Midwives 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.
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.
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.
Showing posts with label public hospital. Show all posts
Showing posts with label public hospital. Show all posts
Thursday, November 28, 2013
Monday, November 11, 2013
'private in public' midwifery
A message today from Katy Fielding, Manager Acute Programs, Victorian Department of Health
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.
How many midwives are we talking about?
Registration data published by the NMBA 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 Those numbers are out of date, and we know that they are increasing each week.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.
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.
What will 'private in public' midwifery look like?
From the woman's 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.
From the midwife's 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.
From the hospital's 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.
When will the new 'private in public' midwifery options be available?
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.
Where do homebirths fit in?
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.
Private midwifery is no longer synonymous with homebirth.
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.
The 'private in public' midwifery framework 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.
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 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."
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.
Opinions expressed are those of the author, Joy Johnston, and are not necessarily shared by all members of Midwives in Private Practice.
Your comments are welcome.
Dear colleaguesI would like to inform you that the Minister for Health has recently approved the release of Eligible midwives and collaborative arrangements: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. The Department plans to evaluate the framework once this new model of care has been in operation for a sufficient period of time.A hard copy of the framework has been distributed to CEOs of public health services and is available on-line at www.health.vic.gov.au/maternitycareI am grateful to all of you for your valuable contribution to the development of this framework and welcome any feedback you may have. ...
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.
How many midwives are we talking about?
Registration data published by the NMBA 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.
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.
What will 'private in public' midwifery look like?
From the woman's 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.
From the midwife's 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.
From the hospital's 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.
When will the new 'private in public' midwifery options be available?
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.
Where do homebirths fit in?
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.
Private midwifery is no longer synonymous with homebirth.
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.
The 'private in public' midwifery framework 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.
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 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."
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.
Opinions expressed are those of the author, Joy Johnston, and are not necessarily shared by all members of Midwives in Private Practice.
Your comments are welcome.
Monday, September 23, 2013
"I need to know when that will happen with midwives. So I ask again: when can we expect to see this?"
Three cheers for Colleen Hartland, the member for Western Metropolitan, for the questions she asked of the Minister for Health, Hon David Davis, in the Victorian Parliament last week:
Thankyou, Ms Hartland!
"there is a dragging of feet"
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".
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.
Hospital access for midwives nationally
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.
The Nursing and Midwifery Board (NMBA) report on registration statistics June 2013 reports that 84 of the total 212 midwives with the 'eligible' notation on their registration are from Queensland (see pic below). A search of Medicare 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).
Clearly, there is "dragging of feet" in most of the country!
*Medicare Item 82120
"In the public interest"
The Health Minister told the Parliament that:
"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 ...
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 (ICM 2011).
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".
How innovative can we get? This is what it looks like:
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?
What would need to be changed?
Please note that opinions expressed in this post are those of the writer, midwife Joy Johnston. Your comments are welcome.
Parliamentary question18.9.13
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?
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.
Supplementary question
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?
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 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——
The PRESIDENT—Thank you, Minister.
Thankyou, Ms Hartland!
"there is a dragging of feet"
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".
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.
Hospital access for midwives nationally
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.
The Nursing and Midwifery Board (NMBA) report on registration statistics June 2013 reports that 84 of the total 212 midwives with the 'eligible' notation on their registration are from Queensland (see pic below). A search of Medicare 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).
 |
| click to enlarge |
Clearly, there is "dragging of feet" in most of the country!
*Medicare Item 82120
Management of confinement for up to 12 hours,
including delivery (if undertaken), if:
(a) the patient is an admitted patient of a
hospital; and
(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
(Includes all attendances related to the
confinement by the participating midwife)"In the public interest"
The Health Minister told the Parliament that:
"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."
"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 ...
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 (ICM 2011).
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".
How innovative can we get? This is what it looks like:
- 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
- Woman and midwife prepare for the care, whether it is uncomplicated, spontaneous, and unmedicated, or not
- Woman contacts midwife when in labour, and midwife arranges to be in attendance at the appropriate time
- Midwife is 'with woman' continuously through established labour and birth, and a few hours after the birth
- 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.
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?
What would need to be changed?
Please note that opinions expressed in this post are those of the writer, midwife Joy Johnston. Your comments are welcome.
