Birth Registration and Birth Certificates

The Victorian Law Reform Commission is conducting a consultation into birth registration and birth certificates, under the Births, Deaths and Marriages Registration Act 1996 (Vic).  The consultation paper is available at the Commission's website.  Submissions to this review are requested by 1 November 2012.

Midwives in Private Practice (MiPP) is preparing a response.

The following questions have been put, to guide responses:

Birth notification 

1. What particulars should the Registrar require at birth notification stage from the responsible person? 
2. Are you aware of any problems with, or do you have any suggestions for improvement of, the notification process? 

Birth registration 

1. Are you aware of any requirement of the registration process that may create barriers to people registering births, in particular people from culturally and linguistically diverse (CALD) or Indigenous communities, or vulnerable or disadvantaged people?
2. Can you suggest ways to make the process for birth registration more accessible, efficient and effective? 

Birth certificates 

1. Are you aware of any requirement of the process for obtaining a birth certificate that may create barriers to people registering births, in particular people from CALD or Indigenous communities, or vulnerable or disadvantaged people? 
2. Can you suggest ways to make the process for obtaining a birth certificate more accessible, efficient and effective? 
3. Should legislation provide for the automatic issue of a birth certificate once a birth has been registered? 

Fees for birth certificates

1. Do you think it is appropriate to charge a fee for a birth certificate? If so, does the current fee create a barrier to obtaining a birth certificate for some people?  
2. The Act allows for a fee waiver but this is rarely granted. What criteria should be applied to the grant of a waiver of fees for a birth certificate? 
3. Should a waiver be possible only on a case-by-case basis or should classes of people qualify (for example those in possession of a Health Care Card)? 
4. Should the criteria for the waiver of fees be explicitly stated in legislation or regulations? 
5. Alternatively, should a policy document outlining these criteria be required to be made public by the Victorian Registry of Births, Deaths and Marriages? 

Vulnerable groups 

1. Are vulnerable or disadvantaged people or those from CALD backgrounds or Indigenous communities more likely to encounter problems with registering a birth or applying for a birth certificate? If so why, and how?

Awareness and access 

1. Is it easy to find out what you need to know about registering a birth and obtaining a birth certificate? 
2. Are members of the community in general sufficiently aware of their obligations and rights to register a birth and to be issued with a certificate?
3. If not, what can be done to improve community awareness and what role should the Victorian Registry of Births, Deaths and Marriages have in improving awareness? 
4. Should legislation be amended to include promoting birth registration and the benefits of obtaining a birth certificate, as a specific function of the Registrar? 

Other 

1. Are you aware of legislative or policy developments in other jurisdictions that may be helpful to consider for Victoria? 
2. Is there anything else you would like to share with us on any aspect of birth registration and obtaining a birth certificate?

An update on midwife prescribing

Midwives who have achieved eligibility for Medicare (MBS) under the Commonwealth Government's National Maternity Service Plan (2010) are also preparing to extend our practices to include prescribing, and participation in the Pharmaceutical Benefits Scheme (PBS).  Midwives with PBS authorisation will be able to prescribe, supply, and administer scheduled medicines. 

Historically, midwives attending homebirth have obtained the few medicines we need in private midwifery practice through a doctor's prescription.  The midwife has administered these drugs without a legislated process.  Oxytocics for the management of post partum haemorrhage by intramuscular injection have been prescribed by doctors for women in our care, and purchased (in boxes of 5 ampoules) from local pharmacies.  The midwife assesses the woman's condition, and administers the drug on her/his own authority.  The management of the third stage pf labour is basic to midwifery, and it is in the public interest that all midwives maintain their competency in the use of oxytocics: that this is not restricted to those who have PBS authorisation. 

A number of Victorian midwives are enrolled in the 6-month Pharmacology course at Flinders University in Adelaide, which is the only such accredited course for midwives seeking PBS authorisation.  We know of a couple of midwives who have completed courses in pharmacology which have been accepted by the regulatory authority (AHPRA) as equivalent. 

Each state and territory have already either undertaken, or are in the process of making, the necessary legislative changes to authorise registered midwives to prescribe under the PBS.  

The Victorian Health Department has appointed the 3CentresCollaboration to consult with stakeholder groups, and to prepare a draft list of Schedule 2, 3, 4 and 8 medicines for prescribing by midwives in Victoria.  The work has advanced to the final checking of the list before it is approved in the law.  The stakeholder groups and experts who have been invited to review the list include relevant midwifery and obstetric colleges, unions and professional organisations, employers of midwives, consumer groups with a remit or interest in midwifery, maternity services or associated services as well education providers (ie midwifery pharmacology course providers). 

