PROTECTING WOMEN?

"The Brumby Government recognises the importance of registering independent midwives in order to protect women who choose this maternity care option."

This statement appears in letters that are currently being received by people who write to the Victorian Health Minister, Daniel Andrews, with reference to the package of health 'reforms' applied to maternity services. Readers of this and linked blogs will appreciate the complexity of the changes that are only months away now, and the devastating impact these changes will have on midwives' ability to practise midwifery in our own right, and on women's ability to employ a midwife privately.

When I received a letter from Daniel Andrews with this statement in it, I paid little attention to it. I agree with statutory regulation of health professionals, including ALL midwives. The mantra, "protecting the public", can not be dismissed. Noone wants to see a health professional abuse their position of trust through either commission or omission. The various Acts and Boards that register and regulate health professionals' practice and education are an accepted and valued part of our society.


It was not until I saw another letter from Mr Andrews (attached - click to enlarge), dated 6 November 2009, in which the same sentence appears, that I considered it in another light.

It's not about registering midwives; it's about "registering independent midwives"

It's not about protecting the public; it's about protecting women who choose this maternity care option.

It's not about the general notion of statutory regulation in the public interest (which is what "protecting the public" means); it's a new level of government control in relation to "this maternity care option".

"This maternity care option" is homebirth with a privately employed midwife.

It is becoming more clear as time passes that "this maternity care option" will not exist lawfully in Australia after 1 July next year. The reform that is progressing through federal and state parliaments will not "protect women who choose this maternity care option"; it will protect the public FROM this maternity care option.

As has been demonstrated time and again, the outcomes related to planned homebirth with a midwife in this country and in other developed countries are exemplary. This fact seems to have been missed by the Minister. What is it about "this maternity care option" that he thinks he ought to protect women from? Is it the caesarean rate of under 10% for all women planning homebirth, compared with approximately 30% in the mainstream? Is it that women planning homebirth VBAC are very likely to safely achieve vaginal birth, compared with 20%-30% VBAC rates in private and public hospitals respectively?
[click here for more detail]


When the reform dust has settled it seems possible that a new hybrid "private midwife" may emerge. The Health Ministers have promised that their reform package will usher in a new era. This midwife is likely to resemble the obstetrician's handmaiden of the past: she will be required to work in collaboration with a doctor or doctors.

Collaboration with doctors is reasonable if a person (a midwife in this case) is supporting that professional in carrying out their professional practice. Collaboration with a doctor is reasonable if a doctor requires midwifery support in the care of an individual woman - as happens because doctors are far too busy to attend a labouring woman throughout the labour: that's the midwife's job.

A doctor is not educated in midwifery. It is not possible for a midwife to collaborate with someone who is not skilled in midwifery. It would be like requiring a dentist to collaborate with an orthopedic surgeon.


Readers who think I am being alarmist are welcome to leave your thoughts in the comments column. Joy Johnston

dear Ms Roxon

dear Ms Roxon
you have more than dampened expectation
you have sold out!
the agent of institutionalization
birth homogenization
increasing medicalisation
you have sold out!

you have sold out on women, responsible women,
rolling in their souls as they’re told to turn over
face to face upon the threshold of fate
in perfect season shall mothers move
instinctual as the sea, rising in swells

you have sold out on babies, innocent babies
stamped on arrival and sent to a future therapy
when life could begin with connectivity,
an hormonal shake, a firing of self
the triumphant love of making it!

you have sold out on fathers, husbanding fathers
bewildered by machines and expertly confusing jargon
men could march from history’s darkness
allied like earth to the clouds of their ladies
chest out upon a 3D engagement of the sacred

you have sold out on midwives, timeless midwives
subordinate to those with 15 minute timelines and pre-determined roads
when midwives could do the good work by just being there
‘women centred care’ is not an answer in a test
it’s what works best!

dear Ms Roxon
you have more than dampened expectation
you have sold out!
the agent of institutionalization
birth homogenization
increasing medicalisation
you have sold out!

dear Ms Roxon
our mobilization will not lie down.
the stirrups do not fit us.


[Viktor, November 2009]

birth statistics

I have looked at the new site mybirth.com.au.

It’s a furphie to think that looking at the statistics enables a person to make informed decisions. The data must be interpreted and applied to the individual in order to contribute to decision making.



I do not support informal collections of birthing data. I’m happy for a site like this to link others to the sites where reliable data collections are accessible, and I’m happy for people to write their analyses of this data, but always giving reference back to the initial source. No data collection is perfect, and we need to scrutinise it carefully.

When I go to a website I am concerned about the reliability of the information and the accountability of the people who manage the site. I need to know who is behind it, and what processes the owners have committed to to ensure that the information is correct and timely. It's a huge task, with the potential to be either very useful, or to contribute to misinformation.


I’m not trying to support or bag the Victorian government for its data, but it’s not true that Victoria does not release information. If you go to http://www.health.vic.gov.au/maternitycare/ you will find enough to study for as long as you have time. It’s not the simple numbers/percentages for each hospital, but it’s still very useful.

Independent midwives put our data up on this blog from time to time, and for some years we have published summaries in Birth Matters, the journal of Maternity Coalition. All midwives who send homebirth data to the government’s perinatal data collection unit receive a copy of the annual homebirth report, so you can ask any independent midwife to show you, and you can make copies. Each hospital also receives one of these reports that compares its own statistics with the data from the whole of the State.



The Victorian Maternity Performance Indicators are an amazing comparison between public hospitals – private hospitals are not given the same scrutiny, but are lumped together. We had a performance indicator analysis of planned homebirths for the past 5 years of data, and the outcomes are brilliant. Have a look at this blog.

