tag:blogger.com,1999:blog-13541916513223762512024-03-14T20:22:52.124+11:00midwivesVictoriaThis site is maintained for Midwives in Private Practice (MiPP), a collective of independent midwives in Victoria. We are committed to the essence of midwifery, being 'with woman' - each woman and her midwife preparing to welcome the child she bears, working in harmony with and protecting intuitive natural processes in birth and nurture of the newborn and the establishment of loving, resilient families.Unknownnoreply@blogger.comBlogger336125tag:blogger.com,1999:blog-1354191651322376251.post-63912798609461293082014-05-12T17:08:00.001+10:002014-05-12T18:51:03.381+10:00handing over and signing off<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-xLx2YqGXAiw/U3BihCFDRaI/AAAAAAAACyI/27jn0PLjPHU/s1600/IMG_0251.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="http://1.bp.blogspot.com/-xLx2YqGXAiw/U3BihCFDRaI/AAAAAAAACyI/27jn0PLjPHU/s1600/IMG_0251.JPG" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">a few days in the tropical sunshine can boost an old girl's energy reserves!</td></tr>
</tbody></table>
Dear reader, <br />
As I <a href="http://midwivesvictoria.blogspot.com.au/2014/04/mipp-review-and-restructure.html">wrote</a> a couple of weeks ago, MiPP is undergoing a restructure.<br />
MiPP members have decided that, as a group they will move out of Maternity Coalition, and sit under the umbrella of Midwives Australia. <br />
<br />
At this time I am nearing the end of my midwifery practice: I need to leave homebirths and activism to the younger, stronger midwives. I have therefore decided to step down from my roles in MiPP. I want to publicly thank my MiPP colleagues (past and present) for the trust they have placed in me over many years, as representative at professional and governmental meetings, as spokesperson to the media, and as confidante and sometimes mentor/guide to younger midwives. Before signing off, and handing this site over to someone else, I would like to take a moment to tell you some of my midwifery story.<br />
<br />
<br />
I found my way into MiPP and independent midwifery practice in 1993, after I had taken a 'package' from a permanent employed night shift position at St George's Hospital, a small maternity unit in Kew. St George's was closing its maternity wards, and amalgamating with Box Hill to form the <a href="http://www.easternhealth.org.au/Services/Maternity/default.aspx">Birralee Maternity Service</a>. At that time I thought I would like to support women for births in hospital - had no idea then that planned homebirth was an option supported by a growing body of evidence. I knew I was 'good' at sorting out breastfeeding problems, and thought I could set up a little business as a midwife lactation consultant. When I heard about MiPP meetings, bi-monthly on Saturdays in the Board Room of Vaucluse Hospital in Brunswick, I (innocently) went along.<br />
<br />
I was ready, personally, to move into private work at that time. My youngest child was 12, and I felt he and the other three young teens would not be upset if they needed to look after themselves after school, in the event that I was not home. They were at the stage of life when they needed parents a driver instructors and taxi services, but not too much personal involvement, thank you! I was in my early 40s. Coming off 'nights', I felt strong and well rested - going to bed each night! I got myself elected to the executive of the Victorian Branch of the Australian College of Midwives; got involved in Maternity Coalition, Midwives and Mothers Action (MAMA), Australian Radical Midwives and Mothers (ARM) and any other group that seemed interested in reform of maternity care. Remember, this was pre-internet, pre-email. We had big, clunky mobile phones, and some midwives carried pagers. <br />
<br />
Back to MiPP. The midwives who were active in MiPP at that time were a bunch of strong women; each different, and all very different from me. Soon after joining I had read and heard enough to whet my interest in homebirth. Being a practical person, I soon worked out that homebirth was the one *item* that midwives in private practice had, that made independent midwifery practice sustainable. And, reading the professional literature, I experienced a bit of an epiphany: that hospital did not make birth safe.<br />
<br />
MiPPs who welcomed me into the group included Jenny Parratt, Annie Sprague, Mary McKenzie McHarg (Reilly) [now deceased], Christine Shanahan, Robyn Thompson, and Patrice Hickey. Someone, early in my membership, aware of my lack of 'alternative' credentials, asked me how I thought I would get clients. By this, she was referring to the fact that I had no sign of feminst or hippy roots, and my own four children had been born in hospitals. I have never used homeopathics, or consulted a naturopath. I was/am a pretty 'straight' person, with white anglo-saxon protestant middle class Christian conservatism written all over me.<br />
<br />
Anyway, despite these 'obvious' drawbacks, Chris, Robyn and Annie all managed to invite me as 'second' midwife (unpaid) to witness homebirth. I was converted! After the third 'witness' experience, and after making a note of the paperwork and who I needed to contact to register births, I considered myself ready to fly 'solo'. That was 1993. By 1997, I was fully involved and passionate about my brilliant career. I started writing a journal, much of which was later copied to my business<a href="http://www.aitex.com.au/joy/journal/contents.htm"> website</a>. I loved midwifery, became an oxytocin junkie, and loved writing about my experiences. At the same time I was writing a lot of professional submissions, reviews and papers, including the publication of Planned Homebirths in Victoria 1995-1998 (Parratt and Johnston 2002. ACM Journal Vol 15 No 2) [available as .pdf on request], and the <a href="http://www.maternitycoalition.org.au/nmap.html">National Maternity Action Plan </a>(Maternity Coalition 2002). At some time I received an invitation to present a lecture on the midwife in private practice to the midwifery students at Deakin University; a role that I have loved, and repeated each year. At some time I received the Irving Buzzard award, managed by the Victorian Branch of Australian Nursing Federation ANF (now ANMF) for midwifery leadership.<br />
<br />
...<br />
<br />
By 2006 I found out about blogging, and, after a tentative start, with a post on <a href="http://villagemidwife.blogspot.com.au/2007/06/natural-birthing-in-australia-today.html">natural birthing in Australia today</a>, I was off! I found that by writing whatever I was discussing with clients or colleagues, I could record the essence of my midwifery knowledge. I loved the idea of the unlimited page that blogging offered. I loved the serial nature of the medium: that I could go back months or even years later and review what I had written. I loved the possibility of a huge audience, spread over the globe. I discovered how to use search functions and other electronic functions that some glorious geek invented just for me!<br />
<br />
By 2008 I began this MiPP blog: midwivesVictoria, and made it into an electronic magazine, recording items and news that might be of interest to other independent midwives, and women who are interested in engaging us for professional services.<br />
<br />
<br />
I hope someone else will take this blog, and its audience, into their life, and make it relevant to the changing terrain of midwifery in Victoria today.<br />
<br />
I plan to continue writing midwifery stories and critical comment on current issues on my personal blog <a href="http://villagemidwife.blogspot.com.au/">http://villagemidwife.blogspot.com.au/</a>. I am also available as <a href="https://www.facebook.com/groups/133213136840070/">villagemidwife</a> at facebook.<br />
<br />
<br />
signing off<br />
Joy JohnstonUnknownnoreply@blogger.com2tag:blogger.com,1999:blog-1354191651322376251.post-25311220106166178382014-04-19T17:27:00.000+10:002014-04-19T17:32:20.726+10:00The costs of institutional births<br />
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/7eZJqMhxD00" width="420"></iframe>
<br />
I would like to share this youtube video<a href="http://midwivesvictoria.blogspot.com.au/2014/04/the-cost-of-institutional-births.html"> </a><a href="https://www.blogger.com/null" rel="nofollow" target="_blank">https://www.youtube.com/watch?v=7eZJqMhxD00</a>
<i>The Costs of Institutional Births: a wake-up call for obstetricians,
</i>presented by Dr Amali Lokugamage at the recent RCOG conference in India.<br />
<br />
It's an excellent summary of the (growing) body of knowledge around
birth place, the physiology of birth, birth ecology, sociology,
economics, continuity of midwifery care, ... and quotes some of the
great Australian research on these matters. <br />
<br />
Please take a moment to watch the presentation, and share it with others who are committed to improving maternity care for mothers and babies.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-41427977865114455642014-04-11T11:00:00.002+10:002014-04-11T11:00:31.321+10:00MiPP review and restructureThe current membership of Midwives in Private Practice (MiPP) is 31 midwives, whose home addresses are predominantly across the Melbourne metropolitan area, and a few in rural Victoria. MiPP is recognised within Victoria as a professional stakeholder, representing privately practising midwives. <br />
<br />
<br />
MiPP has, since its inception in the late 1980s, functioned as a collective of privately practising midwives who provide primary maternity care in our communities. <br />
<br />
Midwives who practise within caseload or group practice models of care are not able to predict their availability for meetings or professional development or even family birthdays! The 'needs' of mothers and babies in our care, particularly around the time of labour and birth, take precedence in our lives. Despite this obvious restriction, MiPP members have<br />
<ul>
<li>attended MiPP meetings, usually bi-monthly, </li>
<li>prepared submissions to relevant reviews by government, statutory and professional bodies, and </li>
<li>provided occasional comment to the media on issues that concern our members. </li>
</ul>
Decision-making is by consensus, and communication between meetings is by email.<br />
Since the mid-1990s, MiPP has been a Participating Organisation in <a href="http://www.maternitycoalition.org.au/">Maternity Coalition (MC)</a>. Recently, the MC management committee announced a review of its Constitution, in which MC intends to delete the category of ‘Participating Organsiation’ from its structure, and change its name to 'Maternity Choices Australia'. Under the new Constitution, MiPP would be able to become a Branch of MC. This constitutional review has prompted MiPP to reconsider its organisational structure. <br />
<br />
Another significant proposed change to the Constitution is in the Statement of Purposes:<br />
<i>change from:</i><br />
<strike>“... a national (Australian) umbrella organisation made up of
individuals and groups who share a commitment to improving the care of
women in pregnancy ...”
</strike><br />
<i>to:</i> <br />
“... a national (Australian) consumer advocacy organisation made up of individuals and groups who share a commitment to improving the care of women in pregnancy, birth and the postnatal period.”<br />
<br />
The options that MiPP has at this time are:<br />
1. Continue our organisational relationship with MC. Members are welcome to vote on changes to the Constitution.<br />
2. Leave MC and set up an independent association<br />
3. Leave MC and establish a new organisational relationship under another body <br />
4. Other?
<br />
<br />
<br />
<br />
<br />
The following is a summary of responses to other questions in the survey:<br />
<br />
<span style="font-size: large;">The midwives </span><br />
<blockquote class="tr_bq">
<ul>
<li>Four of the 14 respondents have been members of MiPP for more than 11 years; three for 6-10 years; and seven for less than 5 years. </li>
<li>These midwives report having attended 182 planned homebirths, as the primary carer (‘first midwife’) in the year 2013. </li>
<li>These midwives report that in the year 2013, they attended 77 births in hospital after transfer of care from planned homebirth, and 73 planned hospital births. </li>
<li>Additional midwifery services, apart from the primary caseload (for planned homebirth) include antenatal and postnatal consultations, lactation/breastfeeding consultations, counselling, and maternal and child health visits. </li>
<li>Only two of those midwives who completed the survey are not eligible/endorsed, or working towards eligibility or endorsement to prescribe </li>
</ul>
</blockquote>
<br />
<span style="font-size: large;">Comments </span><br />
<blockquote class="tr_bq">
Members value MiPP for mutual support, sharing, networking and professional contact with other privately practising midwives.<br />
</blockquote>
<br />
<blockquote class="tr_bq">
Since the federal government’s maternity reforms implemented in 2010, there have been significant changes in the way midwives are able to work in private practice, enabling Medicare rebates for clients, and as midwife prescribers. Victorian midwives do not yet have collaborative agreements with public hospitals, one of the key promises in the reform package.<br />
<br />
<br /></blockquote>
<br />
<br />
Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-82103609772582959992014-03-31T19:00:00.000+11:002014-04-11T17:58:27.125+10:00Definition of obstetric violence/Definición de violencia obstétrica<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/Ziy5kSFm7U8?feature=player_embedded' frameborder='0'></iframe></div>
<br />
<br />
Lecture by Dr. <a class="profileLink" data-hovercard="/ajax/hovercard/user.php?id=100001729850351&extragetparams=%7B%22directed_target_id%22%3A333928523328190%7D" href="https://www.facebook.com/amali.lokugamage">Amali Lokugamage</a> at the <a href="http://www.rcog.org.uk/events/rcog-congresses">RCOG World Congress</a> 2014 in India.<br />
<br />
<span style="font-size: large;">Obstetric violence <span data-ft="{"tn":"K"}" data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body"><span class="UFICommentBody" data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0"><span data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0.$end:0:$2:0"> </span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body"><span class="UFICommentBody" data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0"><span data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0.$end:0:$2:0">"Obstetric
violence is the act of disregarding the authority and autonomy that
women have over their own sexuality, their bodies, their babies and in
their birth experiences.</span><br data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0.$end:0:$3:0" /><span data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0.$end:0:$4:0">"It
is also the act of disregarding the spontaneity, the positions, the
rhythm and the times the labour requires in order to progress normally
when there is no need for intervention.</span><br data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0.$end:0:$5:0" /><span data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.0:$comment-body.0.$end:0:$6:0">"It is also the act of disregarding the emotional needs of mother and baby throughout the whole [childbearing] process"</span>
</span></span><span data-reactid=".n.1:3:1:$comment642538065800566_642870972433942:0.0.$right.0.$left.0.0.3"></span><iframe allowfullscreen="" frameborder="0" height="344" src="//www.youtube.com/embed/7MWXV4Wbld8" width="459"></iframe><br />
<br />
<br />
<br />
This video was prepared by <span class="fwb fcg" data-ft="{"tn":";"}"><a data-hovercard="/ajax/hovercard/user.php?id=100001011035723&extragetparams=%7B%22directed_target_id%22%3A333928523328190%7D" href="https://www.facebook.com/jesusaricoy" id="js_5">Jesusa Ricoy-Olariaga . </a></span><br />
<br />
Further comment and discussion at <a href="http://villagemidwife.blogspot.com.au/2014/04/obstetric-violence-in-australia-today.html">villagemidwife blog</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-37859944160823730922014-03-31T09:12:00.000+11:002014-03-31T09:12:18.848+11:00AdvertisingThe new AHPRA Advertising Guidelines came into effect 17 March, and we await the next move. See previous posts for the detail of our concerns.<br />
<br />
AHPRA has responded to pressure from professional groups. The NMBA and other Boards are using a system of <a href="http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ.aspx">updated FAQ</a> (frequently asked questions)<br />
<br />
<blockquote class="tr_bq">
Updated on 24 March
</blockquote>
<br />
<blockquote class="tr_bq">
...
