Showing posts with label women's rights. Show all posts
Showing posts with label women's rights. Show all posts
Sunday 18 October 2009
Saturday 17 October 2009
Science & Sensibility » Beyond Due Dates: How Late is Too Late?
The following is a quote on the Science and Sensibility blog by Rosie:
"Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average."
The comment above is so important to think about. How do we right this crazy wrong?
The way that that the normal, physiological span for when labour begins has been contracted to the due date is unacceptable and wrong. The 'due date' was always an estimation, not a set in concrete date.
The feverishness with which the medical model approach to childbearing seeks to control women with babies on the inside is simply astonishing and, when you really think about it, deplorable.
We menstruate at different ages, we go through menopause at different ages. Children learn to speak, to crawl and to walk within wildly varying time frames. These time frames are normal. Everyone is different.
Can you imagine what it would be like if we suddenly imposed restrictions and curtailments on what was considered normal and acceptable in those domains of human development?
Such restriction would lead to inhuman and cruel procedures.
The medical control of birthing women's processes is often inhumane and cruel, although it positions itself as 'lifesaving', heroic and really, the only field which really cares about the baby. The medical model view has positioned mother and baby as competing entities and medicine is the advocate of the baby. Barbara Duden is a German historian who has written a great book called Disembodying Women. Barbara talks about how women have been depicted as a faulty ecosystem and the baby is depicted as an endangered species in modern medical discourse.
The rise in the rate of surgical birth, maternal depression and admissions of babies to neonatal intensive care units is the fallout from this crazy making 'emperor has no clothes' medical model approach to try to control women and childbearing.
The childbearing process has to be worked with, not worked on.
Science & Sensibility: Beyond Due Dates: How Late is Too Late?
Shared via AddThis
"Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average."
The comment above is so important to think about. How do we right this crazy wrong?
The way that that the normal, physiological span for when labour begins has been contracted to the due date is unacceptable and wrong. The 'due date' was always an estimation, not a set in concrete date.
The feverishness with which the medical model approach to childbearing seeks to control women with babies on the inside is simply astonishing and, when you really think about it, deplorable.
We menstruate at different ages, we go through menopause at different ages. Children learn to speak, to crawl and to walk within wildly varying time frames. These time frames are normal. Everyone is different.
Can you imagine what it would be like if we suddenly imposed restrictions and curtailments on what was considered normal and acceptable in those domains of human development?
Such restriction would lead to inhuman and cruel procedures.
The medical control of birthing women's processes is often inhumane and cruel, although it positions itself as 'lifesaving', heroic and really, the only field which really cares about the baby. The medical model view has positioned mother and baby as competing entities and medicine is the advocate of the baby. Barbara Duden is a German historian who has written a great book called Disembodying Women. Barbara talks about how women have been depicted as a faulty ecosystem and the baby is depicted as an endangered species in modern medical discourse.
The rise in the rate of surgical birth, maternal depression and admissions of babies to neonatal intensive care units is the fallout from this crazy making 'emperor has no clothes' medical model approach to try to control women and childbearing.
The childbearing process has to be worked with, not worked on.
Science & Sensibility: Beyond Due Dates: How Late is Too Late?
Shared via AddThis
Wednesday 9 September 2009
The Mother of All Rallies 7th September 2009
The rally for women's rights to choose the place of birth and caregiver was wonderful. I travelled with other women, men and children in a two bus convoy from the Central Coast. It was a great trip. Thanks to Monica and Julie, two UTS BMidwifery student midwives for organising the buses. People came from Newcastle and Central Coast to travel on the buses.
I spoke to Natalie Forbes Dash and Amy Bell who told me that 70-80 families travelled down on the day from the Blue Mountains.
Depending upon which report you read, there were between 2000 - 4000 people there. I couldn't get near the centre of the crowd there were so many people and I didn't hear the speeches because of the depth of the crowd. So there were vast numbers present. The atmosphere was unlike anything I have ever been to before. Everyone, including the children and parents were all relaxed, upbeat and happy. The sky was overcast, it rained intermittently and no one's spirits were dampened.
Great to see so many people who travelled from interstate and vast distances. I caught up with so many people I've known and admired over the years.
When you click on the link above, you will be taken to the Riot Act site which has a good run down on the rally, including Rachel Stewart's speech.
It was a great day and a powerful testimony to people's deep desire for autonomy and self determination. Keep up the letter writing everyone. Rachel Stewart was fabulous from all accounts. Andrew Laming is onside and there are bound to be many more thinking politicians.
I spoke to Natalie Forbes Dash and Amy Bell who told me that 70-80 families travelled down on the day from the Blue Mountains.
Depending upon which report you read, there were between 2000 - 4000 people there. I couldn't get near the centre of the crowd there were so many people and I didn't hear the speeches because of the depth of the crowd. So there were vast numbers present. The atmosphere was unlike anything I have ever been to before. Everyone, including the children and parents were all relaxed, upbeat and happy. The sky was overcast, it rained intermittently and no one's spirits were dampened.
Great to see so many people who travelled from interstate and vast distances. I caught up with so many people I've known and admired over the years.
When you click on the link above, you will be taken to the Riot Act site which has a good run down on the rally, including Rachel Stewart's speech.
It was a great day and a powerful testimony to people's deep desire for autonomy and self determination. Keep up the letter writing everyone. Rachel Stewart was fabulous from all accounts. Andrew Laming is onside and there are bound to be many more thinking politicians.
Sunday 23 August 2009
Bullying and harrasment of Doctors who support women's choices
Welcome to my blog. Thank you for your support!
Please take a moment to read Dr Fischbein's blog. He is a medical doctor who supports women's right to autonomy and informed choice.
Please take a moment to read Dr Fischbein's blog. He is a medical doctor who supports women's right to autonomy and informed choice.
Friday 7 August 2009
Senate Committee Meeting update
This is the message from Lisa Metcalfe from Maternity Coalition following the Senate Committee hearing yesterday on the midwives and nurse practitioner bills before the Senate.
