Australian Government acts to give women greater access to midwives and improve care!

An important update on the outcome of the Standing Committee on Health in regards to midwifery care.  So exciting to see this sensible development.  I know many people have been working tirelessly on getting the government to understand the issues.  My deepest gratitude to you all.

MEDIA RELEASE: 11 August 2012
Contact: Liz Wilkes 0423 580 585

Standing Committee on Health Decision will give women greater access to Midwives and improve Care.

Today’s decision by the Standing Committee on Health to enable midwives to collaborate with hospitals rather than individual doctors provides a welcome relief to Medicare provider midwives struggling to provide Medicare funded care to women.

“Until now government policy designed to provide women with Medicare access to private midwifery care has been to date severely restricted by obstetricians not wanting to be involved” said Liz Wilkes President of Midwives Australia.

“The recognition from every Health Minister across the country that midwives work collaboratively with doctors in hospitals and do not need individual doctor sign off is entirely appropriate. We applaud the sense they have shown” said Ms Wilkes

Midwives Australia has seen the legislation requiring midwives to collaborate with individual doctors has created unnecessary administrative burden and has created opportunity for medical veto over women’s access to Medicare rebates.

“What we are seeing here is the opportunity for midwives to develop license agreements and contracts with hospitals which enable true collaborative practice to continue”

“The whole hospital system relies on obstetricians being in the right place to deal with referrals of women. It is not a change in safe practice.”

“Midwifery care should not and does not require the presence of an individual doctor at a tertiary hospital when many other doctors are on staff, what matters is that there is a doctor present who is able to accept referral and transfer as doctors are employed to do this on a daily basis.”

“This week a Melbourne study found the care of a known midwife reduced the need for a caesarean section and actually improved outcomes. It is comforting to know that all Health Ministers agree on the need to make the care of a known midwife more accessible to Australian women.” said Ms Wilkes.

 We hope you will find it informative.

Best regards,
Midwives Australia

Thanks Liz Wilkes for this update! 

Bystanding Behaviour in Midwifery

I was alerted by a friend on facebook, to this article Bystanding Behaviour in Midwifery, about the way midwives don't stand up for women and how midwifery students are acculturated and desensitised to unkind behaviour. The article, written in 2008, is by Margaret Jowitt, who did her masters in Keele in 1998 on Mothers' Experience of Birth at Home and in Hospital. The book "Childbirth Unmasked" was written as a result of her reseach. Margaret is a lay member of the Association of Radical Midwives UK and a columnist for the Huffington Post.

Margaret wrote:

"I HAVE LONG WANTED to write an article on ‘Woman's inhumanity to woman' but have shied away until now for fear of being seen as attacking midwives and failing to acknowledge all they have achieved over the years in the care they give to women, often under very difficult and alien circumstances when they are based in hospitals".

I'm very glad she found a way to move through her fear and publish this article on Bystanding Behaviour in Midwifery and good to see it online as the issues are still alive and well today and not just in the UK.  Distressing as it is to think such articles are necessary, we need to examine and digest the ideas presented in this piece and discover what we can do to change or do better. I shared the article on facebook and twitter, thinking it would be useful for midwifery students.  However, I was prompted to put this post up to explore the ideas further following a reply 'tweet' to the article on Twitter.

@Thinkbirth I was a bystander recently and it traumatized me , worse was my colleagues saying it was normal and I was being dramatic.#scary 

How many of us have had our feelings about and discomfort with the way women have been treated minimised or dismissed?

What happens to us when abuse is normalised?

When there is a disconnect between what we know is right and what is happening, between what is taught and what is practice, there is cognitive and emotional dissonance and a sense of not knowing what to do next...

Photo from Prefrontal Org Blog

How do you deal with that?

Is this your experience?

Creating Optimal Birth Space

The environment in which we live and move and have our being is critical to our physical, mental, spiritual and social functioning. More and more understanding is emerging about how the environment plays a pivotal role in all aspects of our lives. From mice to (wo) men, science is demonstrating that the body's neural network is "plastic", that genes are not destiny and that the "environment" is an integral part of how living creatures function and develop. Every physiological interaction and behaviour, from the way genes are expressed in the sperm and the ovum to our health and experience across the lifecycle depends upon the environment. The environnment gives feedback which will be either nourishing and provide the stimulus to function well and grow or hostile, which disrupts our functioning, leading to disease, distress and decay.

