Monday, December 31, 2012

Letter to the Sunday Age

[In response to the front page article, 'Patient power troubles GPs', Sunday Age, 30/12/12]

I find it troubling that some doctors are not happy with the concept of independent experts who support a patient’s decision making in medical care. 

The statements by Dr Hambleton of the AMA suggest that he is attempting to protect the old ‘doctor knows best’ position of privilege in our society – perhaps that’s part of his job description?

I also take exception to Dr Hambleton’s questioning of “the need for private midwives to be escorting women during hospital births.”

I am one of those private midwives, and I would like to explain briefly why I provide primary maternity care, and attend birth, whether it occurs in hospital or the woman’s home.   

A midwife’s unique skill is the ability to work in harmony with the natural processes through pregnancy, birth, and the postnatal period.  Birth is not an illness.  The midwife’s duty includes promoting health, supporting wellness, and protecting the woman’s ability to do the work of bearing and nurturing her children.  Only when and if complications or illness are present does the midwife need to collaborate with medical and/or hospital systems, and only then with the woman’s informed consent.  Most women trust the midwife’s guidance, but there are grey areas in maternity care, just as there are in the world of GP doctors. 

The planned setting for birth is not set in concrete.  Many women who plan hospital births experience the ‘coming ready or not’ baby who arrives in all sorts of places, including the bathroom at home, the back seat of the family car, or the hospital carpark or lift.  Some women who plan homebirth need to change their plan and move to hospital, for all sorts of reasons.   

Midwives who practise privately, independent of the hospital system, are able to offer personal continuity throughout the episode of care and be with the woman in labour wherever she is.  Privately employed midwives seek to establish a partnership with each woman in our care, at a level that simply cannot be achieved without significant investment of time prior to the birth.  Privately employed midwives offer a distinct professional care package to each woman.  The women who employ us usually intend to give birth spontaneously,  without relying on medical pain management strategies, or artificial augmentation of the birth process, unless there is a valid reason at the time for such a decision to be made.

When private midwives ‘escort’ women to hospital, we have usually provided significant professional services for that woman through the prenatal period.  Several Medicare items give rebate for services such as the initial consultation, long or short antenatal checks, and the development of an individual maternity care plan.  The woman may have laboured at home, in the care of her private midwife, prior to traveling to hospital.  The woman knows her private midwife’s voice, and touch, and is able to be confident within the care plan.  The care plan includes the ongoing process of  informed decision making, with the wellbeing and safety of mother and child being the guiding principle. 

Postnatally the private midwife continues to provide expert professional services, within the primary maternity care relationship.  Postnatal Medicare items are available until the seventh week after the birth.

Dr Hambleton’s attempt to trivialise the private midwife’s role as “so someone can hold their hand” is offensive to me.  If I hold the hand of a labouring woman, it is a significant act of professional support for which that woman has employed me.

Joy Johnston
25 Eley Rd, Blackburn South Vic 3130
03 9808 9614

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