The transcript from the Senate committee hearing will be available on
this link in the next 24 hours or so
http://www.aph.gov.au/Senate/committee/clac_ctte/health_leg_midwives_nurse_practitioners_09/hearings/index.htm
MC, HBA, HAS and ACMI all presented to the committee
some terrific advocacy by the consumers
Thanks to those who represented MC (Bruce Teakle and Makayla Macintosh)
Media monitoring from Heidi this morning
Great to see this in the Age!
http://www.theage.com.au/travel/mothers-irate-at-qantas-baby-bungle-20090805-ea45.html
Lisa
--
Lisa Metcalfe
NSW President
Maternity Coalition
29 Oceana Pde
Austinmer NSW 2515
Ph: 02 4268 1675
Mob: 0437 577 576
Em: nsw@maternitycoalition.org.au
Web: www.maternitycoalition.org.au
The transcript from the Senate committee hearing will be available on
this link in the next 24 hours or so
http://www.aph.gov.au/Senate/committee/clac_ctte/health_leg_midwives_nurse_practitioners_09/hearings/index.htm
MC, HBA, HAS and ACMI all presented to the committee
some terrific advocacy by the consumers
Thanks to those who represented MC (Bruce Teakle and Makayla Macintosh)
Media monitoring from Heidi this morning
Great to see this in the Age!
http://www.theage.com.au/travel/mothers-irate-at-qantas-baby-bungle-20090805-ea45.html
Lisa
--
Lisa Metcalfe
NSW President
Maternity Coalition
29 Oceana Pde
Austinmer NSW 2515
Ph: 02 4268 1675
Mob: 0437 577 576
Em: nsw@maternitycoalition.org.au
Web: www.maternitycoalition.org.au
Wednesday 5 August 2009
Melbourne Homebirth Rally Video
Melbourne Homebirth Rally Video Aug 4 2009
This message has been sent to everyone by Justine Caines, Birth activist extraordinaire!
"Forwarding on the excellent work of homebirth mum, journalist and editor extraordinaire Libby Chow and sending her enormous thanks for documenting this awesome community effort. In the name of choice, freedom and human rights - homebirth.
http://www.youtube.com/user/redmango1975
A fabulous heart warming day for us all. BRING ON CANBERRA!"
This message has been sent to everyone by Justine Caines, Birth activist extraordinaire!
"Forwarding on the excellent work of homebirth mum, journalist and editor extraordinaire Libby Chow and sending her enormous thanks for documenting this awesome community effort. In the name of choice, freedom and human rights - homebirth.
http://www.youtube.com/user/redmango1975
A fabulous heart warming day for us all. BRING ON CANBERRA!"
Sunday 2 August 2009
Language and Paradox in Childbearing
I was reading a piece of work which commented that a woman had an 'uneventful pregnancy'. That word 'uneventful' appears to be innocent at first glance. What 'uneventful' means in the context of maternity care is that there are no problems with the pregnancy. Labeling the life changing transformative experience of a normal healthy pregnancy as 'uneventful' belies the importance of a pregnancy to a woman, her family and society. That word 'uneventful'diminishes the power and magnificence of what is happening within a woman's body and psyche when she is pregnant.
Being pregnant would have to rate up there as one of the most momentous of events in a woman's life. I was thinking about language and words have so much power and convey so much meaning. The use of the word 'uneventful' together with healthy pregnancy creates a paradox. This paradox is not immediately recognised. The paradox may never actually be recognised by the speaker. With one word the wonder of pregnancy is relegated to the status of an unremarkable and therefore somehow meaningless reality. I wonder if the mindset that word 'uneventful' creates is one of the reasons why our maternity services make pregnant women wait for hours in cattleyard-like antenatal clinics?
Carmel Niland said in 1992 in her Anne Conlon Memorial Lecture “Women, Power and the Political Process” to the NSW Women’s Advisory Council “Words are seeds. Whole worlds lie curled in them. Three words like ‘women’, ‘power’ and ‘politics’ have a universe in ideas curled in them”.
The way we speak, what we say and how we say it is culturally and politically determined and reflects our belief structures, perspectives, values and biases. Language also defines structure, creates thought and gives thought form. It not only embodies our history and culture, it reinforces our values and beliefs in a self perpetuating system of meaning making. Words are carriers for cultural ideology. We see the world through the lenses of our values and belief systems. Spoken language is a major form of interpersonal communication. The words used in oral communication demonstrate power structures and positions of those communicating within those power structures. As Sheila Rowbotham (in Waring 1990:18) comments,
“language … is one of the instruments of domination... expresses a reality experienced by the oppressors. It speaks only for their world, their view.”
Changing our language to ensure what we say truly reflects the magnificence of pregnancy, birth and breastfeeding is vital if we want to change maternity services and what happens to women.
Waring, M. If Women Counted: A new feminist economics Harper Collins New York.
Being pregnant would have to rate up there as one of the most momentous of events in a woman's life. I was thinking about language and words have so much power and convey so much meaning. The use of the word 'uneventful' together with healthy pregnancy creates a paradox. This paradox is not immediately recognised. The paradox may never actually be recognised by the speaker. With one word the wonder of pregnancy is relegated to the status of an unremarkable and therefore somehow meaningless reality. I wonder if the mindset that word 'uneventful' creates is one of the reasons why our maternity services make pregnant women wait for hours in cattleyard-like antenatal clinics?
Carmel Niland said in 1992 in her Anne Conlon Memorial Lecture “Women, Power and the Political Process” to the NSW Women’s Advisory Council “Words are seeds. Whole worlds lie curled in them. Three words like ‘women’, ‘power’ and ‘politics’ have a universe in ideas curled in them”.
The way we speak, what we say and how we say it is culturally and politically determined and reflects our belief structures, perspectives, values and biases. Language also defines structure, creates thought and gives thought form. It not only embodies our history and culture, it reinforces our values and beliefs in a self perpetuating system of meaning making. Words are carriers for cultural ideology. We see the world through the lenses of our values and belief systems. Spoken language is a major form of interpersonal communication. The words used in oral communication demonstrate power structures and positions of those communicating within those power structures. As Sheila Rowbotham (in Waring 1990:18) comments,
“language … is one of the instruments of domination... expresses a reality experienced by the oppressors. It speaks only for their world, their view.”
Changing our language to ensure what we say truly reflects the magnificence of pregnancy, birth and breastfeeding is vital if we want to change maternity services and what happens to women.