Recognition of the way the environment is integral to optimal functioning is expanding our understanding of the role of maternity care in providing optimal environments for childbearing women. The science is also demonstrating why woman centred care, facilitating the fulfilment of woman's choices and incorporating women's rights into maternity care are so much a part of optimising outcomes for women, their babies, their intimate relationships and society in general.

My friend and colleague, the wonderful Maralyn Foureur, Professor of Midwifery at the University of Technology of Sydney (UTS) presented on this topic at the recent homebirth conference in New Zealand.  Maralyn is heading up a research team exploring birth space and has attracted a highly prized NHMRC grant for this work. 

Click the link below and it will take you to the slide share of her presentation

Creating Optimal Birth Space

I think you will enjoy and get a lot out of her research.

A coroner's perspective on the death of a baby

The coroner, in his report released today on the intrapartum death of a baby girl at a private hospital in Queensland, was critical of both the midwife and the obstetrician involved in the labour and birth care of the mother.

The care was found to be substandard by the coroner on many levels.  The midwife was found to have altered the woman's medical records after the event; did not follow hospital protocols regarding monitoring and documentation and did not refer to an obstetrician in a timely manner. The coroner will be reporting the midwife to the Director for Public Prosecutions.

The coroner found the doctor's response to the clinical situation to be ''inadequate" and recommended that he be reported to the hospital board.  I wonder why the coroner is not reporting the doctor to the Director of Public Prosecutions too?

The coroner made 21 recommendations from the content of antenatal education and the way they are formatted to the essential nature of good collaborative care for safe care of mothers and their babies.

The president of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Dr Rupert Sherwood commented that this case highlighted the reasons why the college "has always insisted on collaborative arrangements between doctors and midwives".  He further claimed that there were two aspects of good collaborative care: adherence to protocols and timely referral. Those aspects, while very important, are not the key to what constitutes either collaboration or safe maternity care.

There is no doubt that collaborative maternity care is the safest for both mothers and babies. I have had the supreme good fortune of working collaboratively with a number of skilled, compassionate and insightful obstetricians. I have sadly, had the misfortune of working with the others too. The key to collaborative maternity care provision is the way the organisation is structured. There are two aspects to that positioning. One, that the organisation overtly recognises that birth is a normal natural event which sometimes needs expert and timely intervention. The other, fundamentally crucial aspect is the acceptance and promotion of the woman's right to self determination, evidenced by the woman being treated as an equal partner in the care planning and giving. A woman centred maternity service, where both obstetrics and midwifery AND the organisation has the woman, her wellbeing, her desires, needs & requirements at the centre of their practice leads to the leveling of hierarchies and the destruction of professional 'silos' which engenders an atmosphere of trust with optimal communication.  I found in my research that without that organisational structure creating the culture of collaboration, with warm, trusting relationships of mutual respect and woman centred practice, both doctors and midwives lose their emotional and social competence, they act stereotypically, the turf war is in full swing and mothers and their babies suffer.

The loss of this little baby Samara is a tragedy for all concerned.  The fact that with good collaborative care, this baby's death could most likely have been avoided is heart wrenchingly tragic.

This coroner's report is a must read for everyone associated with maternity services, from caregivers to managers as it contains important directions and information regarding staffing, culture and practice.

One born every minute: SBS documentary

SBS: Documentary

 The introduction to the US version of this 'documentary' explains:

"Every minute of every hour, a baby is born. But no birth story is ever the same. One Born Every Minute USA is an eight-part series that celebrates what it really feels like to become a parent.

Experience the high drama, humour and overwhelming emotion of child birth as new lives begin and others change forever.

This ground-breaking series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

In the lead photo to the US version of this series, a gloved hand, not the mother's, attempts to feed an obviously preterm infant, while the mother looks on with an intravenous line in her arm. The gloved hand is doing the important work.

The introduction for the UK version of the SBS documentary says this:

"Every minute of every day a baby is born in Britain. One Born Every Minute is an eight-part series that celebrates what it really feels like to become a parent, by taking a bustling maternity hospital and filling it with 40 cameras.

Filming from the reception desk and neo-natal ward to the operating theatre and birthing pool, this groundbreaking new series observes the dramatic, emotional and often funny moments that go hand in hand with bringing a new being into the world, from the perspective of the soon-to-be parents and family, as well as the hospital staff".

