Thursday, February 21, 2013
Wednesday, February 20, 2013
Is this discrimination against midwives? midwife prescriber Juliana Brennan
Is this discrimination against midwives? Juliana Brennan:
About 3 weeks ago I found out that I was the first midwife
in Australia to receive a PBS prescriber number. I received this notification over the phone
and in writing!
As part of becoming a Medicare eligible midwife I had to
sign an undertaking to AHPRA that within 18 months of becoming Medicare
eligible I would conduct a course of study in Pharmacology to become an
endorsed midwife, with a medicare provider number and a PBS prescriber
number.
In 2005 I completed a pharmacology component of the Master’s
Degree in Clinical Nursing (Nurse Practitioner) at Monash University, as back
then, I thought the only way forward for me was to aim to become a Midwife
practitioner (equivalent to Nurse Practitioner).
After I became an eligible midwife, I was invited to apply
for equivalence for my pharmacology course to be recognised as a suitable
course of study for my Midwifery endorsement.
This process of applying through AHPRA was very tedious (to say the
least) but eventually it was decided in my favour by AHPRA that I should become
the first midwife in Australia to be able to prescribe medicines based on the
Prescribing Formulary put out by the Nursing and Midwifery Board of Australia.
I wrote my first prescription: for Lignocaine 1% in
20mls (a Schedule 4 medicine, listed on the AHPRA midwives formulary and the Victorian midwives formulary), and was told that it is only available at certain pharmacies, especially those attached to a
Public Hospital offering Maternity Care. However, the RWH and
Eastern Health pharmacies told me they are not allowed to accept my prescription as I am not
employed by the hospital! So after all
my work as outlined above, doing a course that I was required to do by AHPRA, I
am not able to submit a prescription for the medicines I am legally allowed to
prescribe in a public pharmacy attached to the hospitals!
Thankfully the pharmacist at Knox Private Hospital agreed to accept
my prescription and had the medication needed in stock!
Even so, this does not make sense to me that a public
pharmacy attached to a hospital would not accept my script, despite me having a
PBS prescriber number. Does this mean
that a pharmacy like the RWH can’t accept a prescription from an outside
Dr? No it doesn’t as I have already had
a script dispensed for one of my clients that was written by a Dr before I
became an endorsed midwife. The Dr is
NOT an employee of the hospital.
So is this discrimination against midwives?
Many midwives have fought tirelessly to gain clinical access
to several public maternity hospitals around Melbourne. I stopped writing letters 6 months ago, as
now I don’t even get a response.
If I had clinical access to a public hospital, then my
prescriptions could be accepted the pharmacist at RWH told me.
So my question is “Why does AHPRA insist on Eligible
Midwives completing a suitable course of study in pharmacology in order to
become endorsed midwives if we have no way of gaining access to hospitals as
privately practicing Midwives, and no way of having our prescriptions for
medicines dispensed from a pharmacy attached to a public maternity hospital”?
RN, RM, M.Mid
Monday, February 11, 2013
'free birth'
Birth is, and probably always will be, a contested territory.
An unknown number of women have made the choice to 'free birth': to give birth without professional attendance. This phenomenon is happening in Australian communities, at the same time as the independent/homebirth midwifery profession is undergoing increasingly demanding levels of regulation from statutory bodies and by way of professional expectations set by our peers.
While any competent individual has autonomy for their own actions and their own bodies, the issue becomes more complex when that body is a woman's body, which is carrying an unborn child. And although courts in various countries have upheld the right of a woman to refuse, for example, caesarean surgery that is intended to protect the life of the child, there are many subtle forces that direct a woman in to compliance with social norms.
Why 'free birth'?
... access?
Women who proceed with a plan for 'free birth' are not necessarily unable to access a midwife privately to attend homebirth, although this is sometimes the case.
... cost?
the cost of private midwifery services for homebirth may be prohibitive.
... belief?
the woman who has formed a strong belief that the presence of any qualified person (ie midwife) will inhibit her ability to proceed naturally with birth, considers that she is better off without any professional attendant.
... objection?
A woman may object to some practice, such as listening to the fetal heart sounds, that a midwife may consider to be a basic requirement for safe practice.