Thursday, January 19, 2012
hospital access for Medicare-eligible midwives
A few months ago I reported on the work of a reference group set up by the Victorian Health Department to develop consistent approaches to the provision of clinical privileges for midwives within public maternity services, to enable admitting and practice rights for eligible midwives, and a new option for women who seek maternity care that protects continuity between the woman and her midwife.
Midwives in Private Practice (MIPP) was represented at the three meetings of the expert reference group. The 'deliverable' of this initial consultation process, which has been managed by the 3Centres Collaboration, is a draft document which provides a framework, and templates for paperwork and various records. This document will progress through careful checking by the Health Department, before it is able to be released. It is hoped that this document will provide a reliable process whereby public maternity hospitals in Victoria will be able to proceed with making arrangements whereby midwives are able to attend women privately for birth and other maternity care in the hospitals.
Readers may wonder how many women would want to be attended privately for birth in public hospitals? How many midwives would apply for visiting privileges, and what number of private clients/births would they be able to expect in a year? It is not known how many women in Victoria employ a midwife privately to attend them in labour in a public hospital. An estimate would be 100-200. Many more employ unregulated birth support people. Some midwives would attend 10-20 planned hospital births each year; others only occasionally.
For many years the predominant focus of private midwifery practice throughout Australia has been homebirth. However, since the introduction of notation as a Medicare-eligible midwife, the options for private midwifery practice have been extended. Some midwives who have achieved their Medicare notation/provider numbers have no experience in, and no intention of attending home births. Their plan is to provide continuity of care (and carer) for women giving birth in hospital. This suggests that as the number of Medicare-eligible midwives increases, the demand for hospital admitting and practice rights will also increase. If 10 newly eligible midwives were each taking 40 caseload bookings for planned hospital births, the estimated 100-200 per year could be 500-600. It's still a tiny proportion of the State's annual number of births, but it's a potential growth area.
In order for a midwife, or doctor, or anyone, to be allowed to practise in a hospital facility, there are basic instructional and policy matters that need to be communicated. Routine fire evacuation plans and other emergency procedures are essential for safety of patients and staff and all concerned. Everyone needs to be skilled in use of the hospital's computer systems, entry of data, admission and discharge, reporting of incidents, ... just to name a few examples.
A midwife who is employed in a hospital, who also has a private practice, or who has recently moved from hospital employment to private practice, would be able to quickly meet the requirements for emergency procedures, IT processes, &c. This midwife would be ideally situated to take up admitting and practice rights. The hospital knows the midwife, and the midwife knows the hospital. The process might be more challenging for a midwife who has not practised recently in the hospital.
It is important to remember that there is a woman and a child behind every episode of maternity care. Private midwifery care for birth is a model that focuses on the woman and her baby, not on the care provider or the facility. MIPP members look forward to the day when the options and arrangements for maternity care will truly value the woman, and thereby promote healthy outcomes.
Midwives in Private Practice (MIPP) was represented at the three meetings of the expert reference group. The 'deliverable' of this initial consultation process, which has been managed by the 3Centres Collaboration, is a draft document which provides a framework, and templates for paperwork and various records. This document will progress through careful checking by the Health Department, before it is able to be released. It is hoped that this document will provide a reliable process whereby public maternity hospitals in Victoria will be able to proceed with making arrangements whereby midwives are able to attend women privately for birth and other maternity care in the hospitals.
Readers may wonder how many women would want to be attended privately for birth in public hospitals? How many midwives would apply for visiting privileges, and what number of private clients/births would they be able to expect in a year? It is not known how many women in Victoria employ a midwife privately to attend them in labour in a public hospital. An estimate would be 100-200. Many more employ unregulated birth support people. Some midwives would attend 10-20 planned hospital births each year; others only occasionally.
For many years the predominant focus of private midwifery practice throughout Australia has been homebirth. However, since the introduction of notation as a Medicare-eligible midwife, the options for private midwifery practice have been extended. Some midwives who have achieved their Medicare notation/provider numbers have no experience in, and no intention of attending home births. Their plan is to provide continuity of care (and carer) for women giving birth in hospital. This suggests that as the number of Medicare-eligible midwives increases, the demand for hospital admitting and practice rights will also increase. If 10 newly eligible midwives were each taking 40 caseload bookings for planned hospital births, the estimated 100-200 per year could be 500-600. It's still a tiny proportion of the State's annual number of births, but it's a potential growth area.