Waring, M. If Women Counted: A new feminist economics Harper Collins New York.
Saturday 1 August 2009
Homebirth is back on the agenda for Labor
The political arena is hotting up regarding women's choice to birth at home with the midwife of her choice
http://www.theaustralian.news.com.au/story/0,25197,25865135-23289,00.html
If you haven't written a letter yet, now's the time - you can google any of the politicians and send a letter to that person.
All very exciting. Great for women, great for babies, great for families, great for midwifery, great for the future of our society.
http://www.theaustralian.news.com.au/story/0,25197,25865135-23289,00.html
If you haven't written a letter yet, now's the time - you can google any of the politicians and send a letter to that person.
All very exciting. Great for women, great for babies, great for families, great for midwifery, great for the future of our society.
Sunday 26 July 2009
Pregnant women's rights US style
Three years ago, a pregnant woman who refused a continuous monitor when she was in labour and refused a caesarian section was given two psychiatrist consultations and found to be behaving 'erratically'. The woman gave birth normally to a healthy baby during the second psychiatric consultation. Because of her non-compliance, the woman was diagnosed as 'paranoid schizophrenic'.
The hospital in question has a caesarian section rate of nearly 50%. 'They' decided, because the woman was not 'cooperative' that the woman and her partner were not fit to care for their child and they took the baby away from her at birth.
Her baby was never returned to her.
That 'stolen child' situation has recently come to media attention
http://www.huffingtonpost.com/louise-marie-roth/is-a-woman-in-labor-a-per_b_242307.html
Some facts:
The baby was born normally and well
The woman had a history of abuse
The woman had a history of depression (pronounced well in 2005 and no longer requiring medication)
The hospital had a caesarean section rate of nearly 50%
The court decided the woman's refusal to have a caesarean indicated child abuse of an unborn child, even though the fetus has no legal rights
The court decided the woman did not have the right to make an informed choice
The court decision cites hospital records that describe the mother, V.M., as "combative," "uncooperative," "erratic," "noncompliant," "irrational" and "inappropriate."
Sounds like normal labour behaviour of many women to me, especially women who have been sexually abused as children and who have not had the opportunity to work things through with their midwife.
The judge was overheard telling V in one of her hearings that he felt she would be 'too argumentative and that would wind up hurting her child. For instance, she would argue with teachers and receptionists at the dentist office.'
Hmmm, anyone else ever argued with someone about something to do with your child? Anyone else ever argued with a teacher?
Henci Goer, the medical writer, joined several doctors and birth/women/rights related organisations and they together filed an amicus curiae (friend of the court) brief to support the appeal that was filed by the parents.
They lost. A supreme court appeal is likely.
In Australia, we all have to be very clear that women are autononous; that women have the right to decide what they will do or not do; that women have sovereignty over their own selves and their pregnancies. Women have the right to give birth where and with whom they choose. Full stop.
The situation that has happened to V could happen here.
Come to Canberra 7th September 2009 and make your presence felt. Write letters, see your local member. Help them understand what normal labour is like and what women need. Our future as a sane and just society depends upon it.
The hospital in question has a caesarian section rate of nearly 50%. 'They' decided, because the woman was not 'cooperative' that the woman and her partner were not fit to care for their child and they took the baby away from her at birth.
Her baby was never returned to her.
That 'stolen child' situation has recently come to media attention
http://www.huffingtonpost.com/louise-marie-roth/is-a-woman-in-labor-a-per_b_242307.html
Some facts:
The baby was born normally and well
The woman had a history of abuse
The woman had a history of depression (pronounced well in 2005 and no longer requiring medication)
The hospital had a caesarean section rate of nearly 50%
The court decided the woman's refusal to have a caesarean indicated child abuse of an unborn child, even though the fetus has no legal rights
The court decided the woman did not have the right to make an informed choice
The court decision cites hospital records that describe the mother, V.M., as "combative," "uncooperative," "erratic," "noncompliant," "irrational" and "inappropriate."
Sounds like normal labour behaviour of many women to me, especially women who have been sexually abused as children and who have not had the opportunity to work things through with their midwife.
The judge was overheard telling V in one of her hearings that he felt she would be 'too argumentative and that would wind up hurting her child. For instance, she would argue with teachers and receptionists at the dentist office.'
Hmmm, anyone else ever argued with someone about something to do with your child? Anyone else ever argued with a teacher?
Henci Goer, the medical writer, joined several doctors and birth/women/rights related organisations and they together filed an amicus curiae (friend of the court) brief to support the appeal that was filed by the parents.
They lost. A supreme court appeal is likely.
In Australia, we all have to be very clear that women are autononous; that women have the right to decide what they will do or not do; that women have sovereignty over their own selves and their pregnancies. Women have the right to give birth where and with whom they choose. Full stop.
The situation that has happened to V could happen here.
Come to Canberra 7th September 2009 and make your presence felt. Write letters, see your local member. Help them understand what normal labour is like and what women need. Our future as a sane and just society depends upon it.
Friday 26 June 2009
Thursday 25 June 2009
Nicola Roxon's bill to outlaw a woman's rights to choose to birth at home with the midwife of her choice
Can everyone please write to Nicola Roxon and tell her (politely, but strongly) what her bill has meant to you?
The Hon Nicola Roxon MP
Minister for Health and Ageing
Australian Government
PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600
Email: nicola.roxon.mp@aph.gov.au
and write to your local federal politician. Google his/her name and you will get their contact details.
The Hon Nicola Roxon MP
Minister for Health and Ageing
Australian Government
PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600
Email: nicola.roxon.mp@aph.gov.au
and write to your local federal politician. Google his/her name and you will get their contact details.
Wednesday 24 June 2009
Women's rights further eroded - Homebirth denied
Today our health minister, Nicola Roxon introduced two Bills to Parliament. One of these bills eroded women's rights to choose to birth at home with the midwife of her choice. This is unacceptable.
It is not acceptable to treat women this way. Every woman deserves to have the choice to employ her own midwife or to access the health service offerings, to choose her place of birth and to be supported in her choice.
Women are citizens of Australia. We are thinking, autonomous beings and want sovereignty over our bodies.
Who got to Nicola? Who over-rode her innate understanding of women's rights?
What do we need to do differently to get this to change?