</blockquote>
<br />
<blockquote class="tr_bq">
<b>There is a clear difference between advertising – which requires an advertiser’s intent to promote a health service – and unsolicited online comment, which does not involve an advertiser’s intent to promote a health service.</b></blockquote>
<br />
<br />
This seems to clarify the issue of unsolicited positive comments about a midwife that may appear on social media, on a site that is not under the control of the midwife.<br />
<br />
It does not clarify the issue of Birth Stories which are posted on, or linked to, the midwife's website or social media site. Many birth videos and photo montages identify the midwife. This has been discussed <a href="http://villagemidwife.blogspot.com.au/2014/02/birth-stories-why-are-they-important.html">earlier</a>. <br />
<br />
The question in our minds will be, does AHPRA consider that everything posted on a midwife's website is advertising? <br />
<br />
<br />
Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-15658291349083548312014-03-23T16:39:00.000+11:002014-03-23T16:45:05.353+11:00AHPRA ACTION Campaign: enough is enough!<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-9NKvgGZ9WwA/Uy5zRyU7YgI/AAAAAAAACxo/4-IY-lvCYnE/s1600/ahpraaction-logo.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-9NKvgGZ9WwA/Uy5zRyU7YgI/AAAAAAAACxo/4-IY-lvCYnE/s1600/ahpraaction-logo.jpg" height="320" width="320" /></a></div>
<br />
Readers who have been following the health professional news about the new AHPRA Advertising Guidelines are invited to sign this Change.org petition, which petitions AHPRA to remove Section 6.2.3 from the Advertising Guidelines. <a href="http://www.change.org/en-AU/petitions/australian-health-practitioner-regulatory-agency-ahpra-remove-section-6-2-3-from-the-advertising-guidelines">SIGN HERE</a><br />
<br />
By way of reminder ... from the <a href="http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx">Advertising Guidelines</a>:<br />
<blockquote class="tr_bq">
6.2.3 Testimonials<br />
Section 133 of the National Law states:<br />
<i>(1) A person must not advertise a regulated health service, or a
business that provides a regulated health service, in a way that – </i><br />
<i>... </i><br />
<i> (c) Uses testimonials or purported testimonials about the service or business </i></blockquote>
For more about this part of the Guideline, go to <a href="http://midwivesvictoria.blogspot.com.au/2014/02/birth-stories.html">Birth Stories</a>. <br />
<br />
It has occurred to me that even Birth Notices that were very popular in the past, when we all read the daily newspaper, could have breached AHPRA's extremely narrow interpretation of 'testimonial'. [I think social media has replaced the Birth Notices column in the newspaper!]<br />
<br />
<br />
In discussing Birth Stories within the (relative) sanctuary of a closed facebook group for eligible midwives, one midwife expressed the opinion that " <span data-ft="{"tn":"K"}" data-reactid=".19.1:3:1:$comment751361151550347_753340321352430:0.0.$right.0.$left.0.0.0:$comment-body"><span class="UFICommentBody" data-reactid=".19.1:3:1:$comment751361151550347_753340321352430:0.0.$right.0.$left.0.0.0:$comment-body.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753340321352430:0.0.$right.0.$left.0.0.0:$comment-body.0.$end:0:$0:0">birth
stories belong to women, and [I] do not see why midwives feel they have to
publish them, and think they could be construed as advertising if
published in midwives' own space."</span></span></span><br />
<br />
<br />
<span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:2"></span><span data-ft="{"tn":"K"}" data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body"><span class="UFICommentBody" data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.0.$text0:0:$0:0">Time will tell!</span></span></span></span><br />
<br />
<span data-ft="{"tn":"K"}" data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body"><span class="UFICommentBody" data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.0.$end:0:$2:0">Yes,
birth stories do belong to women - and if you can show me a birth story
that focuses on the midwife and appears to have a purpose or intention
to </span></span><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$0:0">promote (/advertise) that midwife's practice, then perhaps it could be called a testimonial. </span><br data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$1:0" /><br data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$3:0" /><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$4:0">The guideline says "Testimonials can distort a person’s judgment in his or her choice of health practitioner." </span><br data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$5:0" /><br data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$7:0" /><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$8:0">The
overarching purpose of regulation of health professionals is the
protection of the public. Protection of the public from rogue or
negligent or incompetent professionals and the like. Protection of the
public from charlatans and snake oil sellers who would deceive and
manipulate unsuspecting potential clients.</span><br data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$9:0" /><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$10:0"> </span></span></span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body"><span class="UFICommentBody" data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0"><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$10:0">The scope of the midwife who works in primary maternity care, and the leading theme in birth stories, is natural, unmedicated, unmanaged, (sometimes noisy, sometimes messy, always unpredictable) birth. Natural
childbirth is unique in the spectrum of health care: it requires the
woman to do *it* herself! There are no shortcuts, no special breathing
techniques, no therapies, no magic words or products to be bought, that
make natural childbirth better than it already is. </span><br data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$11:0" /><br data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$13:0" /><span data-reactid=".19.1:3:1:$comment751361151550347_753373588015770:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$18:0">It
seems to me that AHPRA is looking for a broad brush that covers every
possibility in regulated health. I don't think AHPRA is necessarily
targeting midwives in the 'patient stories' part of the guideline.</span></span></span></span></span><br />
<br />
<br />
In conclusion (for now), I support the AHPRA ACTION campaign, and have signed the petition calling for the removal of Section 6.2.3.<br />
<br />
The National Law, which prohibits the use of testimonials in advertising the service or business of a regulated health professional, continues. The onus in this matter must be for AHPRA to demonstrate that the statement (comment - positive or negative - that identifies a regulated health professional on social media, midwife's website, YouTube video, or newspaper Birth Notice) must be shown to be <b>advertising</b> the practitioner or the service in order for it to be called a <b>testimonial</b>.<br />
<br />
<br />
An excellent <a href="http://doctorsbag.wordpress.com/category/social-media/">series of blog posts about 'social media' </a>by
Geraldton WA GP Dr Edwin Kruys provide more argument and comment,
particularly from the medical practitioner's point of view. You can
follow Dr Kruys on Twitter at <a href="https://twitter.com/EdwinKruys">https://twitter.com/EdwinKruys</a>.<br />
<br />
<br />
Note: The opinions expressed in this post are those of the writer, Joy Johnston.<br />
<br />
Your comments are welcome.<br />
<br />
<br />Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1354191651322376251.post-24899233907257030712014-03-08T14:15:00.001+11:002014-03-23T16:51:07.644+11:00... more on health professionals and advertisingThis post is a continuation of the discussion on <a href="http://midwivesvictoria.blogspot.com.au/2014/02/birth-stories.html">Birth Stories</a> a couple of weeks ago on this blog, and on the <a href="http://villagemidwife.blogspot.com.au/2014/02/birth-stories-why-are-they-important.html">villagemidwife </a>blog.<br />
<br />
<a href="http://www.ahpra.gov.au/">AHPRA </a>has published several revised guidelines that are to become effective from 17 March.<br />
<blockquote class="tr_bq">
For registered health practitioners<br />
Guidelines for advertising regulated health services<br />
March 2014
</blockquote>
<blockquote class="tr_bq">
... "A practitioner must take reasonable steps to have any testimonials
associated with their health service or business removed when they
become aware of them, even if they appear on a website that is not
directly associated and/or under the direct control or administration of
that health practitioner and/or their business or service. <b>This
includes unsolicited testimonials.</b> (emphasis added)"
</blockquote>
<br />
An article <i>Medical board’s online backflip </i><br />
7th Mar 2014<br />
Neil Bramwell<br />
published in <a href="http://www.medicalobserver.com.au/">Medical Observer</a> adds another perspective to this interesting dilemma faced by AHPRA: that an aspect of the revised guidelines are not acceptable or workable. <br />
<blockquote class="tr_bq">
... But [Medical Board of Australia] MBA chair, Dr Joanna Flynn, has now said the policy was only ever intended to apply
to proactive advertising or promotion of a regulated health service.
“There is a clear difference between advertising, which requires an intent to promote the
health services, and unsolicited online comment over which practitioners do not usually
have control,” she said. </blockquote>
<br />
<blockquote class="tr_bq">
... However, the MBA now recognises that practitioners are unable to control what is written
about them in a public forum.</blockquote>
This article relates to a statement <a href="http://www.medicalboard.gov.au/News/2014-04-07-online-comment-not-always-advertising.aspx">'Online comment not always advertising' </a>by the Medical Board at the MBA website.<br />
<br />
... the Medical Board "now recognises that practitioners are unable to control what is written about them in a public forum." - good!<br />
<br />
Can you imagine a health practitioner trying to follow public forums, then trying to get them to take down anything that mentioned them in connection with clinical issues?<br />
<br />
The guideline is branded by AHPRA, and adapted for each of the professional Boards. I expect the NMBA will follow the MBA.<br />
<br />
How did the regulatory authority not see this? The guideline is clear:<br />
<blockquote class="tr_bq">
"... even if they appear on a website that is not
directly associated and/or under the direct control or administration of
that health practitioner and/or their business or service. <b>This
includes unsolicited testimonials."</b> </blockquote>
The revised <i>Guidelines for advertising regulated health services </i>need to be revised to remove these unworkable, misguided statements. <br />
<br />
<br />
The other issue for midwives is the use of birth stories, which the guideline refers to as testimonials ('patient stories'), which are prohibited under the Act. I (Joy Johnston) have written to the NMBA about this - we must argue strongly that birth stories that are freely written by the woman are not for the purpose of advertising, and should not be classed as testimonials.<br />
<br />
<br />
Midwives, please don't take birth stories off your websites; don't delete the name of the midwife; don't ask women to be silent about their experience of birth. We need to stand firm on this one. <br />
<br />
<br />
Disclaimer:<br />
Opinions expressed in this article are those of the author, Joy Johnston.<br />
<br />
<br />
<span style="background-color: yellow;">Additional information 17/3/14</span><br />
A legal opinion on the matter <br />
AHPRA UPDATES THE RULES: TESTIMONIALS AND SOCIAL MEDIA ARE IN THE REGULATOR’S SIGHTS is available at <br />
<a href="http://www.tresscox.com.au/resources/resource.asp?id=1474#.UyZ69IV7SUP">http://www.tresscox.com.au/resources/resource.asp?id=1474#.UyZ69IV7SUP </a><br />
<br />
<div class="post-title entry-title" itemprop="name">
<span style="background-color: yellow;">Another link added 22/3/14 </span><a href="http://sarah-stewart.blogspot.com.au/2014/03/ahpra-provides-guidance-for-guidance-on.html">Sarah Stewart's blog post:</a> AHPRA provides guidance for the guidance on advertising, but still leave health professionals with concerns
</div>
<a href="http://blogs.crikey.com.au/croakey/2014/02/25/no-comment-now-the-medical-board-tests-social-media-landscape-with-advertising-guidelines/">Croakey</a> ‘No comment’: now the Medical Board tests social media landscape with advertising guidelines
<span class="entry-meta author vcard"><a class="url fn n" href="http://blogs.crikey.com.au/croakey/author/mariemc/" title="">Marie McInerney</a></span><br />
<br />
<span class="entry-meta author vcard"> </span>
<br />
<span class="meta-sep"></span><br />
Your comments are welcome. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-22183409453856891882014-02-26T21:46:00.002+11:002014-02-26T21:46:52.868+11:00New private midwifery practice in Brunswick<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-grE3ziRWzEU/Uw3FRIDE-jI/AAAAAAAACvo/bXjVuBp4Lig/s1600/My+Midwives.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-grE3ziRWzEU/Uw3FRIDE-jI/AAAAAAAACvo/bXjVuBp4Lig/s1600/My+Midwives.jpg" height="392" width="400" /></a></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">The My Midwives premises at 31 Weston St Brunswick has been
fitted out especially to create a warm and inviting community hub for pregnant
women and families in the early post-natal period.<span style="mso-spacerun: yes;"> </span>The services offered will include Medicare
rebateable pregnancy and postnatal care, lactation services, antenatal education,
pre and postnatal yoga and a range of complementary therapies.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Enquiries:<span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Gabriella
Piemonte 0425 774 543<span style="mso-spacerun: yes;"> </span>Hannah
Quanchi<span style="mso-spacerun: yes;"> </span>0400 564 103 <a href="https://www.blogger.com/null" name="_GoBack"></a></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-74655192659728174012014-02-21T16:10:00.000+11:002014-02-24T11:20:17.607+11:00Birth storiesWomen have written and told their birth stories, and shared their birth pictures for as long as I can remember. Birth stories have been a significant part of the natural birth movement, as women have claimed ownership and responsibility for their life decisions, including decisions related to maternity care. Since the advent of the wonderful www, birth stories have been placed on websites, forums, blogs, and other social media sites. A quick review of the midwives websites linked to this page tells us that many midwives have 'Birth Stories' as one of the features of their sites.<br />
<br />
A new revised version of the<a href="http://www.nursingmidwiferyboard.gov.au/"> NMBA </a>guideline for advertising regulated health services, to come into effect next month (March 2014), appears to prohibit the publication of birth stories by midwives, or by others who may (intentionally or not) link a midwife to the story.<br />
<br />
The National health practitioner law prohibits testimonials as a form of advertising. The revised guideline states (p9):<br />
<br />
<blockquote class="tr_bq">
6.2.3 Testimonials<br />
Section 133 of the National Law states:<br />
<i>(1) A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that – </i><br />
<i>... </i><br />
<i> (c) Uses testimonials or purported testimonials about the service or business </i><br />
<br />
The National Law does not define ‘testimonial’, so the word has its ordinary meaning of a positive statement about a person or thing. In the context of the National Law, a testimonial includes recommendations, or statements about the quality of a regulated health service including clinical care, personal experiences of a regulated health service or about the benefits of a particular practitioner or regulated health service by someone who received the service. Testimonials can distort a person’s judgment in his or her choice of health practitioner. They may misrepresent the skills and or expertise of practitioners and create unrealistic expectations of the benefits such practitioners may offer health consumers. Testimonials in advertising include:<br />
1. using or quoting testimonials on a website, such as patients posting comments about a practitioner on the practitioner’s business website, particularly when the website encourages patients to post comments and/or selectively publishes patient comments, and/or<br />
2. the use of patient stories to promote a practitioner or regulated health service.<br />
<br />
There are a number of independent websites that invite public feedback/reviews about a patient’s experience of a regulated health practitioner, business and/or service. These websites are designed to help consumers make more informed decisions and increase transparency of interactions.<br />
<br />
A review is not considered to be a testimonial or purported testimonial, in breach of section 133 (1)(c) of the National Law when it only comments on non-clinical issues, regardless of whether it is positive, negative or neutral.<br />
<br />
Reviews must not contain statements about the quality of clinical care received from the regulated health practitioner, business and/or service.<br />
<br />
A practitioner must take reasonable steps to have any testimonials associated with their health service or business removed when they become aware of them, even if they appear on a website that is not directly associated and/or under the direct control or administration of that health practitioner and/or their business or service. This includes unsolicited testimonials.<br />
<br />
‘Reasonable steps’ include taking action in the practitioner’s power, such as directly removing, or requesting removal, of the testimonials. For example, a review on a social media site that states ‘Appointment ran very late and magazines were old’, is not considered a testimonial as it makes no reference to the clinical care provided by a regulated health practitioner, business or service. However, a review on the same social media site that states ‘Practitioner was quick to diagnose my illness and gave excellent treatment’, is a testimonial which references clinical care and is considered in breach of the National Law.<br />
<br />
Once the practitioner becomes aware of the testimonial, they must take reasonable steps to have the testimonial removed (also refer to Section 7.1 on social media). </blockquote>
<br />
<span data-ft="{"tn":"K"}" data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body"><span class="UFICommentBody" data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0"><span data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.0"><span data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.0.$end:0:$0:0">
This new guideline appears to prohibit birth stories either on the midwife's
website or somewhere else. <span style="background-color: yellow;">"T</span></span></span><span data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3"><span data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0"><span data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$text0:0:$0:0"><span style="background-color: yellow;">estimonials
in advertising include ... 2. the use of patient stories to promote a
practitioner or regulated health service"</span> and <span style="background-color: yellow;">"a testimonial which
references clinical care and is considered in breach of the National
Law."</span> There are some lovely birth montages and videos on youtube that
give a visual promotion of the birth - including pictures of the
midwives and reference to their names. Are these also in breach of the law?</span><a class="" data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$range0:0" dir="ltr" href="http://www.youtube.com/watch?v=H_z2LHkjXBw" rel="nofollow" target="_blank"></a><br data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$1:0" /><br data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$3:0" /><span data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$4:0">Perhaps
it could be argued that a birth story or montage (on the midwife's site
or someone else's) is not being used to *promote* the practitioner;
rather to educate the public. I don't think this argument would hold.
