Maternity Services Turf Wars

Justine Caines has written a Croakey blog 'Maternity Services Turf Wars have not helped women'.
While agreeing with the main points in the essay, I have posted a comment in which I argue that there is no turf war.

Joy Johnston
Monday, 29 September 2008 3:12:44 PM
We all refer to it as a *turf war*, but really, there is no war. Many years of health policy from both parties, and a submissive attitude from generations of Aussie mothers have put maternity services into the capable and trustworthy hands of the medical profession. Almost totally.

If it really was a turf war, there would have to be 2 sides battling it out. Obstetricians and midwives, you say. We do see the odd little skirmish between a midwife and an organisation representing obstetricians, or the medical association, but it's like the ant standing on the elephant's toe.

If there really was a turf war, there would have to be something that you could call 'turf' - a playing field of sorts. The pregnant woman? That's a finite number of people, for a particular period of time - should be the sort of sums that the public health bean counters are very happy with. But maternity care in this country is not provided as a package based on the individual woman/pregnancy. It's provided on Medicare schedules, each for fragments of the whole care, and state government funding arrangements with hospitals. The individual woman is not really part of the equation. Medicare excludes midwives because they aren't doctors. Hospitals employ midwives, but once again, to provide fragments of care.

Midwives who work privately with individual women are not able to provide that service in hospitals, as we don't have visiting access, or insurance. We can provide it in the home, and the woman can pay. We have become experts in home birth. Our care includes health promotion in pregnancy, protection of normal birth, protection and support of breastfeeding and bonding and early nurture. If a complication requiring medical attention arises we arrange a referral and collaborate with those who are expert in complicated birth. It's win-win.

But it has nothing to do with a turf war. The care is provided outside the 'system' - on the woman's and the midwife's own turf.