It is not acceptable to treat women this way. Every woman deserves to have the choice to employ her own midwife or to access the health service offerings, to choose her place of birth and to be supported in her choice.
Women are citizens of Australia. We are thinking, autonomous beings and want sovereignty over our bodies.
Who got to Nicola? Who over-rode her innate understanding of women's rights?
What do we need to do differently to get this to change?
Wednesday 17 June 2009
Homebirth Rally at Parliament House Monday September 7th 1130am
Put this date in your diary and come with us! This is a critically important rally. The changes in Medicare rebates and the fine print is pointing to the demise of private midwifery and women's choices for birthing at home. For everyone who cares about women's rights to birth where they want and with whom they want, this rally is a must attend. We must show the politicians and the people of Australia that women matter, birth matters and choice is imperative.
The following message is from Justine Caines, an awesome woman and mother who has campaigned tirelessly for women's choices in birth.
HOME - EVERY WOMAN’S BIRTH RIGHT – RALLY FOR HOMEBIRTH – MONDAY SEPTEMBER 7 2009, PARLIAMENT HOUSE CANBERRA
Homebirth Australia is hosting a MAJOR rally in Canberra (outside Parliament House) on Monday September 7 from 11.30am.
There has been much discussion about the potential outlawing of homebirth and the continued lack of equity for women choosing homebirth.
We need this to be BIG. When I met with the federal department of Health they commented on the huge number of submissions (900 of which over half came from homebirth consumers). Sadly I said if you outlaw homebirth I will lead 9000 angry women and babies to Canberra!
Now 9000 may be a tall order but we need thousands.
For all the women and midwives that have contacted and said this issue matters please put it in your diary.
There is lots to organise and we look forward to many providing ideas and support.
The states close to Canberra will be called on to provide as many as possible to attend.
It would be great to have at least a few from every state and territory.
Please forward this meeting far and wide.
Details will soon be on the HBA website.
www.homebirthaustralia.org
For any other info please email justine.caines@bigpond.com
The following message is from Justine Caines, an awesome woman and mother who has campaigned tirelessly for women's choices in birth.
HOME - EVERY WOMAN’S BIRTH RIGHT – RALLY FOR HOMEBIRTH – MONDAY SEPTEMBER 7 2009, PARLIAMENT HOUSE CANBERRA
Homebirth Australia is hosting a MAJOR rally in Canberra (outside Parliament House) on Monday September 7 from 11.30am.
There has been much discussion about the potential outlawing of homebirth and the continued lack of equity for women choosing homebirth.
We need this to be BIG. When I met with the federal department of Health they commented on the huge number of submissions (900 of which over half came from homebirth consumers). Sadly I said if you outlaw homebirth I will lead 9000 angry women and babies to Canberra!
Now 9000 may be a tall order but we need thousands.
For all the women and midwives that have contacted and said this issue matters please put it in your diary.
There is lots to organise and we look forward to many providing ideas and support.
The states close to Canberra will be called on to provide as many as possible to attend.
It would be great to have at least a few from every state and territory.
Please forward this meeting far and wide.
Details will soon be on the HBA website.
www.homebirthaustralia.org
For any other info please email justine.caines@bigpond.com
Saturday 30 May 2009
Improving Maternity Services Package Budget 2009
Improving Maternity Services Package
The following paragraphs are from the federal budget released on the 12th May 09. I've been reading it, seeking to understand what it all really means. I'm not really any closer to finding out. What I do know is that the 'system' is not working well. Women centred care is still a pipe dream in many places. Stories student midwives tell are threaded with examples of bullying and coercion of women to fit in with the policy driven, factory style approach to the birthing process. There is still lots of work to do to create maternity services which are women centred, aware of women's individuality, private, kind and respectful. Is the budget offering a good move?
"The Government will provide $120.5 million over four years for the introduction of Medicare‑supported midwifery services to provide greater choice for women during pregnancy, birthing and postnatal maternity care. This measure includes $3.1 million in capital funding in 2009‑10 for Medicare Australia.
The new arrangements will allow midwives to work as private practitioners, provide services subsidised by the Medical Benefits Schedule and prescribe medications subsidised under the Pharmaceutical Benefits Schedule. The Government will also provide subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings. To ensure that Australia maintains its strong record of safety and quality in maternity care, a safety and quality framework, including professional guidance and an advanced midwifery credentialing framework, will be developed. A new 24‑hour, seven‑days‑a‑week helpline will also be established to provide antenatal, birthing and postnatal maternity advice and information to women, partners and families during the ante‑natal period and up to 12 months following the birth of a child.
The measure will also assist women in rural and remote areas by expanding the Medical Specialist Outreach Assistance Program to provide integrated outreach maternity service teams for women in under serviced areas. The expanded teams will include midwives, obstetricians, general practitioners and other health professionals, such as paediatricians and Aboriginal health workers. Additionally, funding will be provided for the professional development of midwives and for general practitioners to undertake additional training to become GP obstetricians or GP anaesthetists. The package will be implemented progressively from 1 July 2009".
The following paragraphs are from the federal budget released on the 12th May 09. I've been reading it, seeking to understand what it all really means. I'm not really any closer to finding out. What I do know is that the 'system' is not working well. Women centred care is still a pipe dream in many places. Stories student midwives tell are threaded with examples of bullying and coercion of women to fit in with the policy driven, factory style approach to the birthing process. There is still lots of work to do to create maternity services which are women centred, aware of women's individuality, private, kind and respectful. Is the budget offering a good move?
"The Government will provide $120.5 million over four years for the introduction of Medicare‑supported midwifery services to provide greater choice for women during pregnancy, birthing and postnatal maternity care. This measure includes $3.1 million in capital funding in 2009‑10 for Medicare Australia.
The new arrangements will allow midwives to work as private practitioners, provide services subsidised by the Medical Benefits Schedule and prescribe medications subsidised under the Pharmaceutical Benefits Schedule. The Government will also provide subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings. To ensure that Australia maintains its strong record of safety and quality in maternity care, a safety and quality framework, including professional guidance and an advanced midwifery credentialing framework, will be developed. A new 24‑hour, seven‑days‑a‑week helpline will also be established to provide antenatal, birthing and postnatal maternity advice and information to women, partners and families during the ante‑natal period and up to 12 months following the birth of a child.