Midwives are in business, and businesses promote themselves because the
only way they can keep going is if they make enough money. </span><br data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$5:0" /><br data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$7:0" /><span data-reactid=".1u.1:3:1:$comment485332811571328_488785067892769:0.0.$right.0.$left.0.0.0:$comment-body.0.3.0.$end:0:$8:0">It
seems to me as though there is a problem with this very inclusive
definition of the word 'testimonial'. Surely a person's story of their
own birth is theirs to tell or not? The guideline says "<span style="background-color: yellow;">Testimonials
can distort a person’s judgment in his or her choice of health
practitioner."</span> </span></span></span></span></span> <br />
<br />
The overarching purpose of regulation of health professionals is the protection of the public. Protection of the public from rogue or negligent or incompetent professionals and the like. Protection of the public from charlatans and snake oil sellers who would deceive and manipulate unsuspecting potential clients.<br />
<br />
Perhaps this sort of restrictive guideline is appropriate in health related services that may be seen to prey on people's vanity: expensive medical or surgical treatments that are carried out, with little chance of lasting effect on health or wellbeing? Perhaps this is an instance in which the midwife is different from other regulated health practitioners?<br />
<br />
It would appear that the strong arm of the law is being used as 'Goliath' against the 'David' of the natural childbirth movement. Natural childbirth is unique in the spectrum of health care: it requires the woman to do *it* herself! There are no shortcuts, no special breathing techniques, no therapies, no magic words or products to be bought, that make natural childbirth better than it already is. <br />
<br />
Would the birth story of a woman who wanted to give birth naturally after a previous caesarean be able to 'distort a person's judgment' about the professional capacity of the midwife? Surely there is benefit to the public in being able to consider the events and decisions that led to the birth of a baby?<br />
<br />
If birth stories (aka testimonials, under the revised guidelines) really can distort a woman's judgment in her choice of midwife, would it not be more reasonable to require a disclaimer to be displayed with birth stories, warning the public about this risk? By removing birth stories from publicly accessible sites, are we returning to old ways, speaking only of such things in hushed tones behind closed doors? Surely that is not appropriate in today's world.<br />
<br />
Disclaimer:<br />
Opinions expressed in this article are those of the author, Joy Johnston. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-NHHltnmdjos/Uwbb6PLJVJI/AAAAAAAACvI/QEg2dTVdiSk/s1600/Nik1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://1.bp.blogspot.com/-NHHltnmdjos/Uwbb6PLJVJI/AAAAAAAACvI/QEg2dTVdiSk/s1600/Nik1.jpg" height="206" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Thanks to Niki for sharing this special moment</td></tr>
</tbody></table>
<br />Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1354191651322376251.post-33423440361311656442014-02-08T09:00:00.001+11:002014-02-16T08:03:44.881+11:00What medicines are midwives prescribing nationally?<b><span style="background-color: yellow;">Please note:</span></b><br />
<span style="background-color: yellow;">If you are a midwife prescriber in Australia, you are invited to contribute to this <a href="https://www.surveymonkey.com/s/DV3RCFS">survey.</a></span><br />
<br />
<br />
<br />
There is a high degree of enthusiasm amongst midwives who have achieved endorsement as prescribers.<br />
<br />
The <a href="https://www.facebook.com/groups/1466089226948534/">Midwife prescriber </a>facebook group facilitates discussion about prescribing issues. The group welcomes members who have the <a href="http://www.medicareaustralia.gov.au/provider/other-healthcare/nurse-midwives.jsp">eligible midwife prescr</a><span class="text_exposed_show"><a href="http://www.medicareaustralia.gov.au/provider/other-healthcare/nurse-midwives.jsp">iber endorsement</a>, and those who are working toward it, and others who have a strong interest in the subject. At the time of writing there are 130 members.<br /> </span><br />
<span class="text_exposed_show"></span><br />
<a name='more'></a><span class="text_exposed_show">A small group of midwife prescribers have put together this survey, and will report on the responses received. This survey </span>is the first in what we hope will be a series of fact-finding
questionnaires, for midwives who have prescriber notation on their
registrations. These are some of the questions:<br />
<br />
<br />
IN THE SIX MONTHS JULY-DECEMBER 2013:<br />
<ul>
<li>please list any scheduled medicines, and the dose, for which you have written a prescription to be filled by a pharmacist.</li>
<li>please list any medicines, and the dose, that you have used from stock that you carry for emergency use (eg Syntometrine) </li>
<li>how many prescriptions have you written? (if you have not kept a record, please write 'estimated X')</li>
</ul>
<br />
<ul>
<li>Are
there any scheduled medicines that you consider need to be added to the
NMBA or state/territory lists for midwife prescribers? </li>
</ul>
<br />
GENERAL INFORMATION:<br />
<ul>
<li>what is the postcode for the location of your main place of practice</li>
<li>is your private midwifery practice in a group practice/solo/other? Please tell us about your practice. </li>
<li>in what year did you commence private midwifery practice? </li>
</ul>
<br />
IN THE SIX MONTHS JAN-JUNE 2014: <br />
<ul>
<li>how many prescriptions do you expect to write?</li>
<li>what is your expected caseload for the coming six month period, for whom
you provide midwifery care through the pre-, intra- and postnatal
period? </li>
</ul>
<br />
Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-49617278754687479842014-01-18T21:43:00.000+11:002014-02-16T08:04:31.943+11:00A new vision for maternity care<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-ERMY-x0dPfU/UtobH_TgqyI/AAAAAAAACt4/sIhyuafzeIc/s1600/ScanImage001.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://2.bp.blogspot.com/-ERMY-x0dPfU/UtobH_TgqyI/AAAAAAAACt4/sIhyuafzeIc/s1600/ScanImage001.jpg" height="320" width="212" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">ARM 2013 - click to enlarge</td></tr>
</tbody></table>
<span style="font-size: large;">The mother-midwife relationship:</span><br />
<span style="font-size: large;"><i>"central to maternity care: the midwife caring for the mother and providing a safe space in which she can develop confidence in her own ability to give birth and mother her baby."</i> (ARM 2013, p3)</span><br />
<br />
<br />
<br />
<br />
<br />
Last year, 2013, the UK Association for Radical Midwives (ARM) published its <a href="http://www.midwifery.org.uk/?p=593">New Vision for Maternity Care</a>.<br />
<br />
The basic principles are copied in this post. The Vision document is only 16 pages, and well worth the read. In the Conclusion, ARM states:<br />
<blockquote class="tr_bq">
<i>"This is our New Vision for the maternity services of the future. We wish to change the perceptions of the general public about birth and about midwives so that we can practise the profession for which we have been trained. Organisational change and financial and educational input is needed to start the process. Once women know other women who have experienced birth with continuity of care and real autonomy, whether at home or in hospital, this care will be expected. This new standard of care will bring about improved clinical outcomes for mother and baby, substantial savings for the NHS and positive cultural change within maternity services and the wider public. Babies whose mothers have a more confident start to motherhood will have a happier and healthier start to life.</i><br />
<i></i></blockquote>
<blockquote class="tr_bq">
<i>Midwives are unique in their combination of skill, sensitivity and training to be 'with woman' through one of life's landmark experiences which has long-term effects on the individual, the family and society as a whole. We must generate a new respect for both motherhood and midwifery. We owe it to ourselves and to future generations."</i></blockquote>
<br />
<br />
<a name='more'></a>Australian midwives have for many years looked to the United Kingdom for inspiration, as we attempt to survive professionally in a climate of extreme medical dominance. The UK Changing Childbirth: Report of the Expert Maternity Group (1993) declared the 3C's loudly and clearly: that women want, and deserve, Choice, Continuity, and Control.<br />
<br />
Reviews of the best available research have consistently declared that continuous care from a known midwife brings significant advantages in terms of improved outcomes, and better satisfaction by the woman and the midwife. <br />
<br />
<br />
The question that comes to mind as I read the ARM <i>New Vision for Maternity Care</i> is, what vision do we have in Australia? How does Australian maternity vision care compare with that of the UK?<br />
<br />
<br />
Back in 2002, a group of Australian mothers, midwives, and maternity-philes, working under the auspices of Maternity Coalition (MC), published the National Maternity Action Plan <a href="http://www.maternitycoalition.org.au/nmap.html">NMAP. </a><br />
This project, developed under the joint leadership of Tracy Reibel, who was Program Manager of the Community Midwifery Program in Perth and Freemantle, WA, and Barb Vernon, at the time national president of MC. Using our relatively newly acquired skills with internet communication, this national collaboration came up with a vision for reform of Australian maternity services, changing from a 'top-down' obstetric dominated model, to a 'bottom-up' model that placed the woman-baby duo as the focus and centre of care. <br />
<br />
NMAP called on our government to enable choice: that each pregnant woman would be free to choose a midwife as her primary care provider; and access: that the woman would be free to give birth at home or in a public hospital, in the care of her known midwife, and all within public maternity funding.<br />
<br />
There were little ripples that went out from NMAP, with caseload midwifery programs being established in various public hospitals, and a few new homebirth programs introduced. Worthwhile, but too few and far between. Competition for bookings was often fierce. Women who applied to be cared for within caseload models were often disappointed. Furthermore, 'modified' arrangements, apparently designed to improve cost/productivity reduced the likelihood of women being attended in labour by their known and trusted midwife. Midwives who challenged the <i>status quo</i> were informed that a woman who used public maternity services should not expect the 'Rolls Royce' model! (Meaning that if choice and continuity of care was the best, it was not going to be offered to women who paid nothing for their care). In the meantime, private obstetrics accounted for the care of one woman in three, most of whom were classed 'low risk', with consistently high rates of medical interventions such as induction of labour and caesarean birth. <br />
<br />
Then, in 2008, after lobbying and huge efforts on many fronts, the federal government announced its Maternity Services Review. I was personally delighted to see, in the Discussion Paper, <i>Improving Maternity Services in Australia</i>, reference to NMAP. The Discussion Paper noted Australia's low rate of home birth and midwife led models, and in the context of the review it appeared that the reference was favourable towards home birth: <br />
<blockquote class="tr_bq">
"This contrasts with some other countries,
which have considerably higher rates of
home births and births in midwife-led
environments equivalent to Australian birth
centres. In New Zealand, 2.5% of women
had a birth at home, compared with
1.9% of women in the UK and 0.2% of
Australian women." (p11)</blockquote>
The Discussion Paper discussed primary maternity care, with statements about continuity of care and greater choice, such as:<br />
<blockquote class="tr_bq">
"A key area is to expand the scope, within
both public and private sectors, for women
to achieve greater choice and increased
continuity of care. This includes being able to
choose, where clinically appropriate, a midwife-
led service."(p14)</blockquote>
<br />
Many who had held the vision of continuity of care and choice where delighted. We all wrote submissions to the Maternity Services Review; hundreds were received, and placed on the government's website for public access. Comments were recorded at this blog site, such as <a href="http://midwivesvictoria.blogspot.com.au/2008/12/maternity-services-review-update.html">here</a>. <br />
<br />
HOWEVER!<br />
<br />
<br />
The report of the review, while repeating phrases such as 'informed choice', categorically prevented the NMAP vision of choice of place of birth from progressing. While many of the consumer submissions, as well as midwives' responses, pleaded for publicly funded homebirth options, the report deftly dodged the issue:<br />
<blockquote class="tr_bq">
<i>"Issues raised by consumers of maternity care included the limited availability of models of care consistent with their expectations; the impacts upon themselves, their babies and their families from the type of maternity care they experienced; difficulties in sourcing information and making informed choices on maternity care; their perceptions of risk; and, for many, their desire that pregnancy and birth be seen as a natural process." (Report, p4)</i></blockquote>
<br />
Maternity reform since 2010 has brought into maternity services a mixed bag - some would call it a 'dog's breakfast'. For example:<br />
<ul>
<li>Homebirth is still the main setting for private midwifery practice, as most midwives are NOT able to access visiting privileges at hospitals.</li>
<li>Scores of experienced midwives have achieved notation as eligible, and have resigned from their hospital jobs and set up private practices, with the intention of providing Medicare-rebated midwifery continuity of care. Most of these midwives have not been able to achieve hospital visiting access, and have joined the ranks of the independent homebirth midwives who travel great distances to visit clients and compete strongly with each other for enough business to keep the wolf from the door. </li>
<li>Midwives practising privately are now able to purchase professional indemnity insurance that covers pre- and post-natal services, but NOT homebirth. Surely the birth is the main event of maternity care!