One of the reasons the Victorian health department has not gone down the path of publishing simple outcome data is a concern that statistics can be skewed - not comparing like with like. So when the all planned homebirths in 5 years are analysed under performance indicator 'rules' the results become much more reliable and significant. This is the sort of result that should be trumpeted from the rooftops.

Joy Johnston

More from the rallies

Brisbane

Sydney

Our message is clear:

Midwives and the women who employ us CANNOT ACCEPT the medical dominance over childbirth that is now being written into the laws of this country. The requirement that was last Thursday slipped into an amendment to legislation before the Senate, to require midwives to work at all times in formal collaborative arrangements with doctors as a condition of insurance, is thereby a condition of professional registration. It is very likely that this amendment will pass through the Senate without resistance.

Midwives do consult, refer, and transfer care to doctors when clinically indicated, and with the permission of our clients. This is the essence of professional collaboration.

The problem here is that when legislation makes it a legally mandated requirement for one profession to collaborate (midwives) and there is no requirement on the other profession to participate (doctors) we essentially have one hand clapping. (thans Liz for that word picture!) That will enable doctors to say which midwives can be insured, register and practice and that isn’t acceptable. It will also enable a medical veto of women’s choices that doctors do not agree with.

The passing of this legislation will effectively extinguish the right of ANY midwife in Australia from practising to the contemporary scope of a midwife's practice, as defined by the International Confederation of Midwives, and accepted internationally by health and obstetric peak bodies. This means that midwives can only exist in a restricted practice zone. Apart from concerns around workforce and professional career options, the safety and efficacy of such a model of care cannot be assumed.


We understand that our PM, Kevin Rudd, is "unmoved by protests". Until this outrageous situation has been fixed, we must continue to:
WRITE LETTERS TO POLITICIANS
WRITE LETTERS TO EDITORS OF NEWSPAPERS
SPEAK ON RADIO CALL BACK
TALK TO ANYONE WHO WILL LISTEN
USE THE INTERNET EFFECTIVELY - EG COMMENTS ON BLOGS

RALLY at Werribee

[also see villagemidwife blog]

APMA Media Release

Australian Private Midwives Association
Contact: National President Liz Wilkes 0423 580585



Medical veto impacts women’s access to care: Women Rally.

The Federal government may stall on the blocks of its first major initiative in health as the reform of maternity services hits stumbling blocks and criticism. Women will rally around Australia tomorrow to ensure choices are not lost in the wash up.

Liz Wilkes, National President of the Australian Private Midwives Association, will join women and midwives outside Kevin Rudd’s electorate office in Brisbane. Women are seeking assurances that new legislation around private midwives registration and practice will not reduce options for care.

“Midwives are educated and regulated to provide care for pregnancy, labour and birth on their own responsibility under the International Confederation of Midwives definition of a midwife,” Ms Wilkes stated “Suddenly we are told that doctors control the ship and that doctors will be able to decide who can do what.”

Legislation due before the Senate was amended on Thursday by the Government to require midwives to work at all times in formal collaborative arrangements with doctors as a condition of insurance. Doctors will be able to veto these arrangements effectively giving the medical profession the ability to control which midwives can be insured and register.

“The reform of maternity services is the first test of the Governments health reform agenda. It looks like the medical lobby may stall these reforms before they even get started.” Ms Wilkes said today “Placing one profession at the complete mercy of another for registration makes a mockery of professional regulation in this country.”

Women at the centre of the scuffle are concerned that the amendment may erode rather than expand choices as doctors make decisions about what types of care to support. Many choices such as homebirth, vaginal birth after caesarean and care in rural areas may be lost if doctors do not form the formal agreements with midwives.

“For the midwives who are currently self-employed it is no longer a matter of referring a woman who needs care to the appropriate person. Formal agreements with doctors will determine which of these educated, experienced and skilled midwives can actually register.”

Ms Wilkes added “Regulators should control midwifery professional standards, not how a doctor feels about a particular midwife. This takes midwifery back 50 years.”
Women are worried about the choices in birth and are calling on the Prime Minister to make sure that in implementing this first serious reform in health, options for choice are not lost.

Women rally at 10.30am November 9 at electorate offices of Kevin Rudd Brisbane, Julia Gillard Melbourne, Tanya Plibersek Sydney and Stephen Smith Perth.
Contacts: Liz Wilkes 0423 580585 (Brisbane and national) Marie Health 0407266004
(Sydney)Sally Westbury 0422 894 496 (Perth) Clare Lane 0416 130291 (Melbourne)

MIPP Calling Card to Julia Gillard

Deputy Prime Minister, Minister Roxon is not listening!!!

Midwives ALREADY provide safe care yet she continues to submit to the AMA demands.
MIDWIVES do not need medical supervision or permission to care for homebirthing women!

Babies born at home had similar Apgar scores to babies born in hospital. Less than 3% of babies born at home required admission to the special or intensive care nurseries compared to hospital born babies at > 15%.

Medical Observer, 6th November 2009:
"The amendments to the nurse practitioner legislation will come as welcome relief for doctors…AMA vice-president Dr Steve Hambleton, who sits on the Government’s Nurse Practitioner Advisory Group (NPAG), said the crucial amendment would ensure nurse practitioners were not supported to work in competition with doctors."
The amendments to the legislation will also apply to midwives.

The safety of women & babies is clearly not the Health Department's or the AMA's main priority. They care more about the perceived potential loss of income & loss of control over a woman’s basic right to choose how, where & with whom she gives birth.
[Calling Card prepared by Andrea Bilcliff]