I am very bothered by both versions of this documentary. I am bothered because the lead photos (shown above and below) show a version of birth that is a complicated one.The mothers are not at the centre of care, which is where they should be.

The very pale baby being ventilated on the resuscitation trolley implies and transmits a subliminal message that birth is dangerous for babies.

That implication is wildly untrue and is a mean, cruel and dangerous association to put into the minds of people. That association undermines women's sense of self and sense of safety around birthing their babies.  I know sensationalism is what brings 'ratings' but good grief, preying on people's insecurities is despicable.

I was bothered because the assumption was and is, that the sort of maternity care that was shown in this documentary is 'normal'.

Yes, this maternity 'care' is normal if you think that women in labour should:

• be apologetic
• be treated like a nuisance
• be told how busy everyone is
• be surrounded by noise: telephones, pagers, beeping machines, talking
• be confined to the bed
• be strapped to monitors
• be left with only their partners and other support people
• have intermittent surveillance
• be attended by a technician that gives pain modifiers as requested
• be spoken to rudely
• be threatened
• be positioned in a way that ensures fetal distress
• have their babies handled roughly
• be separated from their babies

That view of normal maternity 'care' is what is at the back of the current wave of anxiety and mental health disorders in our population. How can I claim that? Our culture has been interrupting, disturbing and derailing mother-baby bonding and attachment processes for many decades now. Evidence is accumulating that early experiences shape personality, health and wellbeing.  Early emotional experiences have the most profound impact. There is nothing as emotional as birth. The corruption of the most primal and important experience in life, as evidenced in this documentary is startling in the way that such cruelty is accepted without any comment.

I have a very different view of maternity care and what is 'normal' during labour and birth.

In my world, a woman in labour is:

• continuously supported by a midwife she knows and trusts
• in an environment conducive to optimal physiological functioning - quiet, dimmed lighting, warm, private
• free to move, be mobile and adopt positions that feel right
• spoken to encouragingly
• free to focus on themselves and their babies
• supported by her partner and family as desired
• free to drink and eat as desired
• continuously monitored only if there is an indication to do so
• treated kindly and with respect
• able to expect her baby will be handled gently
• able to have the benefits of skin to skin with their babies at birth

What's your view of 'normal' maternity care?

Judging Right and Wrong?

Great changes are happening to midwifery and women's birth choices in Australia. The government has passed legislation that on the one hand gives more autonomy and a wider scope of practice to midwives working in the public health system and on the other hand, restricts the services able to be offered by midwives in private practice. More women will be able to have their babies at home as more public hospital homebirth services are being offered. However women will have less ability to choose their own midwife. In accessing publicly funded services, women will have to, in the main, take 'pot luck' with their midwives. Women who have 'criteria' also known as risk factors will be denied a choice of birth venue, even though many of the risk factors are poor predictors of outcomes. With good midwifery care, these women birth  well.

I have had an email from someone recently who is absolutely distraught because her local hospital staff are bullying her into having another caesarean. The maddening thing is that the woman has given birth normally both before and after the caesarean birth. The hospital where the woman lives has a 'once a caesarean always a caesarean' policy and does not take into account the individual and her circumstances . The woman is unable to pay a private midwife and any other options are non existent.

Just yesterday, a woman who was booked to have a homebirth with a publicly funded service, was explaining to some midwifery students how she found out that her allocated midwife was off when she went into labour. She rang the phone number and got a midwife on the other end who she felt was not the least bit interested in her. The woman told the students how uncomfortable she felt and how she had to ring someone in charge and get another midwife allocated to care for her. She was finally allocated two midwives she felt good with. Once that arrangement was settled, she was able to focus on her baby and her labour. She went on to have a her baby at home.

I've found the various perspectives on the current changes polarised and distressing for many people. I can understand the distress. Change is always challenging. Many people feel we are losing too much. I believe that we have to stay focused on what we want and how we want maternity services to be. Focusing on the problem only adds energy to the problem. Looking clearly at what is going on and then choosing our path and taking action is a much better way.

I truly want everything - I want women led maternity services.  I want women and their babies to be safe and given the care they want so that their physiology works well and their safety is optimised. I want publicly funded birthing services, including venue of choice to be freely available.  I want midwives in private practice able to work to the full scope of their practice. I want 'no fault' compensation for women and their families when babies have problems as they occasionally do regardless of birth venue.  I want women, midwives and doctors to work together and with other health care providers as needed for any particular woman's circumstances.  I believe we can achieve these changes.