</li>
<li>Midwives practising privately are able to purchase professional indemnity insurance for births in hospitals, BUT (more than three years after the reforms were implemented) there are only a small handful of hospitals in South-East Queensland where this is an option.</li>
<li>Midwives who are eligible for Medicare rebates on their services are required to have a signed collaborative arrangement with a medical practitioner. BUT, doctors are not obliged to enter a collaborative arrangement. </li>
<li>Instead of improving choice and continuity of care for women, the Medicare reforms have increased the complexity of care for well women who are quite within the scope of the midwife as primary carer. Women receive the 'carrot' of some Medicare rebate, but most who plan homebirth continue to be out of pocket by approximately $4000 for an episode of care from eligible midwives.</li>
</ul>
<br />
In conclusion, I would like to quote again from ARM's <i>New Vision (2013)</i>:<br />
<blockquote class="tr_bq">
<i>"... that services would be funded and organised from the bottom up around individual women and their families and within the communities in which they live. Birth at home or in a local birth centre should be the preferred option for all low-risk women. Community maternity care needs separate funding to promote, enable and support normal birth where possible. This is a more efficient, less costly, friendlier and safer way to provide maternity care.</i><br />
<i>Instead of being the default place of birth, the consultant-led obstetric unit would become the place to care for women at higher risk of complications and a place for transfer in labour for emergency care ... [with] continuity of care from a known midwife."</i> (p3)</blockquote>
<br />
I would encourage everyone who has an interest in maternity care to maintain the hope that the vision, of the woman at the centre having choice and continuity from a known midwife primary carer, will one day be achieved for all women. <br />
<br />
<br />
The opinions expressed here are those of the author,<a href="http://villagemidwife.blogspot.com.au/"> Joy Johnston</a><br />
Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-88919003827942757072014-01-08T20:36:00.003+11:002014-02-16T08:05:10.655+11:00MATERNITY INFOSHEETSMaternity Coalition has had a group of <a href="http://www.maternitycoalition.org.au/info-sheets.html">INFOSHEETS </a>available online since 2006. INFOSHEETS provide consumer information that is current, accurate, evidence based, women centred, and independent of maternity care providers. INFOSHEETS will assist women to make informed decisions about their maternity care, regardless of their chosen place of birth or care provider. <br />
<br />
These documents are presented as .pdf files, which can be downloaded, copied and distributed freely without change. They are used by midwives, as handouts to clients, at public events, and by other maternity education providers.<br />
<br />
Over time each of the INFOSHEETs needs to be reviewed, revised and updated. Any document that is found to have errors or out of date information can be revised immediately. New INFOSHEETS can be developed at any time.<br />
<br />
Anyone who would like to have a part in the current review process, please join the <a href="https://www.facebook.com/groups/480618588725927/">MATERNITY INFOSHEETS</a> facebook group.<br />
<br />
<br />
<a name='more'></a>At present we are reviewing the following INFOSHEETS:<br />
<br />
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<blockquote class="tr_bq">
<span style="font-size: small;"><span style="color: black;"></span></span><br />
<div class="Text20">
<span style="font-size: small;"><span style="color: black;"><span lang="en-AU">A healthy newborn baby who is kept in skin to skin contact with the mother from birth will begin to seek her breast, usually within minutes of birth. Experts have advised that early initiation of breastfeeding can prevent 22% of all deaths among babies below one month of age in developing countries. Early breastfeeding also protects the health of Australian babies.</span></span></span></div>
<span style="font-size: small;"><span style="color: black;">
</span></span>
<br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="color: black;">Newborn babies, whether they are born naturally or with medical assistance, have natural instincts that enable them to move towards the breast and begin breastfeeding soon after birth. This process is known as the ‘Breast Crawl’. ...</span></span></div>
<span style="font-size: small;"><span style="color: black;">
</span></span></blockquote>
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<div class="TITLE" style="text-align: left;">
<b><span style="font-size: small;"><span lang="en-AU">“</span><span lang="en-AU" style="font-family: "Arial Unicode MS"; font-style: italic;">Who cares?”</span><span lang="en-AU"> </span><span lang="en-AU" style="font-family: "Arial Unicode MS";">Choosing a Model of Maternity Care</span></span></b></div>
<div class="TITLE" style="text-align: left;">
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";"><!--[if !mso]>
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<blockquote class="tr_bq">
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";"></span></span><br />
<div class="Text20" style="margin-left: 27.75pt; margin-right: 12pt; margin-top: 5pt; text-indent: -14.25pt;">
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";"><b><span style="color: black; direction: ltr; font-family: Symbol; unicode-bidi: embed;">·</span><span style="width: 9.8pt;"> </span></b><span style="width: 9.8pt;"></span><span lang="en-AU" style="font-family: Arial; line-height: 125%;">The wellbeing of the mother and her child is the primary focus of all professional maternity care </span></span></span></div>
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";">
<b>
</b></span></span><br />
<div class="Text20" style="margin-left: 27.75pt; margin-right: 12pt; text-indent: -14.25pt;">
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";"><span style="color: black; direction: ltr; font-family: Symbol; unicode-bidi: embed;">·</span><span style="width: 9.8pt;"> </span><span lang="en-AU" style="font-family: Arial; line-height: 125%;">A midwife is the most appropriate primary carer in normal pregnancy and birth</span></span></span></div>
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";">
<b>
</b></span></span><br />
<div class="Text20" style="margin-left: 27.75pt; margin-right: 12pt; text-indent: -14.25pt;">
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";"><span style="color: black; direction: ltr; font-family: Symbol; unicode-bidi: embed;">·</span><span style="width: 9.8pt;"> </span><span lang="en-AU" style="font-family: Arial; line-height: 125%;">Midwives work collaboratively with doctors, nurses, and other professional care providers in complex pregnancy and birthing situations</span></span></span></div>
<span style="font-size: small;"><span lang="en-AU" style="font-family: "Arial Unicode MS";">
</span></span></blockquote>
... <br />
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<br />
<div class="TITLE" style="text-align: left;">
<b><span style="font-size: small;"><span lang="en-AU">Labour in Water</span></span></b></div>
<span style="font-size: small;">
</span><br />
<div class="Text20">
</div>
<blockquote class="tr_bq">
<div class="Text20">
<span style="font-size: small;"><span lang="en-AU">There are many ways in which a labouring woman and those providing care for her can either work with the natural process, or interfere. How you will manage pain is a decision that you need to consider in planning for spontaneous, unmedicated birth. Deep water immersion is a valuable, non-medical, drug free ‘comfort measure’ for women in labour. A pool or bath has a relaxing, calming, positive effect on everyone in your birth environment – you, your baby, your partner, your support people, and your care providers. ...</span></span></div>
</blockquote>
<blockquote>
<br />
<blockquote class="tr_bq">
<span style="font-size: small;">
</span><br />
<div class="MsoNormal">
<span style="font-size: small;"><span lang="en-AU"></span></span></div>
</blockquote>
</blockquote>
Other titles of INFOSHEETS are:<br />
<div class="MsoNormal">
<ul>
<li>A healthy pelvic floor after childbirth (2012) </li>
<li>Postnatal Exercises (2012) </li>
<li>Decision-making for breech births (2013)</li>
<li>A baby's transition from the womb to the outside world(2011) </li>
<li>The third stage of Labour (2011) </li>
<li>Preparing your Birth Plan (2006) </li>
<li>Births after Caesarean (2006) </li>
<li>Bearing down or directed pushing? (2006) </li>
</ul>
<br />
Please leave a comment at this site, or contact us via the MATERNITY INFOSHEETS link above, for more information. </div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-3833564172592036532013-12-19T14:33:00.003+11:002014-02-16T08:06:02.661+11:00Australia's mothers and babies 2011The AIHW report, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129545698">Australia's Mothers and Babies 2011</a>, has been released today. This and similar reports provide useful information about trends in maternity care across the nation. The <a href="http://www.aihw.gov.au/mothers-and-babies-publications/">AIHW </a>site has a large number of related publications.<br />
<br />
<br />
<span style="font-size: large;"><i>From the report:</i></span><br />
<br />
<blockquote class="tr_bq">
<ul>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[0].[2]">In
2011, there were 1,267 women who gave birth at home, representing 0.4 %
of all women who gave birth. The highest proportions were in Victoria
and Western Australia (0.8%) (Table 3.18). It is probable that not all
homebirths are reported t</span></span><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[0]">o the perinatal data collections.</span></span></span></span></span></li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<ul>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[2]"><a name='more'></a>The mean age of mothers who gave birth at home was </span><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[4]">31.7 years (Table 3.49). The proportion of mothers younger than 20 was 1.3%, and the proportion aged 35 and over was </span><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[6]">29.8%. </span></span></span></span></span></li>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[6]">The proportion of mothers who gave birth at home who identified as
being of Aboriginal and Torres Strait Islander origin was 1.1%. </span></span></span></span></span></li>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[6]">Most
women who gave birth at home were living in Major cities (70.8%) (Table
3.49).</span><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[8]"></span></span></span></span></span></li>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[8]">Of
mothers who gave birth at home, about one-quarter had their first baby
(22.3%), and 77.4% were multiparous. </span></span></span></span></span></li>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[8]">The predominant method of birth for
99.3% of women who gave</span> <span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[10]">birth at home was non-instrumental vaginal (Table 3.49). The presentation was vertex for 97.6% of women who gave birth at home.</span><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[12]"></span></span></span></span></span></li>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[12]">Of babies born at home in 2011, 99.2% were liveborn. The mean birthweight of these liveborn babies was 3,614</span> <span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[14]">grams
(Table 3.49). </span></span></span></span></span></li>
<li><span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[14]">The proportion of liveborn babies of low birthweight born
at home was 1.6%, and the proportion of preterm babies born at home was
1.3%.</span><br data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[15]" /><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703361929683603}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[16]">(pp65-66)</span></span></span></span></span> </li>
</ul>
</blockquote>
<br />
Some of the highlights from the press release linked to this report are:<br />
<br />
<blockquote class="tr_bq">
<ul>
<li>The report shows that in 2011, a total of 297,126 women gave birth to
301,810 babies. This was a small rise in the total number of births
compared with 2010 (almost 1%) and a rise of over 18% since 2002.</li>
<li>The average age of women having their first baby has increased
steadily from 27.6 years in 2002 to 28.3 years in 2011,</li>
<li>caesarean section rate has shown an upward trend in the 10 years
to 2011, rising from 27% to a peak of just over 32% between 2002 and
2011.</li>
<li>'Caesarean section rates increased with advancing maternal age,' Professor Sullivan said.</li>
<li>'In 2011, caesarean section rates ranged from 18% for teenage mothers to 49% for mothers aged 40 and over.'</li>
<li>Repeat caesarean sections occurred for 84% of mothers with a history
of caesarean section. About 1 in 8 mothers who had previously had a
caesarean section had a subsequent non-instrumental vaginal birth.</li>
<li>For Indigenous mothers, the caesarean section rate was 27%, significantly lower than for non-Indigenous mothers (32%).</li>
<li>'This may be partially explained by the younger age of Indigenous
mothers of 25.3 years compared to 30.2 years for non-Indigenous
mothers,' Professor Sullivan said.</li>
<li>In 2011, just over 6% of liveborn babies were of low birthweight
(less than 2,500 grams), and among mothers who smoked during pregnancy
the proportion of low birthweight babies was nearly double (11%).</li>
</ul>
</blockquote>
<blockquote class="tr_bq">
The AIHW is a major national agency set up by the Australian
Government to provide reliable, regular and relevant information and
statistics on Australia's health and welfare.<br />
Canberra, 19 December 2013</blockquote>
<br />
<b>MiPP Comment by Joy Johnston:</b><br />
<span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[0]"><br /></span></span></span>
<span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[0]">The
Victorian perinatal data collection unit used to publish an annual
Homebirths report, the same as they published a report for each hospital
- but this has apparently now ceased. The last one I have is 2008.</span><br data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[1]" /><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[2]"> </span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[2]">In
2010 the publicly funded homebirth programs from Sunshine and Casey
hospitals were commenced, and the pilot continued until Feb 2012, so
most of the publicly funded births in the pilot would have been in 2011,
and included in this AIHW report. The report of the pilot has been
published, and it appears that 139 women were eligible for
questionnaires. Not clear how many gave birth at home, but 88% of those
who responded to the questionnaires gave birth spontaneously. It's
always interesting when numbers are not published. </span></span></span><br />
<br />
<span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[2]">Midwives who have been attending homebirths in Victoria for many years suspect that the number of privately attended planned homebirths has grown considerably since 2010, when the federal government's maternity reforms enabled Medicare rebate for certain midwifery services provided by participating midwives. Homebirth was, in a curious twist of bureaucratic nonsense, excluded from rebatable services. However, since home is the only place that a privately employed midwife is able to practise at present, and since the focus of midwifery logically includes the birth in the continuum, it is not surprising that an increasing number of midwives are providing homebirth services for an increasing number of mothers. </span></span></span><br />
<span data-ft="{"tn":"K"}" data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[2]"> </span><br data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]" /><span data-reactid=".r[3dfn0].[1][3][1]{comment703356839684112_703368133016316}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[4]">Midwives please note the ACM Midwifery News (summer edition) - you will see
an article that I wrote, reviewing private midwifery in Victoria. Readers who are not midwives, who would like to see this article, please contact me via email joy[at]aitex.com.au .</span></span></span><br />
<br />
<br />
Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-73518350435951232332013-11-28T16:56:00.000+11:002014-02-16T08:07:53.808+11:00relationships between independent midwives and public hospitalsMidwives who work independently, who are employed directly by the woman and her family to provide midwifery services in pregnancy, birth, and postnatally, are at the front of efforts to reduce unnecessary medicalisation of birth, and to protect, promote and support the natural processes in birth when ever this is reasonable.<br />
<br />
It would be simplistic and untrue to paint a black/white, bad/good picture of the medicalised birthing world (hospitals) compared with the holistic, woman-centred world of private midwifery and homebirth. Unfortunately, many of the stories of disempowered mothers who found themselves experiencing a cascade of medical interventions carried out by strangers, without their informed consent, are stories from hospitals.<br />
<br />