The measure will also assist women in rural and remote areas by expanding the Medical Specialist Outreach Assistance Program to provide integrated outreach maternity service teams for women in under serviced areas. The expanded teams will include midwives, obstetricians, general practitioners and other health professionals, such as paediatricians and Aboriginal health workers. Additionally, funding will be provided for the professional development of midwives and for general practitioners to undertake additional training to become GP obstetricians or GP anaesthetists. The package will be implemented progressively from 1 July 2009".
Tuesday 23 December 2008
Garling Report
That fact that the NSW Health System is in crisis led to the appointment of Mr Peter Garling SC to conduct a review of the acute health care services in NSW in January 2008.
On 27th November, 2008, Mr Garling released his report. Terms of Reference and the report is available here:
http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_index
The report makes sobering and fascinating reading as Mr Garling outlines the problems which are troubling our health care system, for example, problems such as increased numbers of people accessing health care facilities. Mr Garling praised the skill, competence and dedication of the health care staff, but outlines many changes which need to occur for the health care system to improve. A particularly important point that Garling makes is that "Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".
These comments by Garling demonstrate his deep recognition of the power dynamics which are keeping the health care system stuck in its medieval origins and which mitigate against true efficiency and effectiveness for patients well being. Even though Garling only mentions nurse-doctor working relations, his comments are very applicable to the power dynamics which trouble maternity services. His words echo the conclusions of my study into midwife-doctor interactions in the care of birthing women.
thesis available on line here: http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509
The NSW Government is wanting feedback on the Garling Report. You can give feedback here:
http://healthactionplan.nsw.gov.au/provide-feedback.php
Please take a moment to give feedback on this important report. In my feedback I've talked about how birth is normal and that we are seeing iatrogenic outcomes because birth has been treated as an illness. I've argued for an expansion of 1-2-1 midwifery services and talked about how mothers and babies are safer when women feel valued, listen to, respected and given information and then able to make choices which are actioned.
Imagine if we all gave this feedback?
On 27th November, 2008, Mr Garling released his report. Terms of Reference and the report is available here:
http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_index
The report makes sobering and fascinating reading as Mr Garling outlines the problems which are troubling our health care system, for example, problems such as increased numbers of people accessing health care facilities. Mr Garling praised the skill, competence and dedication of the health care staff, but outlines many changes which need to occur for the health care system to improve. A particularly important point that Garling makes is that "Furthermore, the rigid demarcation between what a doctor’s job is, and what a nurse’s job is, needs to be consigned to history. Once the concept of teamwork is accepted as the norm in treating a patient, it is easier to see why a qualified nurse practitioner should be able to do many jobs once reserved for doctors".
These comments by Garling demonstrate his deep recognition of the power dynamics which are keeping the health care system stuck in its medieval origins and which mitigate against true efficiency and effectiveness for patients well being. Even though Garling only mentions nurse-doctor working relations, his comments are very applicable to the power dynamics which trouble maternity services. His words echo the conclusions of my study into midwife-doctor interactions in the care of birthing women.
thesis available on line here: http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509
The NSW Government is wanting feedback on the Garling Report. You can give feedback here:
http://healthactionplan.nsw.gov.au/provide-feedback.php
Please take a moment to give feedback on this important report. In my feedback I've talked about how birth is normal and that we are seeing iatrogenic outcomes because birth has been treated as an illness. I've argued for an expansion of 1-2-1 midwifery services and talked about how mothers and babies are safer when women feel valued, listen to, respected and given information and then able to make choices which are actioned.
Imagine if we all gave this feedback?
Sunday 30 November 2008
My thesis on line
Hi everyone, here is the link to my thesis "Putting women first: Interprofessional Integrative Power"
You can download it here:
http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509
I'm interested in your comments.
Carolyn
You can download it here:
http://ogma.newcastle.edu.au:8080/vital/access/manager/Repository/uon:2509
I'm interested in your comments.
Carolyn
Sunday 16 November 2008
Women rallying across Australia for 1-2-1 midwifery care and The Age misses the point!
Women rallied across Australia today in support of 1-2-1 midwifery care in the wake of the close of submissions to the National Maternity Services Review.
The Age newspaper runs a story with the headline "Huge rise in obese mums-to-be"
Jill Stark November 16, 2008
The article says
"A RISE in the number of obese women becoming pregnant has sparked calls for more vigilant monitoring and weighing of expectant mothers, amid fears babies' lives are being put at risk.
Specialists at leading Melbourne hospitals have told The Sunday Age that women with pre-pregnancy weights of 150 kilograms or more are increasingly common, with some then adding up to 30 kilograms before giving birth — around three times the recommended weight gain of 7 kilograms to 12 kilograms.
The mothers' excess fat is posing serious challenges for medical staff, who are struggling to detect babies on ultrasound machines and monitor their heart rates. Many of the women suffer obesity-related diabetes and high blood pressure, with their size tripling their babies' risk of sudden death or birth defects.
Pregnancies for very large women are considered so risky that most hospitals are turning away expectant mothers with a body mass index higher than 35 or 40. A healthy BMI is 20 to 25."
That's all true of course and worthy of concern. However, two things are of interest here. One is that this story was run when, on the same day, there was a women led rally for better maternity care options. This article could be seen as an effort to keep women in their place and interestingly, the article was written by a woman!
The other interesting and not mentioned fact is that circulating and unremitting levels of stress hormones are part of the problem in the obesity epidemic. Stress hormones interfere with healthy physiology and disrupt growth and repair mechanisms. This means that women are more likely to become fatter as high stress hormone levels interfere with glucose and insulin pathways.
Pregnant women and their babies are vulnerable to the stress caused by ever increasing social pressures. When childbearing women feel loved and cared for, and are able to talk with their midwife about the things that are bothering them, their stress hormones are lower, they feel more in control with what happens to them and their clinical outcomes are improved.
One to one midwifery care, where the focus is on the woman and her needs and wants, has far ranging health and wellbeing benefits for mothers and babies.
Thank goodness Nicola Roxon appears to be listening to good science, rather than scare mongering, power plays and sensationalism.