Imagine my delight when I found this email newsletter in my inbox from a wonderful man, Charlie Badenhop, this evening talking about right and wrong. Charlie is a fourth degree black belt and certified instructor of Aikido in Japan, and a certified trainer in NLP and Ericksonian Hypnosis. He is also a long term practitioner of various forms of bodywork, Self-relations therapy, the Japanese healing arts of sei tai and seiki jutsu, and Yoga.

I have found Charlie well worth listening to as he always has something interesting and appropriate to say. As I read the newsletter, I thought how pertinent Charlie's writing is to our circumstances. I wrote to Charlie and asked if I could share the newsletter. He readily agreed and to my surprise, told me that at one stage he had thought about becoming a midwife but ended up in Japan instead.

Enjoy!  If you like what Charlie has to say, you can subscribe to his newsletters down the bottom of the blog post.

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c).

Punishment, and the concept of "right or wrong"

"A lot of the best learning I received as an Aikido student came when we were outside of the dojo with sensei. We could be having a cup of coffee, or occasionally having a drink, and at some point it would become clear sensei had a message to deliver.

Once we were sitting in a coffee shop waiting for a train in the countryside.
Seemingly out of nowhere, sensei said, "I think there are many people in the world who act in a confrontational manner, and thus I wish more people understood the Aikido principle of non-dissension."

"Instead of spending so much time and so many human lives quarreling over who is right and who is wrong, I think the world would be a better place if we spent more time exploring how both sides are both right and wrong."


Myself, and the other two students sat there and said very little, knowing sensei was just beginning to get warmed up.

"You see," sensei said, "In Aikido we learn to refrain from engaging in confrontation, but that does not mean we shy away from protecting ourselves. It always intrigues me when new students attend a class and ask, ‘How can Aikido really be a martial art if you don't attack or retaliate against your opponents.' By this time the three of you have heard my reply many times over. In Aikido we have no attack form because we have no desire or intention to harm our adversaries. Instead we strive to bring hostilities to a conclusion that is respectful of all involved."

"If my opponent has never harmed me, never struck me, never hurt me, then why would I want to hurt or punish him? Do I want to punish him simply because he has thought about hurting me, or because he has made a weak effort that was easily rebuffed? You see, even in a court of law, you can't charge someone with murder simply because they thought about murdering someone. Attempted murder and actual murder are two very different crimes. When I am relaxed, aware, and fully present in the moment, then my adversary will have little opportunity to successfully attack me. Since he hasn't hurt me, since he hasn't truly threatened me, I have little desire to punish him in any way. His own thoughts, and the negative results he achieves in the world will be punishment enough."

"Related to punishing someone, is the idea of someone or something being either right or wrong. In Aikido, we learn to refrain from believing one path, or one way of thinking, is inherently superior to another. We also learn to refrain from engaging in thinking that any one point of view is the opposite of others."

"When we think in terms of opposites and disagree with someone else's opinion, we begin to oppose the other person's point of view. And this is exactly the kind of thinking that leads to resisting, combat, antagonism, and an overall disrespect for our perceived adversary."

"In Aikido, we do not attack, but we also do not concede or give up. In every day life the same can be true. Without attacking the viewpoint of others, without conceding or giving up our own viewpoint, we can still maintain ourselves, and continue to act in a way that is consistent with our beliefs."

"Keep that in mind," sensei said as he looked across the table. "More than once I've heard you arguing with other students, trying to prove your viewpoint was more correct than theirs. When you act like that, not only will you fail to convince them that you are right, and they are wrong, you'll also wind up losing them as friends and allies."

"Pure Heart, Simple Mind"(tm) is the Seishindo newsletter written and edited by Charlie Badenhop (c). All rights reserved. Click if you would like to subscribe.

Life, birth and death: The horror of poverty

This video from Time, on Maternal Mortality in Sierra Leone, the story of Mamma - one woman's journey from pregnancy to death is a heart wrenching portrayal of what is happening to too many women in
impoverished circumstances.

The Time photo montage shows a photo of young woman with a glazed, far away look on her face, intravenous therapy in her hand, lying on a trolley bed, a baby on a chair beside her.  The photo's caption says:

"Birthing Room
Forced to marry at age 14, Mamma Sessay first gave birth when she was 15. Three years later, at the age of 18, she gave birth to the first of a pair of twins near her village, but when the contractions ceased for the second child, she traveled by canoe and ambulance to the Magburaka Government Hospital, where she waits, in the photo above, to deliver".