In order for a midwife, or doctor, or anyone, to be allowed to practise in a hospital facility, there are basic instructional and policy matters that need to be communicated. Routine fire evacuation plans and other emergency procedures are essential for safety of patients and staff and all concerned. Everyone needs to be skilled in use of the hospital's computer systems, entry of data, admission and discharge, reporting of incidents, ... just to name a few examples.
A midwife who is employed in a hospital, who also has a private practice, or who has recently moved from hospital employment to private practice, would be able to quickly meet the requirements for emergency procedures, IT processes, &c. This midwife would be ideally situated to take up admitting and practice rights. The hospital knows the midwife, and the midwife knows the hospital. The process might be more challenging for a midwife who has not practised recently in the hospital.
It is important to remember that there is a woman and a child behind every episode of maternity care. Private midwifery care for birth is a model that focuses on the woman and her baby, not on the care provider or the facility. MIPP members look forward to the day when the options and arrangements for maternity care will truly value the woman, and thereby promote healthy outcomes.
Thursday, March 24, 2011
Homebirth via public hospitals
 |
| A midwife from Casey Homebirth service, at a maternity conference, with the 'gear' that she takes to a home |
In December 2009 we noted at this blog the announcement that some Victorian women would be able to access homebirth via a publicly funded pilot scheme.
Two metropolital hospitals, Casey in the South-East and Sunshine in the West, have their homebirth programs up and running. We have also been told by a reliable person that Monash Medical Centre, a level 5 hospital in Clayton, is planning to offer homebirth as part of comprehensive maternity services this year. [Click on the highlighted words to go to the websites of the hospitals mentioned]
I have recently met up with a group of the midwives employed at Casey. I was impressed at their enthusiasm for their work. They told me they are loving the work.
Homebirth is a basic aspect of midwifery practice. It allows the practitioner an opportunity to develop a strong midwife identity, accepting the authority in decision-making at any time in the episode of care, and particularly at the time of birth. Homebirth is 'PLAN A' - the woman giving birth spontaneously, without medical intervention, and the midwife acting in harmony with normal physiological processes.
Working in a public hospital homebirth program enables midwives to practise one-to-one (caseload) primary maternity care without taking on the professional marginalisation that is experienced when midwives go into private practice.
Midwives who have moved into private practise may not value this aspect of the hospital program to the same degree as those who take the hospital caseload-homebirth positions.
Hospital midwives are able to provide care for the group of women booked in their caseload, with structured 'backup' processes from other midwives in the program, and arrangements for handing over care if a labour is very long. These midwives value their employment contracts, through which they have a reliable income, employment benefits such as sick leave and long service leave, and their relationship with their clients is separate from their ability to earn a living.
By way of comparison, independent (private practice) midwives value the strong commitment they make to individual women, and very rarely ask another midwife to take over. The 'employment' arrangement is a private one, between the individual woman and her private midwife or midwives.
Both options - private and public - have potential advantages and disadvantages.
‘Hospital at home’ is a reality. Hospitals are over-crowded, and it makes sense to provide services in the home when possible. The hospital risk management includes the latest gadgets that may be useful, such as the 'Neopuff TM' machine shown in the picture above. With the strict policies on inclusion in the program, it’s very unlikely that the midwives will need to use the neopuff. That will come out in audits down the track.
The inclusion by hospitals of this item should not be seen as suggesting that all midwives attending homebirths need to carry such equipment. There would need to be some compelling evidence that babies born at home would be better off. Hospital babies, many of whose labours are induced when they not quite ready to be born, depressed by narcotics, and premature, ... are the ones that would clearly benefit from the Neopuff TM.
Homebirth via public hospitals is a valuable addition to publicly funded maternity services. Women and their babies benefit, as homebirth requires the promotion of normal physiological birthing, feeding, and nurture processes. Midwives benefit in being separated from reliance on unnecessary medical interventions.
I anticipate that there will, in time, be an exchange of midwives between the public and private homebirth options. This will be good for midwifery, and good for birthing women.
Comments by readers are most welcome.
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