The scope of prescribing is limited to medicines appropriate for midwifery practice across pregnancy, labour, birth and post natal care (including neonates up to six weeks).  Midwives who will use their PBS endorsement include those providing private antenatal and postnatal care in a variety of settings and intrapartum care as a private midwifery provider to a private client either at home, or (when midwives are able to have clinical privileges/visiting access) within a health service. 

[MiPP has submitted a response to the draft documents.]
 
Your comments are welcome.

collaboration

Yesterday the Health Ministers announced the extension of the 'exemption', enabling midwives  (1) to continue our work of attending births without indemnity insurance, until 2015, and (2) to make collaborative arrangements with hospitals and health services.

Go to the APMA blog for the wording of the announcement.

Immediate response from the Australian Medical Association (AMA) called on the Health Ministers to reverse their decision about collaboration, stating that “This decision is transferring sensitive patient care and management from a doctor to a bureaucrat. It must not proceed.”


In response, I have left the following message at the AMA media site:

Dr Hambleton, and AMA
I think it would be good to talk to real midwives who have incorporated Medicare into what we offer women.  We are not dangerous.  We are very conscious of the limitations of natural physiological processes in pregnancy, childbirth, and thereafter - and our own limitations when illness or complications present.
I have been practising independently as a midwife for many years, and I attend women who plan homebirth, as well as women who intend to give birth in hospital. 
The collaborative arrangements that have supported the care I provide for my clients, enabling Medicare rebates on antenatal and postnatal consultations, have been mainly with GPs who have never met me.  This is the sort of letter the doctor receives:
Dear Dr D
W has asked me to provide midwifery services for her, with a plan to give birth at home, and a back-up booking at H Hospital.  W’s calculated due date is XX/XX/XX.  With your referral and collaboration I am able to provide Medicare rebates for W for antenatal and postnatal midwifery services.  I am required to demonstrate a collaborative arrangement with a named medical practitioner, to whom she will be referred if the need arises. 
Under this collaborative arrangement, I am required to send you a Maternity Care Plan (draft attached), results of any tests and investigations, and referrals (obstetric or paediatric).  Also I am required to send a discharge summary to you as the patient’s GP.
In preparing a maternity care plan, I have discussed this with W.  The plan is basically to proceed under normal physiological conditions, working in harmony with the natural processes, unless complications arise.  We plan to go to the H hospital without delay for urgent obstetric concerns, or W would be referred to you for non-urgent medical indications.
Thankyou for your assistance in this matter.

I ask that you use the resources of the AMA to enhance collaboration between two distinct professions - not to remove the competition.

Joy Johnston

Your comments are welcome.

NEW MIPP BROCHURE

Thanks to Malinda Morieson for preparing and distributing a new version of the MIPP brochure.
For more details click here.

CHOICES

Information Sessions in Melbourne

Winter 2012

@ MAMA

 

For times and program, go to Website: http://choicesforchildbirth.org.au/find-sessions-vic

 

Colalboration gone wrong!

The Australian Government’s $120.5 million Budget package Providing More Choice in Maternity Care – Access to Medicare and PBS for Midwives, promised that Australian women would have

“more choice in maternity care whilst maintaining our strong record of safe, high quality maternity services.” 

The National Maternity Services Plan (the Plan), endorsed by the Australian Health Ministers’ Conference in November 2010, provided governments with a strategic national framework to guide policy and program development.  The plan declares that primary maternity services will be  

“woman centred, reflecting the needs of each woman within a safe and sustainable quality system."

Year one of the Plan committed jurisdictions to developing 

“consistent approaches to the provision of clinical privileges within public maternity services, to enable admitting and practice rights for eligible midwives and medical practitioners.”

How is implementation of the Plan progressing?

Midwives report little action or hope of conclusion, on matters to do with provision of clinical privileges for Medicare-eligible midwives within public maternity services, except in Queensland.  Anecdotally we are aware of instances of increasing resistance within some public hospitals to the implementation of programs of clinical privileging for private midwives.


Earlier this week I received an early morning call from a distressed colleague.  Having worked with a woman who was planning homebirth for some hours, this midwife arranged to transfer the woman's care to a major public maternity hospital in Melbourne, where the woman had made a back-up booking.

The midwife, who believes she has had a good relationship with the hospital for many years, was distressed that the doctor who admitted her client refused to accept any verbal hand-over, and rudely walked away when the midwife attempted to carry out a professional conversation with him.

It would appear that efforts are being made within public maternity hospitals to derail any plans to enable admitting and practice rights for eligible midwives.