... substitution?
an unregulated birth attendant may be willing to act in supporting the woman, and guiding her through her birth, effectively substituting for the midwife.
Whatever the reason, each woman / each situation, is unique.
Here is a hypothetical example.
In recording this hypothetical example, I would like to be very clear that I understand that Ms A made choices and decisions that she believed would be in the best interests of herself and her baby.
The issue of 'free birth' was addressed in a Victorian ABC TV story 7.30 report last Friday.
Several of the people interviewed for this story were asked if they supported the recent recommendation by the South Australian Coroner that it should be an offense for a person to attend birth without having the qualification of midwife or doctor. The response from Hannah Dahlen, on behalf of the Australian College of Midwives, included a statement that the answer to 'free birth' is not to be found in cracking down, to 'exterminate' its practitioners, as it will only be driven underground.
I concur with this. Although the events that led to the recommendation by the SA Deputy State Coroner are tragic, I do not consider that legislation to protect midwifery practice in South Australia would or could achieve the desired aim of improved public safety.
The choice that some women make, to give birth to their babies at home, takes into account individual social preferences and reasons. Since birth at home is the outcome of a spontaneous physiological natural process, there is no legislation that can control who a woman consults in pregnancy, or who is with, or not with, a woman who is labouring or giving birth spontaneously.
A woman’s right to self-determination in making decisions such as where she gives birth, and with whom, will not be controlled or altered by legislation designed to protect midwifery practice.
It is my belief that the government’s support for the regulated midwifery profession, with funding for homebirth programs, protection of the full scope of private midwifery practice including hospital visiting access, and education for the public in maternity choices, will result in greater protection of public interest than the proposal to protect midwifery practice.
Joy Johnston
An unknown number of women have made the choice to 'free birth': to give birth without professional attendance. This phenomenon is happening in Australian communities, at the same time as the independent/homebirth midwifery profession is undergoing increasingly demanding levels of regulation from statutory bodies and by way of professional expectations set by our peers.
While any competent individual has autonomy for their own actions and their own bodies, the issue becomes more complex when that body is a woman's body, which is carrying an unborn child. And although courts in various countries have upheld the right of a woman to refuse, for example, caesarean surgery that is intended to protect the life of the child, there are many subtle forces that direct a woman in to compliance with social norms.
Why 'free birth'?
... access?
Women who proceed with a plan for 'free birth' are not necessarily unable to access a midwife privately to attend homebirth, although this is sometimes the case.
... cost?
the cost of private midwifery services for homebirth may be prohibitive.
... belief?
the woman who has formed a strong belief that the presence of any qualified person (ie midwife) will inhibit her ability to proceed naturally with birth, considers that she is better off without any professional attendant.
... objection?
A woman may object to some practice, such as listening to the fetal heart sounds, that a midwife may consider to be a basic requirement for safe practice.
... substitution?
an unregulated birth attendant may be willing to act in supporting the woman, and guiding her through her birth, effectively substituting for the midwife.
Whatever the reason, each woman / each situation, is unique.
Here is a hypothetical example.
Ms A and her partner have had two children previously. Baby #1 was born in hospital, after a long and painful labour, in which Ms A had augmentation of labour, an epidural, and a forceps birth.
Ms A felt traumatised after that birth, and in her second pregnancy decided that she wanted homebirth. The midwives who attended her in labour were unhappy with her progress, and recommended that she transfer in labour to hospital. Baby #2 was born in hospital: a big baby; and another difficult birth.
Ms A reflected on her experience, and believed that the midwives were fearful, and that she would have been better off without them. She therefore chose 'free birth' for her third child, and invited two friends who worked as doulas to be with her to support her for the birth.Ms A's complex process in choosing 'free birth' included her belief that the presence of midwives for baby #2 had inhibited her progress, and the availability of a substitute for professional attendants.
In recording this hypothetical example, I would like to be very clear that I understand that Ms A made choices and decisions that she believed would be in the best interests of herself and her baby.
The issue of 'free birth' was addressed in a Victorian ABC TV story 7.30 report last Friday.
Several of the people interviewed for this story were asked if they supported the recent recommendation by the South Australian Coroner that it should be an offense for a person to attend birth without having the qualification of midwife or doctor. The response from Hannah Dahlen, on behalf of the Australian College of Midwives, included a statement that the answer to 'free birth' is not to be found in cracking down, to 'exterminate' its practitioners, as it will only be driven underground.
