Friday, December 18, 2009

Consensus, collaboration and power imbalances - words from the Senate Hearing on Women's choice of birthplace and midwife's role

From the Senate hearing

Senator SIEWERT—The issue around consensus is about somebody who has spent years of her life in a
consensus system—a consensus decision-making process. One of the things I clearly know is that, if there is a power imbalance, consensus tends not to work, because at the end of the day the people holding the power can say, ‘I don’t care what you think; we’re the ones that sign on the dotted line at the end of this process.’ That seems to me to be one of the keys here. You can say that the medical practitioners will collaborate and want a consensus approach, but at the end of the day it is the medical profession and obstetricians who will be responsible for signing off on collaborative care arrangements under the current process, and that is what
people are concerned about. It seems to me that it is clear that there is a power imbalance when you are happy with this amendment but patients, midwives and nurse practitioners are not happy with it. So that says to me that fundamentally there is an issue here.

Dr Pesce—All right. We have lots of very happy patients that do not seem to be unhappy with the power
balance. But in trying to address—

Senator SIEWERT—We have 2,000 emails from people saying that they do not like the current

Dr Pesce—And there are 280,000 births a year. But we do not have to get stuck on that. In terms of the
power imbalance, if there is a power imbalance, I suspect that it emerges from the fact that we have different
competencies and that, at the end of the day, when something goes wrong—in an abnormal or high-risk
pregnancy—it is an obstetrician that is required to perform an instrumental delivery or a caesarean section,
which is not within the competency of a midwife. If there is an imbalance, I suspect that it emerges from the
fact that midwives can care for a patient to a certain point and then, if something goes beyond that, they need
to enlist the services of a collaborating obstetrician. But that obstetrician obviously is hesitant to just become a
technician and say, ‘I will just step in when I am asked to.’ They would like to step in at the right time. So, if
there is a power imbalance, it arises from the different competencies of the people who work in the team,

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