MiPP review and restructure

The 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.


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.

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

• attended MiPP meetings, usually bi-monthly, 
• prepared submissions to relevant reviews by government, statutory and professional bodies, and 
• provided occasional comment to the media on issues that concern our members. 

Decision-making is by consensus, and communication between meetings is by email.
Since the mid-1990s, MiPP has been a Participating Organisation in Maternity Coalition (MC). 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.

Another significant proposed change to the Constitution is in the Statement of Purposes:
change from:
“... a national (Australian) umbrella organisation made up of individuals and groups who share a commitment to improving the care of women in pregnancy ...” 
to:
“... 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.”

The options that MiPP has at this time are:
1. Continue our organisational relationship with MC. Members are welcome to vote on changes to the Constitution.
2. Leave MC and set up an independent association
3. Leave MC and establish a new organisational relationship under another body
4. Other?




The following is a summary of responses to other questions in the survey:

The midwives 

• 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. 
• These midwives report having attended 182 planned homebirths, as the primary carer (‘first midwife’) in the year 2013. 
• 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. 
• 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. 
• Only two of those midwives who completed the survey are not eligible/endorsed, or working towards eligibility or endorsement to prescribe 

Comments 

Members value MiPP for mutual support, sharing, networking and professional contact with other privately practising midwives.

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.

Your comments are welcome.

What medicines are midwives prescribing nationally?

Please note:
If you are a midwife prescriber in Australia, you are invited to contribute to this survey.



There is a high degree of enthusiasm amongst midwives who have achieved endorsement as prescribers.

The Midwife prescriber facebook group facilitates discussion about prescribing issues.  The group welcomes members who have the eligible midwife prescriber endorsement, 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.
 

Midwife prescriber Part 2

A scheduled medicines’ endorsement identifies those midwives who are considered by the Board to be qualified to:
·        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;
·        use those medicines appropriately for the management of women and infants during the pregnancy, birth and post natal periods; and
  apply to Medicare Australia for a Pharmaceutical Benefits Schedule prescriber number.  (NMBA 2011)

obtain ... possess ... prescribe ... supply ... administer 

Useful links are:
Medicare Australia's e-learning site: PBS for new Health Professionals
Pharmaceutical benefits scheme (PBS) for midwives
NMBA search for 'midwife prescriber formulary'
Victorian gazetted drugs - 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.

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.

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.