Midwifery Today Community

G'day!

I haven't visited this forum for a while - have been busy 'on the job'. 

Midwifery Today readers will be aware of the severe restrictions that women who want homebirth or midwife led care face in Australia, with funding monopolies supporting medical care.

A couple of weeks ago the Australian government announced major reform to funding for midwifery.  Eligible midwives will be supported in purchasing professional indemnity insurance, and will be able to access Medicare (the public funding for out of hospital medical services) and have limited prescribing rights.  Links to the press releases and comment are at the midwivesVictoria blog.

While this is clearly a huge step forward in reforming the system, we have many questions.  I have written about this at my blog.  At present we are being told that homebirth will not be covered (yet - whatever that means) under this new scheme.  We don't know what will happen to homebirth, or which midwives will be 'eligible', or ...  Another well known independent midwife Lisa Barrett has blogged her opinion, and has attracted considerable comment.  'Crikey', a web based group that is known for critical comment on everything, has published a couple of statements on its health blog 'Croakey', without attracting much in the way of comment.

That's enough for now.  Watch the blogs if you are interested.  We live in interesting times.

Joy Johnston

Thanks for sharing those links Joy :)

(I'm also a homebirth MW in australia)

 We've just had the joint referral policy for the ANZCOG and it makes scary reading!!  The bit about not supporting home birth or birth in primary units and the cnstant referrals to hospital midwives, with no mention made of independent/self employed midwives...  I somehow expected it from the australian docs (very much a turf war it seems ) but I'm appalled our lot supported it!!  What's happening to our profession?

Meg the midwife:

 We've just had the joint referral policy for the ANZCOG and it makes scary reading!!  The bit about not supporting home birth or birth in primary units and the cnstant referrals to hospital midwives, with no mention made of independent/self employed midwives...  I somehow expected it from the australian docs (very much a turf war it seems ) but I'm appalled our lot supported it!!  What's happening to our profession?

Meg I'm not sure how the policies of the College of O&Gs are to be applied to midwifery. Their statement against home births has been current as long as I have been practising in home birth, and it hasn't stopped women who want home birth.  The ACM referral guidelines are being widely used by midwives, to my knowledge.   We know that obstetricians and midwives often disagree, but obstetricians don't know midwifery, and midwives don't know obstetrics.   So if the disagreement is about care within the midwife's scope of practice, shouldn't the midwife be confident in her judgment?  I think many midwives have accepted the subordinate role, as doctor's assistant, and not stood up as a profession with our own distinct body of knowledge.

You are critical of 'our lot' - meaning the College of Midwives (ACM), I assume.  I don't understand.  What has the ACM supported that makes you appalled?

 Sorry for the confusion Joy, too many late nights!  The 'our lot' i referred to is our own assortment of Ob's here in NZ with whom we generally great collegial relationship.  There have ben several artiles and 'exposes' in the media lately about how our 'bad' example of midwifery focussed care was being used in Aust as a reason for not supporting the adoption of a similar method of practice, or a similar freedom of choice, across the tasman.  I agree that our scopes of practice are very different (midwives and ob's) but I personally feel in order for us to work together when needed we need to have a basic stand point of mutual respect, something i genuinely feel we have in our centre, and i feel this policy undermines that.  We have an accepted set of referral guidelines which have been well thoughtout and are easy to work with already in place, thru the section of legisaltion we work under and the new guidelines at points contradict these at several points. 

I am also working out of a frees tanding primary birthing unit and this is also not supported by the policies.  It makes it more differcult when we reffer women for an appropriate review if we know that the person on the other end of things, IE the doc, isn't going to support her chioce to birth here, as women can be very open to what figures in authority tell them.  At the moment we have a great set up and when we reffer women appropriately we know that unless there is a significant issue the woman's choice to birth here or at home wil be supported.  I was even asked myself why i was not having a homebirth by some of the docs we work with.  It would be a great disappointment if this were to fall to the wayside.

Our college CEO has written to the nz branch of the ANZCOG and it makes quite intereting reading (or maybe i just don't get out enough!) I'd be happy to forward it.  I tried to link it but as it's aletter not a website, not sure how.

Any how, just my thoughts!  I'd love to hear how midwifery works thru independent practice as i've only heard from collegues wo have been hospital based.  Take care, megan

Aha!

Thanks for explaining that Megan. My apologies for the misunderstanding. 

I hope you are able to get guidelines that truly reflect good practice standards.   Joy

 Me too!  hahaha