I concur with this. Although the events that led to the recommendation by the SA Deputy State Coroner are tragic, I do not consider that legislation to protect midwifery practice in South Australia would or could achieve the desired aim of improved public safety.
The choice that some women make, to give birth to their babies at home, takes into account individual social preferences and reasons. Since birth at home is the outcome of a spontaneous physiological natural process, there is no legislation that can control who a woman consults in pregnancy, or who is with, or not with, a woman who is labouring or giving birth spontaneously.
A woman’s right to self-determination in making decisions such as where she gives birth, and with whom, will not be controlled or altered by legislation designed to protect midwifery practice.
It is my belief that the government’s support for the regulated midwifery profession, with funding for homebirth programs, protection of the full scope of private midwifery practice including hospital visiting access, and education for the public in maternity choices, will result in greater protection of public interest than the proposal to protect midwifery practice.
Joy Johnston
Friday, February 1, 2013
Human Rights in Childbirth: Dignity, Respect & Responsibility
Human Rights in Childbirth:
Dignity, Respect & Responsibility
9.30am-4.30pm
This forum will explore the strengths and limitations of human rights and respectful care frameworks in advancing maternity reform in Australia. It aims to bring together the policy, legal and women’s health communities along with professional providers and birth consumer groups to discuss strategies for improving the quality of care for birthing women and those supporting them.
- the European Human Rights conference held in the Hague in June 2012
- the Childbirth and the Law conference in Sydney in October 2012
- the international initiative, Respectful Maternity Care.
Program
9.30-9.45 registration and coffee
welcome
and introduction- Dr Cath Crock, Executive
Director, Australian Institute for Patient and Family Centred care
Session 1- Chair: Professor Rhonda Small
How valuable are human rights
frameworks for evaluating and improving the care of childbearing women?
10-15am-11.15am:
The documentary film: ‘Freedom for
Birth’
11.15-11.30 Morning tea
11.30-1pm discussion led by panel
of speakers: Dr Liz Curran, Dominique Saunders, Dr Regina Quiazon, Prof Euan
Wallace, Bashi Hazard.
Wednesday, January 23, 2013
PDCU News Bulletin
excerpts from the Victorian Perinatal Data Collection Unit News Bulletin
Welcome to The New Year (eleventh) edition of the Victorian Perinatal News Bulletin. This bulletin has been designed to keep you up to date with information from the Clinical Councils Unit and CCOPMM, including the Victorian Perinatal Data Collection (VPDC) and the Victorian Birth Defects Register (VBDR).
...
Electronic copies of our bulletins can also be found on our website: http://www.health.vic.gov.au/ccopmm/publications/index.htm. Please visit our website for more information about the collection, for copies of the VPDC User Manual for Midwives, the VPDC Manual and updates on recent publications.
The VPDC User Manual for Midwives provides clear definitions for commonly used terms especially those that often cause confusion. There are examples and scenarios provided to make things crystal clear. New personnel, who require SDE access, are required to provide their information via the online form at: http://www.health.vic.gov.au/ccopmm/mailing_list.htm. If you have any suggestions that would improve the manual please contact Diana Stubbs.Development of the Online e-formFunding has been allocated for the development of an online e-form to assist sites with small birth numbers and homebirth practitioners in electronically submitting birth information to the VPDC. A forum to educate users will be held once the form is ready for testing. This e-form will replicate the current paper birth report.Our long term aim is to have all data submitted electronically and this will be realised with the e-form resource.New Data ElementA new data element will be introduced in 2013. This data element is “the total number of antenatal visits”. The request is from the National Perinatal Data Development Committee (NPDDC) and has been approved by the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) for inclusion in the data collection from 2013. All settings and software vendors will be notified once collection of this item is about to commence.PublicationsHospital Profiles for 2009The 2009 Hospital profiles have been released to Health settings and are a smaller, more condensed version than previous years. Please ask your senior Maternity manager for a copy of the PDF if you have not had a chance to see your hospital maternity statisticsReportsTo enhance the reporting of information collected and considered by CCOPMM, the 2009 Annual Report, focusing on mortality and morbidity data, was expanded to include summaries of· information pertaining to births (previously Births in Victoria)· research supported by the Council.The redeveloped 2009 CCOPMM Annual report has been released and is available on the WebThe 2008 CCOPMM Annual Report is available on the website.Birth Defects in Vic 2005 -2006 is available on the website.You can find copies of all our reports at: http://www.health.vic.gov.au/ccopmm/publications/index.htmFor more information, please contact
Diana StubbsLiaison Midwifeph. 03 9096 0380
Sunday, January 20, 2013
MAMA featured in newspaper article
From The Age, 18 January 2013
WOMEN are flocking to private midwives to gain access to cheaper services under Medicare, and the demand has led to Victoria's first midwife clinic.