Within the obstetric community there is a strongly held position that a doctor or midwife who is willing to assist women in 'bad choices' is seen as encouraging 'bad choices'.  Women who have attempted to make arrangements with hospitals to facilitate normal birth in situations of acknowledged complexity, such as twins, breech babies, or even birth after a previous caesarean, have been given no choice.  "If you come here, this is what will happen!"  This is an often repeated scenario in both public and private hospitals.  These women have often sought private midwives to attend them in the relative 'safety' of their own homes.


This post is just skimming the surface of a complex issue.

Collaboration with medical and nursing colleagues, within hospital systems, is a basic expectation in all midwifery. 

Midwives are required, by regulation and by definition, to collaborate. 

“... This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance (emphasis added) and the carrying out of emergency measures.   ” 

(From ICM Definition of the Midwife, 2011)



Midwives also have an expectation of ethical professional behaviour towards those in our care.  The current Code of Ethics for Midwives lists 'values' - which in themselves describe the standard to which we aspire.  There is no place for bullying and domineering behaviours in midwifery.

1. Midwives value quality midwifery care for each woman and her infant(s).
2. Midwives value respect and kindness for self and others.
3. Midwives value the diversity of people.
4. Midwives value access to quality midwifery care for each woman and her infant(s).
5. Midwives value informed decision making.
6. Midwives value a culture of safety in midwifery care.
7. Midwives value ethical management of information.
8. Midwives value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

 (From Nursing and Midwifery Board of Australia)

Midwives need a system that recognises us and treats us fairly.

We call on midwives to continue to stand in partnership with women, demanding equity and fairness in all maternity services provided by our governments - federal and state. Collaboration requires both parties to participate, the hospital and/or doctor, as well as the midwife.  There is no such thing as one-way collaboration.  Midwives are committed to the wellbeing and safety of mothers and babies in our care, and it is our duty to demand that the health care systems support us in achieving this goal.

Robyn Thompson reflects on midwifery today

Response to the FOI Release by Robyn Thompson

From the heart and soul of a retiring midwife I thank Homebirth Australia for sending this information.
However, for me this is revisiting old ground. For those of us who spent hours with Nicola Roxon, hours and hours campaigning, me as one of Nicola's constituents, and with Julia Gillard living in my suburb, we were there over the years since the MSR and now we are worse off than ever before.

I no longer trust anyone in politics, the AMA, and some within our own profession, with the exception of Sen Rachael Siewert, WA and Justine Caines with her years of political drive and wisdom.

Sadly for me there is no time to revisit old ground. It's time to 'push' forward as it were. It's time to reclaim our rights, reverse restrictive legislation and offensive language imposed on midwives and women by political/medical game playing.

It's time to educate the new political crew, those who don't understand, while and staying strongly resolved to not accepting control of others over our professional practice. It's time to change our tac, and with good leadership to be strongly on the offensive rather than the defensive. Medicalised control of women, babies and midwives is an international issue, not just national. Midwives can rise again, by recognising their professional skills and being proud that our practice is as distinctly different from obstetrics.

Midwifery is a specialty in it's own right, of being 'with women' through the entire maternity cycle, yet linked at times to include the specialty of obstetrics. Medicalised midwives would be wise to revisit midwifery practice being with women (rather than doctors) through the entire maternity cycle. To re-focus their skills on assisting more women to unhindered natural birth. Turn off the machines that go 'ping', that the administrators are 'leased back'. Stop accelerating labour - reduce unnecessary synthetic pain. Stop administering opioids and other drugs that harm babies, offer emersion in warm water for labour instead. Stop rupturing membranes - leave protective forewaters and hydraulic pressure for the baby, intact. Stop attaching women to restrictive continuous monitoring machines, revisit well educated hearing skills, use a Pinnards stethescope, or hand held dopplers or just your ear. Stop the myriad of unnecessary professional rituals that restrict women. Assist women out of the vulnerable horizontal position. Encourage their inner strengths and let them decide how they will birth their babies.

STOP requesting doctors to sign off our practice, say thank you but NO this is inappropriate, we are professionals in our own right, please recognise that. Women and midwives are stronger than ever before about our their human and professional rights. We are strong enough to shift 'big brother' from our lives and do what evolution, education and practice has taught us, and to connect with the specialty of obstetrics when appropriate.

We all have a responsibility to educate women the midwifery way, to go about our business campaigning constructively, refusing to harm women and babies by re-confirming the wonder of the female body and mind. To carry out our business competently and wisely will strengthen our resolve to inform the medical profession, the politicians and others that women and midwives will no longer agree to participate in bodily abuse at any time in the maternity cycle. That we will by consult and refer if the need arises.

Healthier women and babiesbabies’ means confidently shifting control, including control of the dollar, from others', and return it to women.
Robyn


Thankyou, Robyn for sharing your wisdom.  Joy Johnston