Equally lamentable are the stories that become public knowledge after coronial investigations into deaths, when midwives were providing care for planned homebirth. Any evidence of delay in advice by the midwife that the care should be transferred to hospital places a cloud over independent midwifery and homebirth.<br />
<br />
<br />
<a name='more'></a>Readers of this blog will know that one of the federal government's 2010 maternity reform promises has been the option of private midwifery care for birth in a public hospital. Here's how it would work:<br />
<br />
The eligible midwife who has a Medicare provider number, and an endorsement to prescribe certain medicines; who is insured with the government-backed professional indemnity insurance product - this midwife is theoretically able to apply to public maternity hospitals, and request the right to admit her clients to the hospital for intrapartum care. The hospital is expected to be able to authorise doctors to enter into an agreement with the midwife (or midwives) so that any consultation or referral during the episode of care is smooth, timely, and transparent, and in the interests of the wellbeing of mother and child. A midwife with admitting privileges would work within the hospital's protocols and risk management processes.<br />
<br />
<br />
The purists in the natural birthing community are not supportive of the plan for midwives to provide birthing services in public hospitals. The arguments might include:<br />
<ul>
<li>that the very act of leaving the safety and familiarity of one's own home could interrupt the sensitive hormonal processes of labour and natural birth. </li>
<li>that the ready availability of pain-relieving narcotic drugs and regional anaesthesia (epidural/spinal) would surely increase the likelihood of use, when compared with labouring at home. </li>
<li>that the easy access to the machine that goes 'ping', and other medical gadgets that are not available when a woman is labouring at home - surely there will be an increased reliance on these medical devices in hospital! </li>
</ul>
<br />
The current situation for independent midwives is that public hospitals do not want to throw their doors open to us. As was <a href="http://midwivesvictoria.blogspot.com.au/2013/11/private-in-public-midwifery.html">recently discussed </a>on this site, there is a significant number of eligible midwives, and this number is likely to continue growing. Each eligible midwife is potentially eager to take up hospital admitting privileges as soon as they are offered. A number of midwives who were employed in hospital maternity units until they achieved Medicare eligibility have now set up private practice, and have, in the past three years, quickly transitioned to homebirth practice. These midwives are up to date with all hospital competency requirements, and familiar with hospital processes, and could quickly take up the 'private midwifery in public hospital' option. Other midwives who have practised independently in the community for many years would require support to transition into the new model of maternity care.<br />
<br />
<br />
A midwife cannot afford to take an idealistic view of setting, or place of birth. Regardless of how much we endorse homebirth as a safe and wonderful place for most women to give birth, we need flexibility for those who choose or who need care that is beyond the scope of midwifery. The focus or centre of all midwifery care is the mother [woman+baby], and the midwife acts professionally to ensure the wellbeing and safety of her clients. There is no simple guideline that can predict those who may need specialist medical obstetric or paediatric care - the flexibility of the model must support access to emergency obstetric services when and if indicated.<br />
<br />
In bringing this post to a conclusion, I want to stress the importance of access to appropriately staffed and equipped hospitals for all women in their childbearing, and for all midwives who are suitably credentialled to provide professional services. <br />
<br />
The relationship between independent midwives and public hospitals needs a lot of work. Trust and respect are lacking. The hospitals have learnt to trust other health professionals who are not directly employed by the hospital - doctors, dentists, physiotherapists, pharmacists, and many others. There should be no difference for midwives. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-77974181801512838922013-11-11T15:12:00.000+11:002013-11-13T09:15:31.506+11:00'private in public' midwiferyA message today from Katy Fielding, Manager Acute Programs, Victorian Department of Health<br />
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<br />
<blockquote class="tr_bq">
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Dear colleagues</div>
<div class="MsoPlainText">
<br /></div>
<div class="MsoPlainText">
I would like to inform you that the Minister for Health
has recently approved the release of Eligible midwives and collaborative arrangements:</div>
<div class="MsoPlainText">
<a href="http://docs.health.vic.gov.au/docs/doc/CDC299AF59AE34EECA257C190010D1D1/$FILE/Eligible%20Midwives%20&%20Collaborative%20Arrangements.pdf"><b>An implementation framework for Victorian public healthservices (the framework)</b></a>.</div>
<div class="MsoPlainText">
<br /></div>
<div class="MsoPlainText">
You will recall that the framework aims to assist public
health services to assess how private midwifery services can operate at their
service. As the “private in public midwifery” service model is relatively new
in Victoria, the framework provides direction for public health services
wishing to establish collaborative arrangements with eligible midwives.<span style="mso-spacerun: yes;"> </span>The Department plans to evaluate the
framework once this new model of care has been in operation for a sufficient
period of time.</div>
<div class="MsoPlainText">
<br /></div>
<div class="MsoPlainText">
A hard copy of the framework has been distributed to CEOs
of public health services and is available on-line at <a href="http://www.health.vic.gov.au/maternitycare">www.health.vic.gov.au/maternitycare</a></div>
<div class="MsoPlainText">
<br /></div>
<div class="MsoPlainText">
I am grateful to all of you for your valuable
contribution to the development of this framework and welcome any feedback you
may have. ...</div>
</blockquote>
<div class="MsoPlainText">
</div>
<br />
Midwives who have Medicare numbers, and Prescriber numbers (ie achieved notation on their registrations as 'eligible', and endorsement as authorised to prescribe scheduled medicines) are well positioned to move into the new models, in cooperation and collaboration with mainstream public maternity hospitals.<br />
<br />
<b>How many midwives are we talking about?</b><br />
<br />
Registration data published by the <a href="http://www.nursingmidwiferyboard.gov.au/Search.aspx?q=eligible%20midwife%20notation">NMBA</a> for June 2013 noted that 48 (of 212 nationally) midwives in Victoria had notation as eligible midwives, and 8 (of 22 nationally) had endorsement to prescribe scheduled medicines. Those numbers are out of date, and we know that they are increasing each week. For example, a social media group set up for eligible midwives (nationally) has more than 200 members, and another group recently set up for midwife prescribers has 100 members.<br />
<br />
The conclusion I must draw is that there are many midwives who are ready to move out of employed models into private midwifery practice, as private practice has been redefined by the last federal government. I believe as midwives leave the mainstream system, it will become increasingly difficult for hospitals to staff their maternity units within the old fashioned shift work models. They will need to employ core staff only, and have midwives provide the basic care for their own clients, especially in labour, with early discharge wherever possible. Hospitals will become more and more restricted to providing acute care only.<br />
<br />
<b>What will 'private in public' midwifery look like?</b><b><br /></b>
From the<u> woman's </u>point of view, it will be similar to the option that some women have, by which they have a private doctor within a public hospital. Only this way they will have a private midwife who oversees and coordinates their care while they're admitted to a public hospital.<br />
<br />
From the <u>midwife's </u>point of view, the care provided will be similar to the option that some midwives have, by which they work in a caseload/continuity of care/'know your midwife' model. Midwifery practices will make their own decisions as to how they provide 24/7 midwifery cover - whether in a simple 'one to one' model, or having a named midwife on call covering a particular period, then off call at other times. All midwives providing this 'private in public' midwifery option will be notated as eligible, will have government supported professional indemnity insurance covering intrapartum midwifery services in hospital, and will be credentialed by the hospital for clinical access.<br />
<br />
From the <u>hospital's </u>point of view, the specified medical practitioner who will act as the collaborating consultant obstetrician at any time when a visiting midwife seeks discussion, consultation, or referral of women under the 'private in public' agreement will be the doctor authorised by the hospital to do so. <br />
<br />
<b>When will the new 'private in public' midwifery options be available?</b><br />
<b><br /></b>
Good question. The short answer is that we don't know. However, the release of this framework document is an important step in the right direction. Midwives who seek visiting access are making appointments to meet with hospital administrators. Mothers who would like to use the 'public in private' midwifery options would do well to write to their local hospitals and request information.<br />
<br />
<b>Where do homebirths fit in? </b><br />
<br />
Prior to the introduction of the federal government's maternity reforms, the only setting for private practice was the community, and the only place a privately practising midwife had professional autonomy was the home. This has changed.<br />
<br />
Private midwifery is no longer synonymous with homebirth. <br />
<br />
However, unless the 'private in public' midwifery options are facilitated quickly, many midwives will have no choice but to get into homebirth if they want to practise privately.<br />
<br />
The 'private in public' midwifery framework <span data-ft="{"tn":"K"}" data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447171892054087}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447171892054087}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447171892054087}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[0]">seems obsessed with distancing itself from homebirth. I hope midwives can negotiate agreements with the public hospitals to cover the care
we provide for homebirths, but I have no idea how amenable the
hospitals will be. </span></span></span><br />
<br />
When midwives attend women for planned homebirth one of the most significant decisions that can be made is to transfer from home to hospital. The way this needs to happen, when it does happen, is without delay, in a seamless and professionally accountable way. The writers of the reform legislation and <span data-ft="{"tn":"K"}" data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447173198720623}.[0].{right}.[0].{left}.[0].[0].[0][3]"><span class="UFICommentBody" data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447173198720623}.[0].{right}.[0].{left}.[0].[0].[0][3].[0]"><span data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447173198720623}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3]"><span data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447173198720623}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0]"><span data-reactid=".r[348ht].[1][3][1]{comment447161712055105_447173198720623}.[0].{right}.[0].{left}.[0].[0].[0][3].[0].[3].[0].[0]">the linked documents seem to believe - against all the evidence - that homebirth is dirty. A lawyer commented on social media: "The more they try to integrate private midwives into
the hospital system, the more homebirth becomes isolated and tied up in
endless red tape which it becomes more and more impossible for midwives
to satisfy.</span></span></span></span></span>" <br />
<br />
Homebirth is not going to go away. In a maternity world of machines that go 'ping', many women and midwives know that there is no better way to give birth than within the woman's own normal physiology, and that this can be achieved within the privacy and safety of the woman's own home, unless a valid reason exists to interrupt the natural process.<br />
<br />
<br />
Opinions expressed are those of the author, Joy Johnston, and are not necessarily shared by all members of Midwives in Private Practice.<br />
<br />
Your comments are welcome. Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1354191651322376251.post-53503032654395554502013-11-03T17:09:00.000+11:002013-11-03T17:09:51.873+11:00MiPP today<!--[if gte mso 9]><xml>
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A dozen or so midwives have joined the MiPP ranks in recent
times.<span style="mso-spacerun: yes;"> </span>Most have achieved eligibility
for participating in Medicare, and have either resigned their hospital positions,
or cut back their employed hours, to enable focus on, and build, their private
practices.<span style="mso-spacerun: yes;"> </span>Others who have graduated
recently do not yet have the three years’ full time equivalent midwifery
experience, required for application for notation.</div>
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<br /></div>
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MiPP is a participating organisation in Maternity
Coalition.<span style="mso-spacerun: yes;"> </span>This governance model has
allowed MiPP to focus on professional matters, while supporting, with our
membership fees and more, the bigger maternity reform agenda, working with
other “individuals and groups who share a commitment to improving the care of
women in pregnancy, birth and the postnatal period.” (Maternity Coalition
Constitution 2008)</div>
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<br /></div>
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Homebirth is the main practice setting for MiPPs. No midwife in Victoria has achieved a collaborative agreement with a hospital to cover intrapartum care in the hospital - the only birth option for which midwives are able to purchase indemnity insurance. This is a matter of ongoing concern to the MiPP and homebirthing community. Under federal health practitioner legislation, midwives (and all regulated health professionals) are required to have professional indemnity insurance. However, as there is no indemnity insurance product available to cover private midwives attending homebirth, an exemption has been granted for homebirth, until 2015.</div>
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There is no record of the number of women who employ a
midwife privately to provide antenatal care, attend them in labour at home, and
support them for birth in hospital, with the intention of providing continuity
of care, promoting normal birth, and continuing professional services
postnatally.<span style="mso-spacerun: yes;"> </span>In this model the private midwife
is sometimes referred to as “just a support person”, because she has no
authorisation by the hospital to practise.<span style="mso-spacerun: yes;">
</span>However restricted the role, we note that ’support’ is a legitimate part
of midwifery.<span style="mso-spacerun: yes;"> </span>Furthermore, we know that
the midwife will be judged as a midwife – not as “just a support person”, if
actions by the midwife are thought to amount to conduct that is a significant
departure from accepted professional standards. <span style="mso-spacerun: yes;"> </span></div>
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<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-AU; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;">Having noted that midwives attending homebirth are, at present, exempt from the requirement for professional indemnity insurance, it is clear that there is no such 'exemption' for the practice of providing private support for a woman who is planning to give birth in hospital. The <a href="http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx#decisionmakingframework">NMBA Guidelines for Professional Indemnity Insurance for Midwives</a> state that:</span></span><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-AU; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><!--[if gte mso 9]><xml>
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<![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">"Under section 129 of the National Law, midwives
must not practise their profession unless they are covered in the conduct of
their practice by appropriate professional indemnity insurance arrangements."</span> </span></span></blockquote>
<br />
It would appear that the midwife who accompanies a woman to hospital, either when transferring care from planned homebirth, or when providing continuous midwifery support in planned hospital birth, is practising without professional indemnity insurance. It could be argued that the midwife who has no clinical privileges in a hospital is thereby prevented from practising, but, as noted above, the midwife is still a midwife, and may be judged as a midwife if there is a professional investigation into conduct.<br />
<br />