The Age newspaper runs a story with the headline "Huge rise in obese mums-to-be"
Jill Stark November 16, 2008
The article says
"A RISE in the number of obese women becoming pregnant has sparked calls for more vigilant monitoring and weighing of expectant mothers, amid fears babies' lives are being put at risk.
Specialists at leading Melbourne hospitals have told The Sunday Age that women with pre-pregnancy weights of 150 kilograms or more are increasingly common, with some then adding up to 30 kilograms before giving birth — around three times the recommended weight gain of 7 kilograms to 12 kilograms.
The mothers' excess fat is posing serious challenges for medical staff, who are struggling to detect babies on ultrasound machines and monitor their heart rates. Many of the women suffer obesity-related diabetes and high blood pressure, with their size tripling their babies' risk of sudden death or birth defects.
Pregnancies for very large women are considered so risky that most hospitals are turning away expectant mothers with a body mass index higher than 35 or 40. A healthy BMI is 20 to 25."
That's all true of course and worthy of concern. However, two things are of interest here. One is that this story was run when, on the same day, there was a women led rally for better maternity care options. This article could be seen as an effort to keep women in their place and interestingly, the article was written by a woman!
The other interesting and not mentioned fact is that circulating and unremitting levels of stress hormones are part of the problem in the obesity epidemic. Stress hormones interfere with healthy physiology and disrupt growth and repair mechanisms. This means that women are more likely to become fatter as high stress hormone levels interfere with glucose and insulin pathways.
Pregnant women and their babies are vulnerable to the stress caused by ever increasing social pressures. When childbearing women feel loved and cared for, and are able to talk with their midwife about the things that are bothering them, their stress hormones are lower, they feel more in control with what happens to them and their clinical outcomes are improved.
One to one midwifery care, where the focus is on the woman and her needs and wants, has far ranging health and wellbeing benefits for mothers and babies.
Thank goodness Nicola Roxon appears to be listening to good science, rather than scare mongering, power plays and sensationalism.
Sunday 26 October 2008
My submission for the Maternity Services Review
Submission to the National Maternity Services Review
October 2008
Submitted by: Carolyn Hastie RM, RN, Grad Dip Primary Health Care, IBCLC, Master of Philosophy
Introduction
The current system of maternity service provision in Australia disempowers women in both birth and motherhood (1). Modern maternity care is also plagued with communication failures and turf wars, none of which advantages women and their babies(2, 3). The history of maternity care in Australia is replete with stories of medical domination, midwifery subordination and women being left out or caught in the middle of the warring factions(4, 5). Adverse outcomes in health and maternity care are linked to poor communication (6, 7) and while efforts have been made to improve relationships through workshops and policies promoting teamwork between doctors and midwives, these strategies are insufficient on their own to change the culture (8). The way that the maternity care system is organised must be changed if there is to be any real benefit to childbearing women and their babies. That is because organisational factors are more important than the personalities of the individuals involved in providing maternity care. Organisational factors frame, direct and limit what discourses and therefore behaviours are possible(8). The problem is the underlying structure of health service delivery which gives preference and privilege to one group over another and the enormous power imbalance this system of preferential treatment creates. As the history of maternity services demonstrates, the enormous power imbalance inherent in modern maternity care creates tensions, underhanded practices, over inflated personalities and unsatisfied women. It also produces avoidable adverse outcomes for women and babies(8).
When there is a women centred approach to service delivery, then team work, collaboration, good interprofessional relationships and optimal outcomes for mother and baby are more likely to occur (8). A woman centred approach in maternity care means the care is individualised. The woman is regarded as an autonomous being who is the expert on herself and the best person suited to care for her baby. The woman has the right to be self determining and have control over what happens to her. She has the right to be fully involved in decision making about her care (9). When a woman feels in control, her stress hormones are reduced, enabling her physiology to work in optimal ways, keeping mothers and babies safer (10, 11). In this model, the midwife and doctor establish a partnership with the woman to meet her needs within the context of her childbearing experience. Australia needs a primary health care, woman and family-focused approach to maternity services, which addresses this empowerment issue while providing safe and effective maternity services. (1) A major challenge is that the concept of collaboration for doctors tends to mean midwifery cooperation and submission to medical authority (8). Midwives, however, view collaboration as meaning equal relationships based on professional recognition and respect with a common goal (8). For midwifery, that goal is women centred care. Any organisational effort designed to improve collaboration and outcomes of maternity care will fail unless or until we have a woman centred approach to care provision (8). For a true women centred approach to be made a reality, it must be coupled with successful interventions that move towards disbanding professional silos, instituting genuine dialogic relationships between midwives and doctors as well as addressing social and emotional intelligence and competence in both professional groups (8).
Barriers to equitable, effective and sustainable maternity care
Commonwealth policies and processes are contributing to the lack of women’s access to choice and quality in maternity care and reduced economic effectiveness in the following ways:
• The current organisation of maternity services is geared to the needs of the health professional, particularly medical, rather than the woman’s needs.
• Funding arrangements which perpetuate medical dominance in maternity services and subjugates other professional bodies, such as midwives
• Exclusion of midwives from access to Medicare provider numbers creates an inappropriate monopoly by GP and specialist Obstetricians in private maternity care and disadvantages health services which provide midwifery led options for care in public maternity care.
• The provision of Medicare rebates for medical intervention in birth creates financial incentives to intervene inappropriately in the private arena of maternity service provision.
• The health insurance rebate for private maternity care services provides large subsidies for a sector of maternity care providers who are unaccountable for their outcomes, and who are usually over-servicing clients (e.g. high rates of caesarean section in private hospitals) (12, 13).
• Allowing state expenditure of Commonwealth health funding on inadequate and expensive models of maternity care in public hospitals that deprive women of relationship based care which has been shown to be safer and more satisfying for women.
• State/Commonwealth cost shifting diverts resources and focus from the needs of women and their families.
Although these are only some of the elements obstructing women centered and therefore, equitable, effective and sustainable maternity services in Australia, it is clear that funding is the key element to solving the current crises in maternity care.
Recommendations
Promotion of a woman centered approach to maternity service provision
The Federal government should lead the way in promoting a woman centered approach to maternity service provision. Any and every policy document, guideline or announcement should articulate a women centered focus and approach to maternity service provision.
