 2011

    A flawed analysis

    This week's leading story on Medscape OB/GYN and Women's Health []
    Planned Home vs Hospital Birth: A Meta-Analysis Gone Wrong

    A Flawed Analysis

    The highly charged debate over the safety of home birth was inflamed by the publication of a meta-analysis by Joseph R. Wax and coworkers,[1] which concluded that "less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate." The statistical analysis upon which this conclusion was based was deeply flawed, containing many numerical errors, improper inclusion and exclusion of studies, mischaracterization of cited works, and logical impossibilities. In addition, the software tool used for nearly two thirds of the meta-analysis calculations contains serious errors that can dramatically underestimate confidence intervals (CIs), and this resulted in at least 1 spuriously statistically significant result. Despite the publication of statements and commentaries querying the reliability of the findings,[2-6] this faulty study now forms the evidentiary basis for an American College of Obstetricians and Gynecologists Committee Opinion,[7] meaning that its results are being presented to expectant parents as the state-of-the-art in home birth safety research.

    In this article we describe in detail numerous mistakes in design, methodology, and reporting in the Wax meta-analysis that place clinicians and patients at risk for being misinformed.

    Soon after the Wax et al article was published, the Midwives Alliance of North America published a similar critique.

    Click here for the MANA press release, published by midwivesVictoria blog at the time.

    Wax and colleagues were mirrored at about the same time by a similarly outrageous 2010 publication by Kennare et al in the Medical Journal of Australia.
    Planned home and hospital births in South Australia, 1991-2006: differences in outcomes (MJA 2010;192:76-80)

    The authors of the Australian study, which looked retrospectively at data, claimed that "planned homebirths had a perinatal mortality rate similar to that for planned hospital births, but a sevenfold higher risk of intrapartum death and a 27-fold higher risk of death from intrapartum asphyxia." Huge confidence intervals and small numbers were clear limitations, as well as decisions about inclusions and exclusions, yet the flawed conclusions have been circulated widely in a shrowd-waving "doctor knows best" campaign.

    Thursday, March 24, 2011

    Homebirth via public hospitals

    A midwife from Casey Homebirth service, at a maternity conference, with the 'gear' that she takes to a home

    In December 2009 we noted at this blog the announcement that some Victorian women would be able to access homebirth via a publicly funded pilot scheme.

    Two metropolital hospitals, Casey in the South-East and Sunshine in the West, have their homebirth programs up and running. We have also been told by a reliable person that Monash Medical Centre, a level 5 hospital in Clayton, is planning to offer homebirth as part of comprehensive maternity services this year. [Click on the highlighted words to go to the websites of the hospitals mentioned]

    I have recently met up with a group of the midwives employed at Casey. I was impressed at their enthusiasm for their work. They told me they are loving the work.

    Homebirth is a basic aspect of midwifery practice. It allows the practitioner an opportunity to develop a strong midwife identity, accepting the authority in decision-making at any time in the episode of care, and particularly at the time of birth. Homebirth is 'PLAN A' - the woman giving birth spontaneously, without medical intervention, and the midwife acting in harmony with normal physiological processes.

    Working in a public hospital homebirth program enables midwives to practise one-to-one (caseload) primary maternity care without taking on the professional marginalisation that is experienced when midwives go into private practice.

    Midwives who have moved into private practise may not value this aspect of the hospital program to the same degree as those who take the hospital caseload-homebirth positions.

    Hospital midwives are able to provide care for the group of women booked in their caseload, with structured 'backup' processes from other midwives in the program, and arrangements for handing over care if a labour is very long. These midwives value their employment contracts, through which they have a reliable income, employment benefits such as sick leave and long service leave, and their relationship with their clients is separate from their ability to earn a living.

    By way of comparison, independent (private practice) midwives value the strong commitment they make to individual women, and very rarely ask another midwife to take over. The 'employment' arrangement is a private one, between the individual woman and her private midwife or midwives.