As has been documented in this and other social media and professional sites, maternity reform has been, at times, a bumpy ride. Legislative change takes many years to accomplish. There is no easy solution to our professional indemnity problems, on the horizon.<br />
<br />
Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-88791635888169980762013-10-25T11:07:00.000+11:002013-10-25T22:24:13.792+11:00Midwife prescriber Part 2<blockquote class="tr_bq">
<i><span style="color: #281f18; font-size: 8.5pt;">A
scheduled medicines’ endorsement identifies those midwives who are considered
by the Board to be qualified to:</span></i><br />
<span style="color: #281f18; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 8.5pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><i><span style="color: #281f18; font-size: 8.5pt;">administer,
obtain, possess, prescribe or supply specified schedule 2, 3, 4 and 8 medicines
to the extent authorised under the relevant legislation that applies in the
State or Territory in which they practise;</span></i><br />
<span style="color: #281f18; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 8.5pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><i><span style="color: #281f18; font-size: 8.5pt;">use
those medicines appropriately for the management of women and infants during
the pregnancy, birth and post natal periods; and</span></i><br />
<i><span style="color: #281f18; font-size: 8.5pt;"> </span><span style="color: #281f18; font-family: "Calibri","sans-serif"; font-size: 8.5pt; line-height: 115%; mso-ansi-language: EN-AU; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> apply to Medicare Australia
for a Pharmaceutical Benefits Schedule prescriber number.</span></i><span style="color: #281f18; font-family: "Calibri","sans-serif"; font-size: 8.5pt; line-height: 115%; mso-ansi-language: EN-AU; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> (NMBA 2011)</span></blockquote>
<br />
<h2>
<span style="color: #281f18; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 8.5pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: large;"><span style="font-family: inherit;"><i><span style="color: #281f18;">obtain ... possess ... prescribe ... supply ... </span></i></span></span><span style="font-size: large;"><span style="font-family: inherit;"><i><span style="color: #281f18;">administer
</span></i></span></span></h2>
<br />
<br />
Useful links are:<br />
Medicare Australia's e-learning site: <a href="http://www.medicareaustralia.gov.au/provider/business/education/e-learning.jsp#prof">PBS for new Health Professionals </a><br />
<a href="http://www.pbs.gov.au/browse/midwife">Pharmaceutical benefits scheme (PBS)</a> for midwives<br />
NMBA search for '<a href="http://www.nursingmidwiferyboard.gov.au/Search.aspx?q=Midwife%20prescriber%20formulary">midwife prescriber formulary</a>' <br />
<a href="http://www.health.vic.gov.au/dpcs/prescriber/registered-midwives.htm">Victorian gazetted drugs</a> - The list of Schedule 2, 3, 4 and 8 poisons approved by the Minister for
Health for the purposes of Section 13(1)(bc) of the Act for registered
midwives was published in Victoria Government Gazette No. S 410 Friday
30 November 2012.<br />
<br />
It's easy to become confused or unsure when venturing into new territory, such as that of an endorsed 'midwife prescriber'. Prescribing covers a cluster of activities, some of which every midwife is familiar with, and others which are new. A restricted drug such as Syntocinon (synthetic oxytocin), and other oxytocics, have been used by midwives in home birth situations, for many years. Although midwives have not had authority to prescribe, the usual process has been that a prescription has been written by a General Practitioner for a pregnant woman who is planning homebirth. The midwife takes responsibility for decisions around the use of the medicine. <br />
<br />
It seems that midwife prescribers are now able to tick all the boxes as far as the law is concerned. This is good. Noone wants to face a challenge when a medicine group as basic to midwifery, and as potentially life-saving for women, as oxytocics are concerned. The endorsed midwife prescribers are also able to manage other important drugs within our scope of practice: a significant extension of practice for most who have referred women to their GPs for anything from Maxolon for vomiting. to antibiotics for urinary tract infection, postnatal uterine infection, or mastitis. <br />
<br />
<br />
<br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-32334275457726791202013-10-20T17:03:00.000+11:002013-10-21T19:59:06.040+11:00midwife prescriberMidwives across this country are extending our practices as those who are classified as 'eligible' complete the requirements for endorsement to prescribe scheduled medicines. For the details of notation and endorsement, go to the <a href="http://www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/Endorsements-Notations.aspx">NMBA website</a>. The most recent <a href="http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx">statistics </a>(June 2013) provided by NMBA tell us that 22 midwives had endorsement to prescribe medicines, of the 212 midwives who have the 'eligible' notation on their registration.<br />
<br />
To access the NMBA <i>Prescribing Formulary for Eligible Midwives with a Scheduled Medicines Endorsement</i>, as a .pdf document, search formulary<i>+</i>midwives at that site (the hyperlink I tried was incomplete). This document lists the medicines, route of administration, duration of use, and indications for use, and states that:<br />
<blockquote class="tr_bq">
<i>A scheduled medicines’ endorsement identifies those midwives who are considered by the Board to be qualified to:<br />• administer, obtain, possess, prescribe or supply specified schedule 2, 3, 4 and 8 medicines to the<br />extent authorised under the relevant legislation that applies in the State or Territory in which they practise;<br />• use those medicines appropriately for the management of women and infants during the<br />pregnancy, birth and post natal periods; and<br />• apply to Medicare Australia for a Pharmaceutical Benefits Schedule prescriber number.<br />The Board has approved the lists of schedule 4, schedule 8 and intravenous medicines (below) for prescribing by eligible midwives with a scheduled medicines endorsement. These lists are to be read in conjunction with the Board’s Guidelines and Assessment Framework for Registration Standard for Eligible Midwives and the Registration Standard for Endorsement for Scheduled Medicines for Eligible Midwives (July 2010).</i></blockquote>
<i><br /></i>Another fount of useful information about Medicare and Prescribing is the <a href="http://www.medicareaustralia.gov.au/provider/other-healthcare/nurse-midwives.jsp">Medicare </a>site for Nurse Practitioners and Midwives.<br />
<i><br /></i>
Making the transition from being an 'ordinary' midwife (with all the social and professional restrictions that we have become used to) to the new class of eligible midwife who has a Medicare number, a Prescriber Number, and a personalised script pad may at times call for support and discussion between peers. With this in mind, a <a href="https://www.facebook.com/groups/1466089226948534/">new group</a> has been formed using a social media site. It's a closed group, and those who send a request to join are asked to introduce themselves to the group.<br />
<blockquote class="tr_bq">
<span style="font-family: inherit;">Midwife Prescriber - Australia </span><br />
<h5 class="uiStreamMessage userContentWrapper" data-ft="{"type":1,"tn":"K"}">
<span class="messageBody"><span class="userContent"><span style="font-family: inherit;">This
group is for discussion about prescribing issues, for eligible midwives
who have the prescriber endorsement, and those who are working toward
it. <br /> There may be clinical questions, for which members are able to share insight and experience. <br /> Members may have questions about processes.<br /> Files and links to the medications lists in the various states and territories can be shared and stored at this site.</span></span></span></h5>
</blockquote>
<br />
This new group grew to 50+ members in its first 24 hours of existence. One member who joined by invitation is a supportive obstetrician.<br />
<br />
A midwife who has worked independently for many years may be unsure of which antibiotic would be best for a postnatal uterine or wound infection. In previous years that midwife would have referred a woman with suspected infection to a hospital or doctor for diagnosis and prescription. Now that midwife can arrange to have a high vaginal swab taken for culture and sensitivity, and prescribe a suitable antibiotic treatment.<br />
<br />
The Schedule 4 medicines listed on the NMBA formulary, and on the Pharmaceutical Benefits Scheme (PBS) Midwife Items, as being suitable for postnatal infection, include Amoxycillin, Amoxicillin with clavunic acid, Cephalosporin, Dicloxacillin, and Lincomycin, with several others that are not PBS items. <br />
<br />
The complexities of knowing which drug is best, which dose is appropriate in the situation, how often it should be taken, and for how many days - this is the sort of knowledge that a midwife needs to have in order to act professionally in this situation. Eligible midwives are required to have collaborative arrangements for each woman, and it is anticipated that a phone call will be made to the collaborating doctor or hospital, or a friendly supportive obstetrician, if the midwife is in any way uncertain of the best course of action.<br />
<br />
<br />
<br />
ps. Note that some States have formularies that have been gazetted by that jurisdiction, while others have adopted the NMBA formulary.<br />
<br />
Click <a href="http://www.health.vic.gov.au/__data/assets/pdf_file/0007/835054/PrescribingFAQ2013.pdf">here </a>for a FAQ document from the Victorian Health Department. <br />
<br />
Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-85817782077552428982013-10-02T21:51:00.001+10:002013-10-03T07:34:47.551+10:00Finding a midwife in VictoriaToday we have updated the 'Midwives' websites' list at the right on this blog. These midwives are registered with <a href="http://www.ahpra.gov.au/">AHPRA,</a> and members of Midwives in Private Practice (MiPP).<br />
<br />
Face to face meetings of MiPP are held at least bi-monthly, usually in the Melbourne metropolitan area. Continuing professional education, such as newborn resuscitation workshops with NETS, is facilitated by members from time to time.<br />
<br />
<br />
Each MiPP member is responsible for her/his own practice of midwifery, maintenance of professional standards, and appropriate record keeping.<br />
<br />
The midwife joining or renewing full membership agrees to:<br />
<ul>
<li>Practice in a way that is consistent with the International Confederation of Midwives' Definition of the midwife </li>
<li>Attend MIPP meetings when able. If this is not possible at any time, the midwife sends an apology, and contributes to current discussion by other means. </li>
<li>Contribute to the activities and work of MIPP. </li>
<li>Participate in professional standards peer review within the collective. </li>
<li>Contribute to periodic reviews, providing quantitative and/or qualitative data as appropriate. </li>
</ul>
Note: MIPP welcomes Associate members. A midwife who wishes to commence private practice, ie ‘fee for service’ outside the acute health sector/hospital, is encouraged to seek mentoring with experienced independent midwives.
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-24560719535339609732013-09-23T16:49:00.002+10:002013-09-23T17:37:24.356+10:00"I need to know when that will happen with midwives. So I ask again: when can we expect to see this?"Three cheers for <a href="http://www.parliament.vic.gov.au/members/id/1682">Colleen Hartland</a>, the member for Western Metropolitan, for the questions she asked of the Minister for Health, Hon David Davis, in the Victorian Parliament last week:<br />
<br />
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<span style="color: #1f497d; font-family: "Calibri","sans-serif"; font-size: 11.0pt;">Parliamentary question </span></div>
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<span style="color: #1f497d; font-family: "Calibri","sans-serif"; font-size: 11.0pt;">18.9.13</span></div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;"></span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">Ms HARTLAND (Western
Metropolitan)—My question today is for the Minister for Health. In 2011 the
Department of Health asked the Royal Women’s Hospital, Monash Medical Centre
and Mercy Hospital for Women to develop a framework for collaborative
arrangements between Victorian public hospitals and eligible midwives. These
arrangements would allow for the provision of private midwifery services in
public hospitals so that labouring women can receive care from their chosen
midwife private practitioner if or when they are admitted to hospital. The
draft framework was provided to the department in 2012, and after review the
final draft was provided to the minister in February this year. My question for
the minister is: when will the framework be made public, and when will private
midwives have appropriate formal arrangements with hospitals to improve the
continuity of care that is provided to labouring women?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;"> </span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">Hon. D. M. DAVIS
(Minister for Health)—I can inform the house that the series of steps outlined
by the member is substantially accurate. I can also inform the house that Ms
Hartland and I had a conversation around this yesterday to find a way to look
forward to greater choice and greater options for women. When I am satisfied
with the formal advice I have received on each aspect of this matter, we will
make an announcement. I can assure the member that it will not be too far away.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;"> </span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">Supplementary
question</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;"> </span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">Ms HARTLAND (Western
Metropolitan)—The minister and I did have a conversation yesterday about a
separate matter; this is another report. I am very concerned that, considering
this issue of maternity services went to him in February this year, there is a
dragging of feet. Private obstetricians have these arrangements with public
hospitals. I need to know when that will happen with midwives. So I ask again:
when can we expect to see this?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;"> </span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">Hon. D. M. DAVIS
(Minister for Health)—When I am satisfied with the arrangements that would
operate in the public interest and for the safety of the women who would seek
to give birth under these arrangements and when the advice that I am provided
enables me to make those decisions with great confidence, then I will </span><span style="font-family: "Times New Roman","serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">make those decisions. I am prepared to look at
innovative arrangements that will provide greater choice and greater safety,
arrangements that provide the best outcomes for women and their babies in our
community. The preparedness to request and receive the advice is a clear
demonstration of the government’s preparedness to take innovative steps in this
area. They will be taken in a way—— </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;"></span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">
</span><b><span style="font-family: "Times New Roman","serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">The PRESIDENT</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">—Thank you, Minister. </span></blockquote>
<br />
Thankyou, Ms Hartland!<br />
<br />
<br />
<b>"there is a dragging of feet"</b><br />
Those who have been following this blog over time will be aware that the matter of access arrangements for midwives to attend our clients in public hospitals is an important one. Midwives have, since the federal government's 2010 maternity reforms were announced, been preparing themselves for the promised changes, one of which is visiting access to hospitals. As Ms Hartland said in the Victorian Parliament, "there is a dragging of feet".<br />
<br />
The MiPP collective in Victoria has welcomed at least 10 new members for whom this applies. Midwives have resigned or reduced their hospital and birth centre employment, with the understanding that they will be able to attend women privately, and that women will be able to give birth at a public hospital, in their care, with Medicare rebate for the service. This change in career is not undertaken lightly: midwives have financial and career commitments and goals like everyone else. Yet they have found themselves ostracised by the very people who were professional colleagues up 'til the time they achieved the Eligible Midwife notation. <br />
<br />
<br />
<b>Hospital access for midwives nationally</b><br />
The State that has led the way with credentialing midwives who are able to attend women admitted to hospital (particularly for intrapartum midwifery services) is Queensland.<br />
<br />