Access to continuity of midwifery care for all childbearing women in the public health system
Make available to all women the choice of having a community midwife provide continuous maternity care through their childbearing experience in the publicly funded health system. Access to continuity of midwifery care will ensure savings in health dollars and bring Australia into line with international best practice in addition to meeting community demands for a range of readily accessible and appropriate maternity services (10). Whatever the medical risk status of a childbearing woman, the provision of continuity of midwifery care is vital for her emotional and social wellbeing which translates into better physical wellbeing for the woman and her baby.
Remove Medicare item 16400.
Remove the payment for nurses to provide antenatal care. Antenatal care is outside the educational background and scope of practice of all nurses. They have neither the qualifications nor the experience of providing antenatal care to pregnant women. It is dangerous for women to receive antenatal care from a nurse who is being pressured to provide care outside the nurse’s scope of practice. Regulatory bodies for nurses and midwives have developed national competency standards and the provision of antenatal care is not one of the competencies of nursing. GP’s are often ill equipped to provide antenatal care as they do not have the necessary knowledge to do so and it is poor organisation to have them responsible for another health practitioner’s care when they themselves are not competent in that aspect of caring for a pregnant woman.
Medicare provider numbers for midwives
Medicare provider numbers for midwives will enable health services which provide midwifery led models of care to bulk bill Medicare for maternity services provided by midwives and pathology and ultrasonography services ordered by midwives in these models. It will also enable midwives to engage in private practice on a level playing field with medical doctors.
Medicare rebates for birth
Provide the highest rebate rate for normal birth and reduce the payment rate for every intervention performed, as the more women pay for maternity care, the more intervention they receive (12-14).
Accountability
All services receiving direct or indirect taxpayer funding be required to provide timely and publicly accessible data on outcomes. Currently in many states no outcome information is available to the public from facilities providing maternity services. This secrecy is inconsistent with goals of safety, accountability or the control of costs.
References
1. Maternity Coalition, Australian Society of Independent Midwives, Community Midwifery WA Inc. National Maternity Action Plan: Maternity Coalition; 2002 September.
2. Reiger K, Lane K, Possami-Inesedy A. Childbirth and the culture of risk. Health Sociology Review 2006(Special Issue).
3. Reime B, Klein M, C, Kelly A, Duxbury N, Saxell L, Liston R, et al. Do maternity care provider groups have different attitudes towards birth? British Journal of Obstetrics and Gynaecology 2004;111:1388-1393.
4. Fahy K. An Australian history of the subordination of midwifery. Women and Birth 2007;20(1):25-29.
5. Reiger K. Domination or mutual recognition?:Professional subjectivity in midwifery and obstetrics. Social Theory and Health 2007;in press.
6. Hart E, Hazelgrove J. Understanding the organisational context for adverse events in the health services: the role of cultural censorship. Quality and Safety in Health Care 2001;10:257-262.
7. Douglas N, Fahy K, Robinson J. Final Report of the Inquiry into Obstetric and Gynaecological Services at King Edward Memorial Hospital 1990-2000”, (Five volumes), Western Australian Government.Inquiry into Obstetric and Gynaecological Services at King Edward Memorial Hospital Western Australia State Law Publishing. ; 2001.
8. Hastie C. Putting women first: Interprofessional Integrative Power. Newcastle: The University of Newcastle; 2008.
9. Powell Kennedy H. A model of exemplary midwifery practice: results of a Delphi study. Journal of Midwifery and Women's Health 2000;45(1):4-19.
10. Hatern M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4.; 2008.
11. Power ML, Schulkin J, editors. Birth, Distress and Disease. First ed. Cambridge: Cambridge University Press; 2005.
12. Fisher J, Smith A, Astbury J. Private health insurance and a healthy personality: new risk factors for obstetric intervention. Journal of Psychosomatic Obstetrics and Gynecology 1995;16(1).
13. Roberts C, Tracy S, Peat B. Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. British Medical Journal 2000;321:137-141.
14. Tracy S, Tracy M. Costing the cascade: estimating the costs of increased intervention in childbirth using population data. British Journal of Obstetrics andGynaecology 2003;110:717-224.
October 2008
Submitted by: Carolyn Hastie RM, RN, Grad Dip Primary Health Care, IBCLC, Master of Philosophy
Introduction
The current system of maternity service provision in Australia disempowers women in both birth and motherhood (1). Modern maternity care is also plagued with communication failures and turf wars, none of which advantages women and their babies(2, 3). The history of maternity care in Australia is replete with stories of medical domination, midwifery subordination and women being left out or caught in the middle of the warring factions(4, 5). Adverse outcomes in health and maternity care are linked to poor communication (6, 7) and while efforts have been made to improve relationships through workshops and policies promoting teamwork between doctors and midwives, these strategies are insufficient on their own to change the culture (8). The way that the maternity care system is organised must be changed if there is to be any real benefit to childbearing women and their babies. That is because organisational factors are more important than the personalities of the individuals involved in providing maternity care. Organisational factors frame, direct and limit what discourses and therefore behaviours are possible(8). The problem is the underlying structure of health service delivery which gives preference and privilege to one group over another and the enormous power imbalance this system of preferential treatment creates. As the history of maternity services demonstrates, the enormous power imbalance inherent in modern maternity care creates tensions, underhanded practices, over inflated personalities and unsatisfied women. It also produces avoidable adverse outcomes for women and babies(8).
When there is a women centred approach to service delivery, then team work, collaboration, good interprofessional relationships and optimal outcomes for mother and baby are more likely to occur (8). A woman centred approach in maternity care means the care is individualised. The woman is regarded as an autonomous being who is the expert on herself and the best person suited to care for her baby. The woman has the right to be self determining and have control over what happens to her. She has the right to be fully involved in decision making about her care (9). When a woman feels in control, her stress hormones are reduced, enabling her physiology to work in optimal ways, keeping mothers and babies safer (10, 11). In this model, the midwife and doctor establish a partnership with the woman to meet her needs within the context of her childbearing experience. Australia needs a primary health care, woman and family-focused approach to maternity services, which addresses this empowerment issue while providing safe and effective maternity services. (1) A major challenge is that the concept of collaboration for doctors tends to mean midwifery cooperation and submission to medical authority (8). Midwives, however, view collaboration as meaning equal relationships based on professional recognition and respect with a common goal (8). For midwifery, that goal is women centred care. Any organisational effort designed to improve collaboration and outcomes of maternity care will fail unless or until we have a woman centred approach to care provision (8). For a true women centred approach to be made a reality, it must be coupled with successful interventions that move towards disbanding professional silos, instituting genuine dialogic relationships between midwives and doctors as well as addressing social and emotional intelligence and competence in both professional groups (8).