    Both options - private and public - have potential advantages and disadvantages.

    ‘Hospital at home’ is a reality. Hospitals are over-crowded, and it makes sense to provide services in the home when possible. The hospital risk management includes the latest gadgets that may be useful, such as the 'Neopuff TM' machine shown in the picture above. With the strict policies on inclusion in the program, it’s very unlikely that the midwives will need to use the neopuff. That will come out in audits down the track.

    The inclusion by hospitals of this item should not be seen as suggesting that all midwives attending homebirths need to carry such equipment. There would need to be some compelling evidence that babies born at home would be better off. Hospital babies, many of whose labours are induced when they not quite ready to be born, depressed by narcotics, and premature, ... are the ones that would clearly benefit from the Neopuff TM.

    Homebirth via public hospitals is a valuable addition to publicly funded maternity services. Women and their babies benefit, as homebirth requires the promotion of normal physiological birthing, feeding, and nurture processes. Midwives benefit in being separated from reliance on unnecessary medical interventions.

    I anticipate that there will, in time, be an exchange of midwives between the public and private homebirth options. This will be good for midwifery, and good for birthing women.

    Comments by readers are most welcome.

    Friday, March 11, 2011

    NMBA and Professional Indemnity Insurance

    The Nursing and Midwifery Board of Australia is seeking feedback from all stakeholders on the revised Professional Indemnity Insurance Arrangements Registration Standard, and Guidelines. Click here for the link.

    Submissions are due by 6 May.

    The Board is seeking feedback on the following two approaches:
    Approach 1:
    The Board specifies a minimum amount of cover for professional indemnity based on advice from the insurance industry.
    Approach 2:
    The Board does not specify a minimum amount of cover for professional indemnity.

    Two approaches are outlined because the Board has received some feedback that the draft Guideline should include advice about the minimum dollar value of quantum of cover for midwives wishing to practise independently. The Board realises however that there are potential drawbacks to both approaches, and is therefore keen to provide the most useful advice to practitioners seeking PII cover.

    Blog readers are invited to share your views on professional indemnity insurance generally, and any points that you think ought to be included in submissions to this inquiry.

    Wednesday, February 23, 2011

    New arrangements for midwives

    A number of privately practising midwives are progressing towards being endorsed as eligible for Medicare. At least one MIPP who practises in and around Melbourne expects to receive notification of that endorsement tomorrow (24 Feb) after her application is approved by the Nursing and Midwifery Board (NMBA).

    A .pdf fact sheet summary (pictured) of the New arrangements for midwives is available here.

    A similar fact sheet for the medical profession, addressing the new arrangements for midwives, and especially collaborative arrangements between doctors and midwives, and hospitals and midwives, is available here.

    The MIPP Professional Practice Review (PPR) has been submitted to the Nursing and Midwifery Accreditation Council (ANMAC) for approval. The MIPP PPR is a review process for midwives who practise the full scope of midwifery for individual women in primary maternity care settings. The PPR enables a midwife to demonstrate personal competence to peer reviewers of the full scope of midwifery practice over time and across the continuum of care, as defined by the International Confederation of Midwives (ICM, 2005), and further developed in current Australian midwifery codes and standards.

    Successful completion of a professional practice review is a requirement for midwives applying for notation as eligible. The one process that has been approved is the ACM Midwifery Practice Review (MPR).

    Monday, January 31, 2011

    Private midwifery in Victoria at the end of January 2011

    This post is a brief round-up, especially aimed at midwives considering private practice as a career option, and women considering employing midwives to attend and work professionally with them throughout the birthing continuum, including when they give birth.

    Thursday, January 13, 2011

    nhmrc and Vitamin K

    Forwarding message:
    I would like to inform you that the NHMRC Joint statement and recommendations for vitamin K administration to newborn infants to prevent vitamin K deficiency bleeding in infancy (the Joint Statement) was re-issued in by NHMRC CEO in November 2010.