The Nursing and Midwifery Board (NMBA) report on registration statistics <a href="http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx">June 2013</a> reports that 84 of the total 212 midwives with the 'eligible' notation on their registration are from Queensland (see pic below). A <a href="https://www.medicareaustralia.gov.au/statistics/mbs_item.shtml">search of Medicare</a> Item #82120* (see description below) for the 2012-2013 financial year reveals that 134 of the 138 claims paid were from Queensland (and, it is likely that the other 4 were claimed in error, and will be refunded to Medicare).<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-cK1qIU09-VE/Uj_eR70b6qI/AAAAAAAACnw/UkD7LY5vwdc/s1600/ScanImage002.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="244" src="http://4.bp.blogspot.com/-cK1qIU09-VE/Uj_eR70b6qI/AAAAAAAACnw/UkD7LY5vwdc/s320/ScanImage002.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">click to enlarge</td></tr>
</tbody></table>
<br />
Clearly, there is "dragging of feet" in most of the country!<br />
<br />
<br />
<br />
*Medicare Item 82120<br />
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<br />
<div class="MsoNoSpacing">
<span style="font-size: 8.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Management of confinement for up to 12 hours,
including delivery (if undertaken), if:</span></div>
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<span style="font-size: 8.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">(a) the patient is an admitted patient of a
hospital; and</span></div>
<div class="MsoNoSpacing">
<span style="font-size: 8.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">(b) the attendance is by a participating midwife
who: (i) provided the patient’s antenatal care; or (ii) is a member of a
practice that provided the patient’s antenatal care</span></div>
<span style="font-family: "Calibri","sans-serif"; font-size: 8.0pt; line-height: 115%; mso-ansi-language: EN-AU; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">(Includes all attendances related to the
confinement by the participating midwife)</span><br />
<br />
<br />
<br />
<br />
<b>"In the public interest"</b><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-AU; mso-fareast-theme-font: minor-latin;">The Health Minister told the Parliament that: </span><br />
<blockquote class="tr_bq">
<span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">"When I am satisfied with the arrangements that would
operate in the public interest and for the safety of the women who would seek
to give birth under these arrangements and when the advice that I am provided
enables me to make those decisions with great confidence, then I will make those decisions. I am prepared to look at
innovative arrangements that will provide greater choice and greater safety,
arrangements that provide the best outcomes for women and their babies in our
community."</span></span></blockquote>
<br />
"In the public interest", "greater safety", "best outcomes for women and their babies" - these are all expected by our society. Laws governing access to professional services, and the regulation of professionals, are supposed to be about public interest, safety, best outcomes ... <br />
<br />
And, as it happens, best maternity care outcomes for women and babies are achieved, according to truckloads of evidence, when midwives are able to provide primary maternity care for women in a way that is consistent with the international definition of the midwife (<a href="http://www.internationalmidwives.org/assets/uploads/documents/Definition%20of%20the%20Midwife%20-%202011.pdf">ICM 2011</a>).<br />
<br />
According to the Honourable Health Minister, someone needs to come up with "innovative arrangements" that "provide the best outcomes for women and their babies in our community".<br />
<br />
How innovative can we get? This is what it looks like:<br />
<br />
<ul>
<li>Midwife provides antenatal services through the pregnancy, working within her scope of practise as the primary maternity care provider, and refers for obstetric review or other medical review as indicated </li>
<li>Woman and midwife prepare for the care, whether it is uncomplicated, spontaneous, and unmedicated, or not</li>
<li>Woman contacts midwife when in labour, and midwife arranges to be in attendance at the appropriate time</li>
<li>Midwife is 'with woman' continuously through established labour and birth, and a few hours after the birth</li>
<li>Midwife continues to provide primary maternity care through the postnatal period, both while they are in hospital, and after the woman and baby return home.</li>
</ul>
Innovative? Hardly, but it's the model that leads to the best possible outcomes ...<br />
<br />
There is no real difference between this model being provided by a midwife in private practice, and 'caseload' provided by a midwife employed by the hospital, except that the woman chooses the midwife. Is that so bad? <br />
<br />
What would need to be changed?<br />
<br />
<br />
Please note that opinions expressed in this post are those of the writer, midwife Joy Johnston. Your comments are welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-35976961494507279442013-09-21T14:20:00.002+10:002013-09-22T13:20:51.125+10:00human rights and childbirthA number of Australian midwives and birth activists are watching with interest the campaign demanding human rights in childbirth, particularly in European countries where midwives may face criminal proceedings when they attend women for homebirth.<br />
<br />
For information on this movement, and details of the next conference, click the hyperlink:<br />
<blockquote class="tr_bq">
<span style="font-size: large;"><a href="http://humanrightsinchildbirth.com/conference/">Birth Rights in the European Union: Mobilizing Change</a></span><br />
Monday November 4th 2013<br />
in Blankenberge, Belgium</blockquote>
<br />
<span style="font-size: large;"><b>Rights .... choices </b></span><br />
<span style="font-size: large;"><b></b></span><br />
<br />
<br />
The meaning of phrase 'human rights and childbirth' may be debated at length. Notions of individual freedom, fairness, equality, respect ... - such ideals are often at odds with what happens in the real world.<br />
<br />
Human rights in the European Union should not be very different from those in resource-rich Australia, or developing countries such as Papua New Guinea where national maternal morbidity and mortality rates are among the highest in the world. Yet the choices that are available for women in childbirth vary enormously from place to place, and between socio-economic groups, as variable as differences in outcomes.<br />
<br />
What are the intrinsic <b>*rights*</b> of any (human) woman in her childbirth experience?<br />
<br />
Let's consider this question:<span style="background-color: yellow;"><i> Does a woman have the right to demand the type of birth she considers best? </i></span><br />
<br />
Does a woman have a <b>*right*</b> to a birth that requires expert medical, midwifery, and nursing services, and a host of related ancillary services, in order to achieve her chosen birth: induction of labour, regional anaesthesia (spinal/epidural), or even elective caesarean? I am not asking if a woman can access these elements of her choice - ability and right are two different matters. And many readers may claim that it's easier in Australia today to access elective caesarean on demand than to access a maternity service that has a good track record with spontaneous, unmedicated, (garden-variety-natural) birth.<br />
<br />
I would suggest that there is no human rights imperative in medically managed birth. In modern maternity services there are professional/legal duties of care, to help and not to harm, but the access to surgical intervention or medical treatment is limited by factors such as availability of the necessary resources, and professional willingness to support the woman's individual choice. <br />
<br />
<br />
Which brings me to the other side of the question, <i><span style="background-color: yellow;">Does a woman have the right to demand the type of birth she considers best?</span></i><br />
<br />
Does a woman have a <b>*right*</b> to a birth that avoids medical intervention and optimises her chance of working in harmony with natural physiological processes?<br />
<br />
Not really. Perhaps there is more of a right in this situation than in the former, because the woman is the only person able to give birth spontaneously, and she does have the right to refuse any 'help'. But in essence the woman's ability to proceed along the natural pathway, and give birth to a healthy baby without complication, is not about human rights. It's about a finely tuned process that relies on physical, hormonal and emotional elements that can be either supported and protected by those who are with the labouring woman, or terribly messed up, to the detriment of the mother and her baby. Even if 95% of women who received optimal support and care (whatever that looks like) through their childbearing experience were able to proceed naturally and spontaneously to great births, the other 5% of women who wanted natural births would miss out. It's not a right unless it can be applied to all.<br />
<br />
Effective maternity services are ones that provide the 'best practice' options for all women, placing the individual woman at the centre of the package of care that is available for her. In most cases, it is not possible to plan or choose the outcomes. Careful decision making throughout the journey enables the woman to access the best care, and thereby expect the best outcomes. <br />
<br />
<br />
<span style="font-size: large;"><b>Decision-making</b></span><br />
<br />
Decision making is a process that constantly evolves as we move through a childbearing episode. The trump card that a woman has is 'Plan A' - her capacity to do it without assistance or education or coaching or therapies or any outside help*. But it's the fine line between Plan A and Plan B, when intervention is likely to lead to better outcomes - that may call for expert and timely professional action.<br />
<br />
There are times when the best option is not clear, when doing one thing may avoid one potential risk, but for some increase another. This question of risk-utility analysis in decisions around childbirth is huge, and will, I hope, continue to occupy the minds of each generation of mothers and their professional care providers (whoever they are) for as long as childbearing continues.<br />
<br />
I fought/aggitated for the rights of women to have their husband/partner present in hospital births in the early 1970s. I gave birth to my fourth child in a birth centre in 1980 - my personal statement of ownership of my birthing potential, and moving out of medicalised childbirth. I mention this because I have seen and experienced the changes in maternity care over 40 years in 2 continents, and am now nearing the end of my period of usefulness as a midwife.<br />
<br />
The physiology of the birthing process requires a woman to minimise the activity of her neocortex - her thinking brain - and work with her intuitive brain as she progresses towards the climax of giving birth. This is where the authentic midwife is able to be guardian of the space, so that the woman is free to do the primal, hormonally driven (rather than intellectually driven) work of giving birth. The reality in my mind is that this is not a matter of empowerment or conscious choice - or of any sort of legal *rights*.<br />
<br />
A woman's body will do the work of birth if it can, whether she likes it or not, because we are wonderfully made. On the other hand, decisions about interventions which are designed to protect the wellbeing of mother and/or baby, when obstetric complications arise, are influenced by wealth and availability of /funding for maternity services.<br />
<br />
<br />
*Note that I am not advocating for 'free' birth: Giving birth under 'Plan A' is an option regardless of place of birth or professional services available. A woman can give birth without assistance or education or coaching or therapies or any outside help in the care of a midwife, a doctor, a hospital or any other service.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-27108513037761447642013-09-15T18:56:00.001+10:002013-09-15T18:56:13.655+10:00midwives and medicinesThe Nursing and Midwifery Board of Australia (National Board) is consulting publicly on the draft Registration standard for endorsement of registered nurses and/or registered midwives to supply and administer scheduled medicines under protocol and invites comments and feedback from interested parties. The proposal is that provisions which are already in place for midwives (and nurses) in rural and remote settings be extended across the professions.<br />
<br />
For more information, and to access the consultation discussion paper and draft Registration standard, <a href="http://www.nursingmidwiferyboard.gov.au/News/Current-Consultations.aspx">click here</a>.<br />
<br />
The National Board is inviting submissions from the public, as well as professional groups and individuals.<br />
<br />
<br />
Please note that this consultation does not relate to midwife prescribers: eligible midwives who have completed a course of study approved by the National Board, and been <a href="http://www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/Endorsements-Notations.aspx">endorsed to prescribe scheduled medicines. </a><br />
<br />
<b>Why is this an important issue?</b><br />
<b></b><br />
<br />
A midwife who is currently recognised as being able to supply and administer scheduled medicines under protocol is usually a midwife employed by a health service or hospital. The employer has set down protocols under which a midwife is permitted to use a scheduled drug. This has been in effect, to a greater or lesser degree, for many years. Oxytocics for prevention or management of postpartum haemorrhage are an obvious category of drugs that every midwife is expected to be able to manage competently. A midwife may also supply and administer an anti-emetic in labour, antibiotics in labour as prophyllaxis for Group B Streptococcus, or Anti-D to prevent Rhesus immunisation. These are prescribed by a doctor, dispensed and sold by a pharmacist, and subsequently supplied and administered by a midwife to the woman in her care.<br />
<br />
<b>What is the relevance of this consultation for independent midwives?</b><br />
<br />
Midwives who practise privately, being employed directly by the woman rather than by a health service or hospital, may also be affected by any Registration Standard that the National Board develops. Midwives attending homebirths have historically for many years carried oxytocics, and used them when required. The midwife may ask women to obtain a prescription for Syntocinon 10units and Syntometrine from their local doctor. The midwife usually makes decisions about administration on her own authority, with the wellbeing and safety of the mother, in relation to postpartum blood loss, being the primary concern. This process is not covered by any formal protocols or reporting mechanisms. The midwife does not usually consult about the need for the scheduled medicine with the doctor who signed the prescription - delay could lead to compromise. <br />
<br />
The proposed Registration Standard <br />
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<![endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-ansi-language: EN-AU; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">"... will ensure that registered nurses and midwives who work in
situations where medical and nursing supervision is low and the clinical risk
is relatively high are educationally prepared and competent to supply medicines
to their patients/clients."</span></blockquote>
Women planning homebirth in the care of an independent midwife are usually well, and in spontaneous labour. Homebirth is a situation where the midwife acts on her own authority. Whether a midwife is practising solo, or with another midwife, each midwife is responsible to act in a competent and professional manner. There is no clinical supervision of independent midwifery practice. Obviously, the 'clinical risk' is relatively high. This places private midwifery practice within the scope of the National Board's proposed Registration Standard. <br />
<br />
The education of all midwives is required to prepare midwives for basic midwifery practice, as stated in the <a href="http://www.internationalmidwives.org/assets/uploads/documents/Definition%20of%20the%20Midwife%20-%202011.pdf">ICM Definition (2011)</a>:<br />
<br />
<blockquote class="tr_bq">
<span style="font-family: "Trebuchet MS",sans-serif;">... The midwife is recognised as a responsible and accountable professional who
works in partnership with women to </span><br />
<blockquote class="tr_bq">
<span style="font-family: "Trebuchet MS",sans-serif;">give the necessary support, care and
advice during pregnancy, labour and the postpartum period, to </span><br />
<span style="font-family: "Trebuchet MS",sans-serif;">conduct births
on the midwife’s own responsibility and to </span><br />
<span style="font-family: "Trebuchet MS",sans-serif;">provide care for the newborn and the
infant. </span><br />
<span style="font-family: "Trebuchet MS",sans-serif;"></span></blockquote>
<span style="font-family: "Trebuchet MS",sans-serif;">This care includes </span><br />
<blockquote class="tr_bq">
<span style="font-family: "Trebuchet MS",sans-serif;">preventative measures, </span><br />
<span style="font-family: "Trebuchet MS",sans-serif;">the promotion of normal birth,
</span><br />
<span style="font-family: "Trebuchet MS",sans-serif;">the detection of complications in mother and child,</span><br />
<span style="font-family: "Trebuchet MS",sans-serif;">the accessing of medical
care or other appropriate assistance and </span><br />
<span style="font-family: "Trebuchet MS",sans-serif;">the carrying out of emergency
