Wednesday, June 5, 2013

for the record ...

A couple of dodgy situations have arisen in the Melbourne private midwifery world this past week, and I am noting them here, for the record.  People will not be named, but be assured, these stories are not fictional.

Story #1 - Woman W1 and doctor GP:
W1: (39 weeks pregnant, planning homebirth) "My midwife told me to ask you for the paperwork I will need to register the baby's birth, and get the baby bonus."
GP: "I have never been asked for that paperwork.  In fact I don't know where to get it."
For readers who are unfamiliar with the process, this paperwork is issued after birth by the midwife who attends a birth at home, or by the hospital where the baby was born. 

The GP phoned a well known and respected midwife to inquire as to how to obtain the paperwork.  That midwife immediately questioned the request.  If W1 is in the care of a midwife, that midwife should issue the paperwork, and sign the declaration to enable registration with Centrelink, baby bonus or paid parental leave, adding the baby's name to Medicare card, and other standard processes including obtaining a birth certificate.  Simple as that!

In this case W1 is probably planning homebirth without a registered midwife in attendance.  Call it freebirth or pure birth or attended by a birth worker or whatever you like.   A GP would be unwise to issue the birth paperwork, unless she or he was also prepared to attend the birth and sign the professional declaration.

Story #2 - Lay birth attendant LBA phone call to midwife M2:
LBA: "I am looking for a midwife who will visit the woman W2 in her home once labour has started, and do an assessment so that we can be sure she is at least 4 centimeters dilated."
M2: "Why do you want this?"
LBA: "Because W2 had a caesarean birth last time and she does not want to go to hospital until she is in established labour ..."
M2: "Let me get this straight.  You are asking me to visit when you call me, check mother and baby, give you that information, then go away?"
LBA: "Yes."

A midwife is immediately wary of this request for a number of reasons.  Here are a few:
  • the professional relationship is between a midwife and a woman; not the woman's friend, or partner, or employee.
  • information obtained in an assessment (maternal observations: frequency, strength and duration of contractions; fetal observations including lie, presentation, position, heart rate; and dilatation of the cervix) will not necessarily give the information that W2 or LBA are after.  The skill of midwifery includes interpretation of clinical observations over time.  

  • the midwife cannot delegate professional responsibility for midwifery care to an unqualified, unregulated person.
 A midwife would be unwise to attend a woman in labour unless she or he was also prepared to attend the birth and take professional responsibility for decisions made.  An exception would be if another midwife who was unable to attend a client who said she was in early labour, asked the midwife to provide a 'locum' service and report back.
 One of the realities of physiological birth is that the labour must begin spontaneously - in the woman's own time.  Most women make the decision themselves as to when to ask their midwife to attend, or when to go to hospital.  Sometimes they get it wrong - too early, too late!  Sometimes just right. 

This dilemma will not be resolved by having a private midwife provide a one-off consultation.  If people want that sort of information, they could 'do it yourself' DIY.  They could get hold of a fetal monitor and listen to the baby's heartbeat as much as they want to.  They could get hold of a little internal camera that takes pictures of the cervix.  The technology exists.  Also blood pressure monitors, a thermometer, ...  

'DIY' will never replace the midwife, who is 'with woman' in a partnership that requires trust and reciprocity throughout the episode of professional care.  

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