Read more at Time Photos: Maternal Mortality in Sierra Leone

The video of Mamma Sessay's life and death experience is recorded and reproduced here:

Video: Maternal Mortality in Sierra Leone

Poverty and the associated lack of clean water, sanitation, good food, contraception, respect for women, education, family planning, antenatal care, being married too young, having babies too early - the list goes on and on, is the real problem. The other real problem is social apathy and feelings of helplessness about women's lot in disadvantaged situations. Labour and birth are peak and demanding activities. Women do best when they are well nourished, well hydrated, informed, have good midwifery care during pregnancy, labour and postnatal period, are having babies when they want to, have been well prepared for labour and birth, are able to labour and birth with loved ones around and able to access good medical care if and when required.

The article in Time, called The perils of pregnancy is horrific, but the emphasis is wrong. The emphasis should be on the perils of poverty.


Why are our governments spending our hard earned tax dollars on war for oil, when we could spend our money on making life better for our brothers and sisters across the world. With a different way of looking at world affairs we could save the lives of women like Mamma.

There are some good signs. According to Dr Margaret Chan, Director-General of the World Health Organisation, in her opening address on behalf of eight organizations at the Women Deliver 2010 Ministers Forum Washington, DC, USA  on the 7th June 2010

"Domestic resources and donor funds are making a real difference to the lives of millions. The number of children dying before reaching their fifth birthday has been falling for several years. We are now seeing early signs of progress in reducing the number of women dying in pregnancy and child birth, in addition to the achievements in HIV, TB and malaria".

and added

"This progress is most welcome, but is fragile, uneven, inequitable and inadequate. Far too many women and children continue to die needlessly"

calling for a world wide, coordinated effort and finances, including:

"government leadership of inclusive partnerships at country and global levels to design, implement and monitor the commitments and promises of all stakeholders".

Letter writing and political activism required. 

What do you think?

BBC News - Post-natal depression in fathers 'often undiagnosed'

Modern day pressures on men have escalated in the last couple of decades as men seek to find relevance in a world that is rapidly changing their role in society and the family.

At last researchers are turning their attention to men's experiences of birth and early parenting. Researchers from the Eastern Virginia Medical School team looked at 43 studies involving 28,004 parents from 16 different countries. The countries included the UK and the US. In a news item in the BBC news, the researchers were quoted as saying:

"One in 10 new fathers may have the baby blues, US researchers believe - based on their trawl of medical literature. While this rate is lower than in new mothers, it is more than currently recognised, they told the Journal of the American Medical Association. Lack of sleep and new responsibilities, or supporting a wife with post-natal depression can be triggers, they say".

Childbearing and early parenting are stressful experiences.  New roles, new experiences and general unfamiliarity with babies provide a catalogue of changes that both women and men are having to deal with and integrate. A new reality for many along with smaller family sizes and the nuclear family phenomenon is that a vast majority of young parents have never even held a baby before they hold their own. Many men are inadequately prepared for being present at the birth of their baby and parenting.

BBC News Article

Midwives have a real role in including fathers-to-be in their work with childbearing women. Many men feel left out and sidelined during antenatal visits and during the birth process. Feedback from women on their experiences of midwifery student follow through often contain comments about how the student included their partner. The women always say how grateful they are that their partner was included and made to feel important by the student. The fact that the women feel a need to comment on this aspect of the student's involvement in their childbearing experience indicates to me that partners are not generally included in the care given by midwives and doctors.

Midwives and other health professionals have to recognise that childbearing is an emotional experience for men too. Working with women across the continuum of childbearing is enhanced when their partners are included in the woman centred focus of the midwife. Respect, kindness, inclusion and relationship building are core attributes of midwifery practice and set the foundation for women's feelings of being well cared for and valued during their experience of maternity care. Engaging fathers in the same way obviously has implications for how men emerge from their experience of maternity care too.

John Heron (born 1928) , a wonderful man who pioneered a participatory research method called cooperative inquiry, provided (for me) the first clear understanding about the importance of emotions in human interactions and wellbeing. John Heron identified three core emotional needs:

1. To love and be loved
2. To choose and be chosen
3. To understand and be understood

Heron said when these core emotional needs were not met, people develop defense mechanisms. Defense mechanisms are often counter productive to optimal relationships; optimal interactions on both cellular and social levels and overall mental and physical health and wellbeing.

