Tuesday, September 10, 2013

regulation of midwives

Several MIPP midwives were amongst 60+ national attendees at a meeting this week in Melbourne, hosted by AHPRA.
The meeting was called 'The Light at the End of the Tunnel Midwifery Workshop', and presentations were made by various midwifery leaders and regulatory people.

The aim of the Workshop was:
1. To improve and foster understanding between the NMBA, midwives and stakeholders regarding midwifery issues incorporating:
a. Accreditation & education
b. Midwifery Practice
c. Association
d. Workforce 
2. To move closer to the intent of the National Registration and Accreditation Scheme by ensuring that there is a common understanding about midwifery practice.
Mary Chiarella from the NMBA chaired the workshop.  The round table discussions and feedback were well organised.  Attendees will receive summary notes and powerpoint slides, and the Board is committed to using the information gathered in the workshop as policies are developed.

Separate midwifery regulation
There will be a review of the national law (? next year - not sure) and there is support amongst midwives for a separate Midwifery Board to be established.  Although the current NMBA can be seen as an improvement on its preceding state and territory nurses boards, many midwives believe that the profession of midwifery is not well served by the current arrangements.  In the meantime the need for midwives to be on each of the state and territory Boards (members appointment by jurisdictional health minister), and to be on panels hearing complaints regarding midwives practice, were stressed by several attendees.

Quality and Safety Framework, and practice review
It was noted that a new quality and safety framework is being developed and will be distributed for comment in the near future. It will cover all midwifery practice - not just homebirth/private practice. There seemed strong support for midwifery practice review by all midwives. 

Home birth after caesarean, and mandatory notifications
One issue that was raised, which some readers may be interested in, is that independent midwives in some areas have been 'reported' for planning vaginal birth after caesarean (VBAC) homebirths. They have been told by the hospitals that notifications have been made under mandatory reporting: meaning that the person who made the report believes that a midwife who plans HBAC has departed from accepted professional standards, and is thereby placing the public at risk. The members of the national Board who were at this workshop were emphatic that this sort of action does not have the support of the NMBA . It's a practice issue, and the Board does not have any policy in regard to HBAC.

Making a 'mandatory notification' is a serious step that is aimed at preventing members of the public who receive professional services being placed at risk of harm, and should only be taken with sufficient reason.  Making a notification that is vexatious or not in good faith may expose the reporting practitioner to proceedings for defamation. Women who ask midwives to attend them for planned homebirth after a previous caesarean usually do so believing that this care plan gives them the opportunity to come into spontaneous labour, and establish labour without interruption. 

There was some discussion around the impact on the midwife of notifications and investigations into professional conduct.  Participants requested that the Board provide support for midwives who face proceedings by NMBA and AHPRA, as they defend their professional position.  The public interest is served not only by punitive measures for professionals who have misbehaved, but by ensuring that everyone is treated with respect and natural justice and their cases are dealt with in a timely, transparent and accountable manner.

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