Barriers to equitable, effective and sustainable maternity care
Commonwealth policies and processes are contributing to the lack of women’s access to choice and quality in maternity care and reduced economic effectiveness in the following ways:
• The current organisation of maternity services is geared to the needs of the health professional, particularly medical, rather than the woman’s needs.
• Funding arrangements which perpetuate medical dominance in maternity services and subjugates other professional bodies, such as midwives
• Exclusion of midwives from access to Medicare provider numbers creates an inappropriate monopoly by GP and specialist Obstetricians in private maternity care and disadvantages health services which provide midwifery led options for care in public maternity care.
• The provision of Medicare rebates for medical intervention in birth creates financial incentives to intervene inappropriately in the private arena of maternity service provision.
• The health insurance rebate for private maternity care services provides large subsidies for a sector of maternity care providers who are unaccountable for their outcomes, and who are usually over-servicing clients (e.g. high rates of caesarean section in private hospitals) (12, 13).
• Allowing state expenditure of Commonwealth health funding on inadequate and expensive models of maternity care in public hospitals that deprive women of relationship based care which has been shown to be safer and more satisfying for women.
• State/Commonwealth cost shifting diverts resources and focus from the needs of women and their families.
Although these are only some of the elements obstructing women centered and therefore, equitable, effective and sustainable maternity services in Australia, it is clear that funding is the key element to solving the current crises in maternity care.
Recommendations
Promotion of a woman centered approach to maternity service provision
The Federal government should lead the way in promoting a woman centered approach to maternity service provision. Any and every policy document, guideline or announcement should articulate a women centered focus and approach to maternity service provision.
Access to continuity of midwifery care for all childbearing women in the public health system
Make available to all women the choice of having a community midwife provide continuous maternity care through their childbearing experience in the publicly funded health system. Access to continuity of midwifery care will ensure savings in health dollars and bring Australia into line with international best practice in addition to meeting community demands for a range of readily accessible and appropriate maternity services (10). Whatever the medical risk status of a childbearing woman, the provision of continuity of midwifery care is vital for her emotional and social wellbeing which translates into better physical wellbeing for the woman and her baby.
Remove Medicare item 16400.
Remove the payment for nurses to provide antenatal care. Antenatal care is outside the educational background and scope of practice of all nurses. They have neither the qualifications nor the experience of providing antenatal care to pregnant women. It is dangerous for women to receive antenatal care from a nurse who is being pressured to provide care outside the nurse’s scope of practice. Regulatory bodies for nurses and midwives have developed national competency standards and the provision of antenatal care is not one of the competencies of nursing. GP’s are often ill equipped to provide antenatal care as they do not have the necessary knowledge to do so and it is poor organisation to have them responsible for another health practitioner’s care when they themselves are not competent in that aspect of caring for a pregnant woman.
Medicare provider numbers for midwives
Medicare provider numbers for midwives will enable health services which provide midwifery led models of care to bulk bill Medicare for maternity services provided by midwives and pathology and ultrasonography services ordered by midwives in these models. It will also enable midwives to engage in private practice on a level playing field with medical doctors.
Medicare rebates for birth
Provide the highest rebate rate for normal birth and reduce the payment rate for every intervention performed, as the more women pay for maternity care, the more intervention they receive (12-14).
Accountability
All services receiving direct or indirect taxpayer funding be required to provide timely and publicly accessible data on outcomes. Currently in many states no outcome information is available to the public from facilities providing maternity services. This secrecy is inconsistent with goals of safety, accountability or the control of costs.
References
1. Maternity Coalition, Australian Society of Independent Midwives, Community Midwifery WA Inc. National Maternity Action Plan: Maternity Coalition; 2002 September.
2. Reiger K, Lane K, Possami-Inesedy A. Childbirth and the culture of risk. Health Sociology Review 2006(Special Issue).
3. Reime B, Klein M, C, Kelly A, Duxbury N, Saxell L, Liston R, et al. Do maternity care provider groups have different attitudes towards birth? British Journal of Obstetrics and Gynaecology 2004;111:1388-1393.
4. Fahy K. An Australian history of the subordination of midwifery. Women and Birth 2007;20(1):25-29.
5. Reiger K. Domination or mutual recognition?:Professional subjectivity in midwifery and obstetrics. Social Theory and Health 2007;in press.
6. Hart E, Hazelgrove J. Understanding the organisational context for adverse events in the health services: the role of cultural censorship. Quality and Safety in Health Care 2001;10:257-262.
7. Douglas N, Fahy K, Robinson J. Final Report of the Inquiry into Obstetric and Gynaecological Services at King Edward Memorial Hospital 1990-2000”, (Five volumes), Western Australian Government.Inquiry into Obstetric and Gynaecological Services at King Edward Memorial Hospital Western Australia State Law Publishing. ; 2001.
8. Hastie C. Putting women first: Interprofessional Integrative Power. Newcastle: The University of Newcastle; 2008.
9. Powell Kennedy H. A model of exemplary midwifery practice: results of a Delphi study. Journal of Midwifery and Women's Health 2000;45(1):4-19.
10. Hatern M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4.; 2008.
11. Power ML, Schulkin J, editors. Birth, Distress and Disease. First ed. Cambridge: Cambridge University Press; 2005.
12. Fisher J, Smith A, Astbury J. Private health insurance and a healthy personality: new risk factors for obstetric intervention. Journal of Psychosomatic Obstetrics and Gynecology 1995;16(1).
13. Roberts C, Tracy S, Peat B. Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. British Medical Journal 2000;321:137-141.
14. Tracy S, Tracy M. Costing the cascade: estimating the costs of increased intervention in childbirth using population data. British Journal of Obstetrics andGynaecology 2003;110:717-224.
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