If midwives and other health practitioners make a clear goal to ensure the emotional needs of women and their partners are met in their work with them through the childbearing year and beyond, many of the ills that plague new parents may be 'headed off at the pass'.

BBC News - Post-natal depression in fathers 'often undiagnosed'

Why midwives and women have to stay upbeat about birth: The wisdom of herds: How social mood moves the world - 19 May 2010 - New Scientist

In the latest New Scientist (19th May 2010), an article by John Casti, Senior Research Scholar and a futurist (castiwien@cs.com) based at the International Institute for Applied Systems Analysis in Laxenburg, Austria who is developing early-warning indicators for extreme events in society, informs us that

"No collective human activities or actions, such as globalisation or, for that matter, trends in popular culture such as fashions in films, books or haute couture, can be understood without recognising that it is how a group or population sees the future that shapes events. Feelings, not rational calculations, are what matter. To see what our world might be like tomorrow, next year or next decade, we need to spend time and money investigating "social mood". Put simply, the mood of a group - an institution, state, continent or even the world - is how that group, as a group, feels about the future".

How would we, as a group of people who care about what happens to women and babies during the childbearing year, be described as feeling about the future?

Are we optimistic or pessimistic? "

According to John Casti, how we feel and how we see the future, does much to create it. In the Selfish Gene, British scientist, Richard Dawkins coined the word 'meme' as a concept to enable discussion about these collective social, cultural moods/orientations and behaviours as evolutionary principles in explaining the spread of ideas and cultural phenomena.

What's our meme? What do we want it to be?

Casti's essay is based on his new book Mood Matters: From rising skirt lengths to the collapse of world powers.

The wisdom of herds: How social mood moves the world - 19 May 2010 - New Scientist

Programming the future

My friend came back from England yesterday.  I picked up her daughter in the early hours and we drove to the airport together to meet her mum. Her daughter is in year 12. Studying is her major activity. The sunrise was stunning. Intensely pink and orange light filled the sky over Sydney as we made our way towards the airport. We chatted about her studies and what she hoped to do in the future. I was impressed with her clarity and vision.

Next week, as part of her family and children studies, all her group are being given a 'baby' to take home. The students all have to pretend it is a real baby and do all the things that mothers do when they have a new baby.  As many new mothers have never even held  a baby until they give birth to their own, this initiative is an effective way to help address that deficit in embodied knowledge.

I asked about feeding the baby. "oh, I have to give it a bottle and make up the formula" was the answer.

The conversation that followed explored the damaging message that this very creative and innovative exercise was unwittingly sending about how babies are fed.

The well intentioned, but ill advised, baby care education promotes bottle feeding as 'normal'. Young girls get that message early, for example, when given a baby doll complete with bottle as a gift for their birthday or Christmas. Have you noticed how those dolls all have bottles?

I went to the NSW Department of Education's website and looked up the curriculum for the "Exploring Early Childhood" program. 

The syllabus is very comprehensive.

Infant feeding, including a thorough section on breastfeeding is there, but no mention about how these subjects are taught. The practical application of knowledge to behaviour by providing a baby model for each student to take care of and feed is excellent. However, teachers need to ensure that students are able to 'breastfeed' the 'baby' as a matter of course.

Then young adults will get the right message: that breastfeeding is 'normal'.

As we pulled into the airport car park, my friend's daughter said she was grateful for the conversation, because she 'hadn't thought of it like that'. 

Neither would she.

Why would she? 

People don't know something until they know there is something to know!  When all society's clues and subliminal messages point to bottle feeding as 'normal', for a counter truth to have traction, you need other experiences or input, perhaps from a breastfeeding aunt, friend, neighbour or mother to enable you to think differently to the crowd, to be able to challenge the 'status quo'.

 La Leche Materna

After the event is a terrible time to learn the truth about what you can do to give your baby the optimal start in life. 

Midwifery Legislation Update from Maternity Coalition

Update from Maternity Coalition about Health Care Legislation.

The Senate passed the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 on Tuesday 16 March. This legislation should give Australian women greater access to affordable, continuity of care with a known midwife.