Two years ago, federal changes allowed eligible private midwives to offer Medicare rebates for some pregnancy services.
To December, national Medicare figures show that 152 eligible private midwives had provided 30,264 services to pregnant, birthing, and postnatal women. ...
WOMEN are flocking to private midwives to gain access to cheaper services under Medicare, and the demand has led to Victoria's first midwife clinic.
Two years ago, federal changes allowed eligible private midwives to offer Medicare rebates for some pregnancy services.
To December, national Medicare figures show that 152 eligible private midwives had provided 30,264 services to pregnant, birthing, and postnatal women. ...
Monday, December 31, 2012
Letter to the Sunday Age
[In response to the front page article, 'Patient power troubles GPs', Sunday Age, 30/12/12]
I find it troubling that some doctors are not happy with the concept of independent experts who support a patient’s decision making in medical care.The statements by Dr Hambleton of the AMA suggest that he is attempting to protect the old ‘doctor knows best’ position of privilege in our society – perhaps that’s part of his job description?I also take exception to Dr Hambleton’s questioning of “the need for private midwives to be escorting women during hospital births.”I am one of those private midwives, and I would like to explain briefly why I provide primary maternity care, and attend birth, whether it occurs in hospital or the woman’s home.A midwife’s unique skill is the ability to work in harmony with the natural processes through pregnancy, birth, and the postnatal period. Birth is not an illness. The midwife’s duty includes promoting health, supporting wellness, and protecting the woman’s ability to do the work of bearing and nurturing her children. Only when and if complications or illness are present does the midwife need to collaborate with medical and/or hospital systems, and only then with the woman’s informed consent. Most women trust the midwife’s guidance, but there are grey areas in maternity care, just as there are in the world of GP doctors.The planned setting for birth is not set in concrete. Many women who plan hospital births experience the ‘coming ready or not’ baby who arrives in all sorts of places, including the bathroom at home, the back seat of the family car, or the hospital carpark or lift. Some women who plan homebirth need to change their plan and move to hospital, for all sorts of reasons.Midwives who practise privately, independent of the hospital system, are able to offer personal continuity throughout the episode of care and be with the woman in labour wherever she is. Privately employed midwives seek to establish a partnership with each woman in our care, at a level that simply cannot be achieved without significant investment of time prior to the birth. Privately employed midwives offer a distinct professional care package to each woman. The women who employ us usually intend to give birth spontaneously, without relying on medical pain management strategies, or artificial augmentation of the birth process, unless there is a valid reason at the time for such a decision to be made.When private midwives ‘escort’ women to hospital, we have usually provided significant professional services for that woman through the prenatal period. Several Medicare items give rebate for services such as the initial consultation, long or short antenatal checks, and the development of an individual maternity care plan. The woman may have laboured at home, in the care of her private midwife, prior to traveling to hospital. The woman knows her private midwife’s voice, and touch, and is able to be confident within the care plan. The care plan includes the ongoing process of informed decision making, with the wellbeing and safety of mother and child being the guiding principle.Postnatally the private midwife continues to provide expert professional services, within the primary maternity care relationship. Postnatal Medicare items are available until the seventh week after the birth.Dr Hambleton’s attempt to trivialise the private midwife’s role as “so someone can hold their hand” is offensive to me. If I hold the hand of a labouring woman, it is a significant act of professional support for which that woman has employed me.
Joy Johnston
25 Eley Rd, Blackburn South Vic 3130
03 9808 9614
http://villagemidwife.blogspot.com.au/
Subscribe to:
Posts (Atom)