measures. </span>
</blockquote>
</blockquote>
...<br />
<br />
MIPP will be preparing a submission to this consultation.<br />
<br />
Your comments are, of course, welcome.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-35291477410070534032013-09-10T17:24:00.000+10:002013-09-10T17:24:27.751+10:00regulation of midwivesSeveral MIPP midwives were amongst 60+ national attendees at a meeting this week in Melbourne, hosted by <a href="http://www.ahpra.gov.au/">AHPRA</a>.<br />
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.<br />
<br />
The aim of the Workshop was:<br />
<blockquote class="tr_bq">
1. To improve and foster understanding between the <a href="http://www.nursingmidwiferyboard.gov.au/">NMBA</a>, midwives and stakeholders regarding midwifery issues incorporating:<br />
<blockquote class="tr_bq">
a. Accreditation & education<br />
b. Midwifery Practice<br />
c. Association<br />
d. Workforce </blockquote>
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.</blockquote>
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.<br />
<br />
<b>Separate midwifery regulation</b><br />
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.<br />
<br />
<br />
<b>Quality and Safety Framework, and practice review</b> <br />
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. <br />
<br />
<b>Home birth after caesarean</b><b>, and mandatory notifications</b><br />
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 <a href="http://www.nursingmidwiferyboard.gov.au/Search.aspx?q=mandatory%20reporting">mandatory reporting</a>:
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.<br />
<br />
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. <br />
<br />
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.<br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-8846621366855495692013-09-03T14:24:00.000+10:002013-09-03T14:24:54.788+10:00letters from MIPPAbout a month ago we <a href="http://midwivesvictoria.blogspot.com.au/2013/08/amended-regulation.html">reported </a>on amendments to legislation applying to eligible midwives and Medicare.<br />
<br />
The ability of a midwife to attend a woman giving birth in a hospital
was a major item in the Medicare reforms, introduced more than three
years ago.<br />
<br />
Yet ... <br />
<br />
<ul>
<li>Despite many assurances that the Victorian government supports the federal government's maternity reforms, and has developed a framework for credentialing of midwives, no midwives in Victoria have made collaborative agreements with hospitals. </li>
<li>Midwives are able to buy insurance policies through <a href="http://www.miga.com.au/content.aspx?p=164">MIGA</a>, underwritten by Treasury, providing uncapped cover for women receiving midwifery services from eligible midwives for birth in hospital - yet they can't get access to the hospitals.</li>
<li>Women would be able to claim up to approximately $1500 rebate for intrapartum midwifery services (2 midwives) - if the midwives could get access to the hospitals.</li>
<li>Midwives are continuing to provide professional services for women in their communities, and accompanying them to hospital for birth or other specialist obstetric services if and when the need arises. </li>
<li>Midwives report that some doctors who have previously agreed to collaborate with midwives have withdrawn, giving reasons such as "I don't think homebirth is a good idea" - when the collaborative arrangement covers only antenatal and postnatal midwifery services.</li>
</ul>
This is unacceptable. What other profession would sit back and accept persistent exclusion from their usual places of practice? Why are women who would prefer to give birth in hospital in the care of their known and trusted midwife being prevented from doing so? <br />
<br />
<br />
A new round of letters has been sent by MIPP to the public hospitals, respectfully requesting an update on progress.<br />
<br />
A similar letter has been prepared, and is being sent to obstetricians and GPs who have agreed to collaborate with midwives, usually through a letter of referral, or in some instances, through a signed collaborative agreement. <br />
<br />
The content of this letter is copied below: <br />
<br />
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<br />
<blockquote class="tr_bq">
<blockquote class="tr_bq">
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span class="contentstyle1"><b style="mso-bidi-font-weight: normal;">Re:<span style="mso-spacerun: yes;"> </span>Collaboration and hospital visiting
access for Midwives </b></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span class="contentstyle1">Dear
Doctor</span></span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt;">
<span style="font-family: Arial,Helvetica,sans-serif;">This letter is to inform you of
recent changes in legislation governing the requirement for collaborative
arrangements for eligible midwives, such as referral of women to the midwife
for antenatal and postnatal midwifery services.<span style="mso-spacerun: yes;">
</span>We thank you for your participation in collaborative arrangements to
date, which have enabled women to claim Medicare rebate on the fees of midwives
who have Medicare provider numbers.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt;">
<span style="font-family: Arial,Helvetica,sans-serif;">Since the introduction <span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">in
April 2010 of amendments to the Health Insurance Act (1973), some midwives have
reported ongoing difficulties in establishing collaborative arrangements. This
has hindered their ability to participate in the Medicare arrangements</span><span class="contentstyle1">.</span></span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">In recognition of this, at the 10
August 2012 Standing Council on Health (SCoH) meeting, the Commonwealth agreed
to expand the types of collaborative arrangements available to midwives in an
attempt to make it easier for midwives to work collaboratively with medical
practitioners employed or engaged by hospitals or other health services. On
July 25<sup>th</sup> 2013 the Health Insurance Amendment (Midwives) Regulation
2013 </span><a href="http://www.comlaw.gov.au/Details/F2013L01432">http://www.comlaw.gov.au/Details/F2013L01432</a>
<span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">was introduced.</span></span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt; mso-margin-top-alt: auto;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US" style="color: black; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Accordingly, the purpose of
the regulation is to enable midwives to demonstrate collaborative arrangements
that provide pathways for consultation, referral and transfer of care to
specified medical practitioners employed or engaged by a public or private
hospital or other entity such as a health service, through an arrangement with
the hospital or entity. The regulation adds a new type of collaborative
arrangement for an eligible midwife who is credentialed for clinical privileges
within a hospital.</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"><span style="mso-spacerun: yes;"> </span><span style="color: black;">It is expected that
the hospital will have a formal written agreement with such midwives,
addressing consultation, referral and transfer of care, relevant clinical
guidelines and locally determined policies. </span></span><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"></span></span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt; mso-margin-top-alt: auto;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US" style="color: black; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;">Letters have been sent to
the public maternity hospitals on behalf of MIPPS, requesting an update on the
processes that are being implemented, by which the hospitals will provide eligible
midwives the opportunity to have collaborative arrangements. <span style="mso-spacerun: yes;"> </span>Until these new processes are established,
midwives and our clients will continue to rely on the collaborative agreements
and arrangements, such as referral, that have been used in the past couple of
years. </span><span class="contentstyle1"><span style="mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-AU;"></span></span></span></div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span class="contentstyle1">Yours sincerely,</span></span></div>
</blockquote>
</blockquote>
<br />
<br />
Your comments are welcome. <br />
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1354191651322376251.post-50413521746227409592013-08-18T17:25:00.001+10:002013-08-18T17:27:19.089+10:00Maternity care planMidwives who are eligible to participate in Medicare, and offer Medicare rebates for women in their care, have this item in the Medicare schedule:<br />
<br />
Item 82115<br />
<blockquote class="tr_bq">
Professional attendance by a participating midwife, lasting at least 90 minutes, for assessment and preparation of a <span style="background-color: yellow;">maternity care plan </span>for a patient whose pregnancy has progressed beyond 20 weeks, if:
</blockquote>
<br />
<blockquote class="tr_bq">
(a) the patient is not an admitted patient of a hospital; and
</blockquote>
<br />
<blockquote class="tr_bq">
(b) the participating midwife undertakes a comprehensive assessment of the patient; and
</blockquote>
<br />
<blockquote class="tr_bq">
(c) the participating midwife develops a written <span style="background-color: yellow;">maternity care plan </span>that contains:
</blockquote>
<br />
<blockquote class="tr_bq">
<blockquote class="tr_bq">
(i) outcomes of the assessment; and
</blockquote>
<blockquote class="tr_bq">
(ii) details of agreed expectations for care during pregnancy, labour and delivery; and
</blockquote>
<blockquote class="tr_bq">
(iii) details of any health problems or care needs; and
</blockquote>
<blockquote class="tr_bq">
(iv) details of collaborative arrangements that apply to the patient; and
</blockquote>
<blockquote class="tr_bq">
(v) details of any medication taken by the patient during the pregnancy, and any additional medication that may be required by the patient; and
</blockquote>
<blockquote class="tr_bq">
(vi) details of any referrals or requests for pathology services or diagnostic imaging services for the patient during the pregnancy, and any additional referrals or requests that may be required for the patient; and
</blockquote>
</blockquote>
<br />
<blockquote class="tr_bq">
(d) the <span style="background-color: yellow;">maternity care plan </span>is explained and agreed with the patient; and
</blockquote>
<br />
<blockquote class="tr_bq">
(e) the fee does not include any amount for the management of labour and delivery
(Includes any antenatal attendance provided on the same occasion)
Payable only once for any pregnancy
</blockquote>
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<tr style="page-break-inside: avoid;"><td style="padding: 0cm 5.35pt 0cm 5.35pt; width: 43.4pt;" valign="top" width="58">[Schedule 1 Part 1 of</td><td style="padding: 0cm 5.35pt 0cm 5.35pt; width: 334.25pt;" valign="top" width="446"><br /></td></tr>
</tbody></table>
<a href="http://www.comlaw.gov.au/Details/F2013C00010">Health Insurance (Midwife and Nurse Practitioner) Determination 2011]</a><br />
<br />
<br />
It's clear from the legislation that a '<span style="background-color: yellow;">maternity care plan</span>' is an important aspect of the antenatal care provided by a participating midwife. The professional attendance linked to Item 82115 is to take at least 90 minutes, and the scheduled fee is $319.00. This compares with other antenatal attendances of at least 40 minutes, with a scheduled fee of $53.40. Clearly, someone who advised the writer of this piece of legislation considered that the writing of a <span style="background-color: yellow;">maternity care plan</span>, and the other tasks (listed above) are very significant.<br />
<br />
<br />
A midwife who has recently received her endorsement as an eligible midwife wrote to a social media site "I wonder
if anyone could share their written maternity care plan format? Just want to know what you include and how to set it out ..."<br />
<br />
This is a good question. What does a maternity care plan look like?<br />
<br />
<br />
It has occurred to me that the <a href="http://internationalmidwives.org/assets/uploads/documents/Definition%20of%20the%20Midwife%20-%202011.pdf">ICM Definition of the Midwife</a> is a clear statement of a midwife's maternity care plan:<br />
<br />
The midwife ...<br />
<blockquote class="tr_bq">
is recognised as a responsible and accountable professional
who<br />
<ul>
<li>works in partnership with women to give the necessary support, care
and advice during pregnancy, labour and the postpartum period, </li>
<li>to
conduct births on the midwife’s own responsibility and </li>
<li>to provide care
for the newborn and the infant. </li>
</ul>
</blockquote>
<blockquote>
This care includes preventative
measures, the promotion of normal birth, the detection of complications
in mother and child, the accessing of medical care or other appropriate
assistance and the carrying out of emergency measures. <br />
...</blockquote>
<br />
<br />
The insurance company MIGA, in consultation with <a href="http://www.midwives.org.au/scripts/cgiip.exe/WService=MIDW/ccms.r">ACM </a>and <a href="http://www.privatemidwives.com.au/">APMA</a>, has developed a <a href="http://www.miga.com.au/content.aspx?p=165">care plan </a>that some midwives have adopted. This care plan has a lot of boxes to tick, and much of the information would be collected routinely by midwives in taking a history and discussing care options with each woman. Those who are using specially designed software would have many of the points of this care plan covered in entering the client information, and would be able to generate a <span style="background-color: yellow;">maternity care plan </span>printout when required.<br />
<br />
<br />
The <span style="background-color: yellow;">maternity care plan</span> is to be kept with other professional records for each woman and baby, by the midwife. The care plan usually does not need to be shared with anyone, unless asked for, for example, in a Medicare audit or an investigation.<br />
<br />
There is ongoing discussion and concern about the relationship between midwives and public hospitals, particularly those hospitals that have, to date, refused to discuss any collaborative arrangements with midwives. MIGA states that, in order to meet the legislative requirements, a midwife is required to have:<br />
<ul dir="ltr">
<li><blockquote class="tr_bq">
A Collaborative Arrangement with a doctor or Hospital, <span style="background-color: red;"><span style="background-color: cyan;">or</span></span></blockquote>
</li>
</ul>
<blockquote>
</blockquote>
<ul dir="ltr">
<li><blockquote>
A Care Plan communicated to a public Hospital providing obstetric services</blockquote>
</li>
</ul>
<blockquote>
</blockquote>
<blockquote>
</blockquote>
<ul dir="ltr"><ul>
<li><div style="margin-right: 0px;">
<blockquote>
You should ensure this is acknowledged by the Hospital either in writing or as a record in your notes of an oral acknowledgement</blockquote>
<br />
<br />
We note here that midwives in Melbourne, and many other places, who have attempted to comply with this requirement of acknowledgment (written or oral) by a hospital have had no success. The hospitals have, to date, not been interested in collaborating with midwives. Some hospitals have returned care plans to the midwife, and instructed her not to send them. This problem seems to be ongoing, as was discussed in a <a href="http://midwivesvictoria.blogspot.com.au/2013/08/amended-regulation.html">previous </a>post on this blog.<br />
<br />
<a href="http://midwivesvictoria.blogspot.com.au/2013/08/amended-regulation.html">XXX</a><br />
<br />
<br />
The MIGA <span style="background-color: yellow;">maternity care plan</span> seems to attempt to cover the 'what if' situations, in which a midwife might be required to defend her or his actions. That makes sense - that's the job of insurance companies.<br />
<br />
But, ...<br />
<br />
Midwifery is not, primarily, about defensive practice. It's about the midwife acting in a way that protects the wellbeing and safety of mother and baby. It's about being 'with woman', in a special professional relationship. It's about health promotion: healthy mothers and babies. Midwives should not be instructed by an insurer, an entity that exists to make a profit for shareholders, as to the care plans they make.<br />
<br />
Midwives are encouraged to make a positive statement in each woman's <span style="background-color: yellow;">maternity care plan, </span>such as: <br />
<br />
<span data-ft="{"tn":"K"}" data-reactid=".r[1s21r].[1][4][1]{comment634254803260983_634295673256896}.[0].[right].[0].[left].[0].[0].[0][2]"><span data-reactid=".r[1s21r].[1][4][1]{comment634254803260983_634295673256896}.[0].[right].[0].[left].[0].[0].[0][2].[0]"><span data-reactid=".r[1s21r].[1][4][1]{comment634254803260983_634295673256896}.[0].[right].[0].[left].[0].[0].[0][2].[0].[16]">"When providing primary maternity care for a well woman, the plan is to
proceed under normal physiological conditions, working in harmony with
the natural processes, unless complications arise. If illness or
complications are suspected, a transfer to the planned hospital would be
arranged without delay for urgent obstetric concerns,</span></span></span> ..."<br />
<br />
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</li>
</ul>
</ul>
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