It marks the beginning of a new era of maternity care for Australia’s maternity consumers. It is a huge achievement; and thanks to the work of generations of women and to you.

In recent months, much of our focus in the birth community has been on the aspects of the maternity reforms we are unhappy with including the collaborative arrangement and the threat to births at home. But we should remember that this legislation is a giant step forward in the right direction to woman-centred maternity care.

What this means

We don’t know how it will all work in practice yet as Health Minister Roxon still needs to make decisions on a number of things including definitions for ‘eligible midwife’ and ‘collaborative arrangement’ and details around Medicare and prescribing are still not finalised.

But what we do know is that:
• Consumers, from November 2010, will be able to choose (in theory) their own midwife for their pregnancy, birth care in a hospital and post-natal care. How intrapartum care in hospital will work still needs to be sorted with visiting/admitting rights. This care will be more affordable as they can get Medicare rebates for it. This has the potential of increasing the numbers of Australian women who can access continuity of care with a known midwife from less than 5% to a New Zealand figure of around 80% or higher.
• Midwives will have access to
o Medical Benefits Scheme
o Pharmaceutical Benefits Scheme
o Professional Indemnity Insurance (excluding birth at home) and the Government will also pay any insurance claims that exceed $1 million. Note: The need for a collaborative arrangement to be in place before a midwife could access this indemnity was dropped in the Bills.

What MC is doing?
MC is working hard. We have:
• representatives at all working groups of the Department of Health and Ageing involved in implementing these reforms.
• given evidence at two Senate enquiries.
• attended consultations and made submissions to provide the consumer perspective on maternity issues.
• engaged in strategic conversations with other stakeholders.

MC and a range of midwifery and nursing organisations have agreed on a consensus for collaborative arrangements and took this proposal to the Minister’s office. We’re feeling optimistic about this. Senator Joe Ludwig (ALP) clearly stated in the Senate it was not the Government’s intention in the legislation to give one professional group control over another. We need to keep the Government accountable to this.

What about homebirth?
There is nothing in the Bills for homebirth – the Bills neither support nor outlaw homebirth. However Health Minister Roxon has made it clear that she intends women to be able to continue to access midwifery care for homebirths. To hear it straight from the Minister, see this video:
http://www.youtube.com/watch?v=iK_Vt18eq0s

MC, along with the Australian College of Midwives, has developed an alternative proposal for the Quality and Safety Framework midwives will need to work to in order to qualify for the two year exemption from professional indemnity insurance. As the whole purpose of this exemption was to secure women’s access to homebirth care, MC expects an outcome which will work.

We have asked that this framework be finalised by 1 April 2010 giving women and midwives 3 months in which to make plans. The final version of the framework will be released in the next few days. Look to the website for a link to it shortly.


MC’s perspective of an ideal outcome for homebirth (in terms of what’s going on at the moment) is that midwives providing homebirth care will be:
• registered as a midwife and able to practice
• exempt from professional indemnity insurance for the first two years of national registration (from July 2010)
• working in much the same way they do now.

Some homebirth midwives might also choose to become an ‘eligible midwife’ with access to MBS and PBS. In which case they will need to have a collaborative arrangement in place so that their clients can receive Medicare rebates for their pregnancy and post-natal care.


What you can do right now?

• The National Health and Medical Research Council has released its draft ‘Guidance on Collaborative Maternity Care’. This is a very important document. They are asking for feedback on this document and want it by Friday 27 April. For more information go here: http://www.nhmrc.gov.au/guidelines/consult/consultations/ngcmc.htm. When you read it, ask yourself how these arrangements would work for you as a consumer. SEND YOUR COMMENTS TO l.metcalfe@tpg.com.au for incorporation into a response to the NHMRC.

• If you haven’t written/visited your Federal MP for awhile, get back in touch and tell him/her that birth and birth care really matter to women and families, and we expect governments to take responsibility for the quality of care and choices available to women [how do you see this yourself?]. Remind them that they need to find a long-term solution for indemnity for midwives providing homebirth by June 2012 and that the clock is ticking.

• Keep up your membership to Maternity Coalition and other consumer and midwifery groups. In numbers we have strength. Without you, we are nothing. To renew your membership with MC and find out when and where the next meeting is close to you, go to our website www.maternitycoalition.org.au



Lisa Metcalfe
President Maternity Coalition
Em: president@maternitycoalition.org.au
Web: www.maternitycoalition.org.au