Birth at home Safer than at Hospital: eMJA: Planned home birth in Australia: politics or science?

Good news from the latest review of homebirth statistics. Despite the fact that the AMA can't read research, and then go on to make gooses out of themselves by quoting incorrect statistics to frighten people about birth, the news for women who want to have their babies at home is very good.

The correct information is this:

1. The rate of perinatal mortality for the period under examination (1991-2006) was 8.2 per 1000 births for planned hospital births; for infants born at home 2.5 per 1000 births.

According to the reviewers, one of the two infants who died after being born at home

"had congenital anomalies suspected on ultrasound; the parents declined further investigation, and the infant had palliative care and died from lethal anomalies. The other was a fresh stillbirth from a water birth. Although birth under water was thought not to have contributed to the death, closer monitoring during labour may have changed the outcome.

The evidence clearly shows that birth at home is safer than birth in hospital!

Image from Wikipedia

The reviewers said:

Although it is not anticipated that large numbers of women will opt for home birth, women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law.4 Respecting their choices and achieving the best outcome for all concerned is likely to remain a challenge that will require more light and less heat than it has received thus far.

A pity that the AMA has chosen the route of "Lies, damned lies and statistics" to further their 'shroud waving' agenda to frighten women and their families about birth.

Image from http://www.mothersbliss.com/nine/birth/hospital.asp

eMJA: Planned home birth in Australia: politics or science?

The really important point amidst all this stupid shroud waving and fear mongering on behalf of the AMA is that women do best where they feel safest. Our jobs as health professionals is to be supportive of women's choices and provide an environment where women feel supported and cared about and to intervene appropriately. That's it.

Sadly, the AMA has forgotten about the therapeutic use of self. Using fear to coerce women into submission to fit the 9-5 agenda is not kind, good or ethical.

Overdue NSW woman gets police check up | News.com.au

A New South Wales woman, Rochelle Allan and her partner Daniel Jones, have been seeing their private midwife throughout her pregnancy and attending the local hospital for the screening tests that are routine in pregnancy. Rochelle and Daniel's intention was to have their second baby at home with a midwife they knew and trusted.

Rochelle and Daniel, looking forward to their new baby (from News.com.au)

"Ms Allan said that she had decided on having a home birth after a "horrific experience" at the same hospital two years ago when their son Bailey was born. I was induced and I spent 48 hours in labour," she said. "I don't want to go through with that again."

Ms Rochelle Allan was twelve days overdue and attended the hospital for a routine,  "CTG" a monitoring process, that records the fetus's heart rate and the woman's uterine activity together. The idea of this test, is to pick up any signs of fetal distress. The CTG is a useful tool, but no guarantee. The best way to ensure a fetus is well and happy is to ensure the woman feels relaxed, connected with her baby, well supported and knows her baby's movements - the mother is often able to detect if things are not 'right' and contact her caregiver for a check up. The CTG was normal and reassuring, however the doctors decided that Rochelle needed to be induced because she was 12 days overdue (not even two weeks overdue!) and booked her for induction the next day. Rochelle declined to be induced and told the hospital staff that and reminded them that she was giving birth at home with her midwife. Ms Allan rang the hospital and told them the next day that labour was beginning and she wouldn't be coming in.

The hospital staff sent the police around to 'check up' on Rochelle.

"I couldn't believe it when I saw the police officers at my door," Ms Allan said. "They told me they had been asked by the hospital to check on my welfare because I had not attended".
"The hospital knew I did not want to be induced and they gave me no medical reason why I should be."
Throughout her pregnancy, Ms Allan and her partner Daniel Jones have been regularly attending the hospital's antenatal clinic for mandatory tests and scans to monitor the baby's progress. A hospital spokeswoman confirmed police were sent to Ms Allan's house to conduct a "welfare check".

http://www.news.com.au/national/overdue-pregnant-nsw-woman-gets-police-check-up/story-e6frfkvr-1225820277538


Now, I didn't know that NSW was a police state! I live here and I didn't know that.  Well, clearly the decision to send the police around was made in error, because the next day, the following headline appeared in the 'news'.


Home birth mum receives apology

http://www.news.com.au/breaking-news/home-birth-mum-receives-apology/story-e6frfku0-1225820359124

The report says:

The Greater Western Area Health Service today offered Ms Allan an apology for the unexpected police visit, saying they just wanted to check she was alright.

"We are sorry if it ... caused her any distress but our intention was to check on her welfare," area health spokeswoman Sue-Anne Redmond told ABC Radio today.

The health service denied it was trying to pressure Ms Allan into being induced.

Sure sounds like 'pressure' to me!

Sending the police to get people to comply in a health related matter like this is 'bullying' and as such, is against the law. We all know what bullying does to a person's physiology! What an outrageous thing to happen to a pregnant woman, especially at this stage of her pregnancy, when peace, calmness and support are the ideal environmental conditions for a happy labour and birth.

There is a very happy ending to this story, as well as the very welcome news that the health service very sensibly apologised, as they should, for their heavy handed tactics with this young woman.

Rochelle gave birth to her beautiful baby this morning, in the peace and quiet of her own home, with her husband and her midwife. Her midwife drove three hours to be with Rochelle and her partner for the birth! Well done team!

  Welcome to your new baby Rochelle and Daniel. I bet Bailey is thrilled.

Mothers' views of maternity: interventions

Mothers' views of maternity: interventions
January 2, 2010 -The Age newspaper

The president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr Ted Weaver, said while a fear of litigation arising from complications of vaginal births had partly driven intervention rates in recent years, more women were also asking for them than before.

He said this trend meant many private obstetricians felt they should agree to interventions if their patients had been properly counselled on the pros and cons of the procedures.

''In private, most doctors will do [elective caesareans] because they think if I don't do it, someone else will do it. It's about consumer demand,'' he said.

Mothers' views of maternity: interventions

Now we are blaming women for asking for interventions after years of scaring women about birth! You will note it is still about money.

"If I don't do it someone else will".

Wouldn't you love to be a fly on the wall to hear the 'proper counsel on the pros and cons of the procedures'? This statement reminds me of a great cartoon some time back in MIDIRS, the English publication on all matters to do with childbearing. The cartoon had a doctor, complete with stethoscope around the neck and white coat, sitting talking to an anxious looking pregnant woman sitting on the edge of her chair. The first frame showed the doctor saying "of course I believe in choice". The second frame had the doctor waving his hand expansively saying "you can bleed to death at home or have your baby safely in hospital!!"

I would encourage you all to obtain Labouring Under an Illusion. Have a look at my entry on 22nd December Social construction of Childbirth - how the media works for details and the trailer for the movie.

Australia's maternity system like 'herding yards'

Mother Care: It's like herding yards

JULIA MEDEW
January 2, 2010

"Chronic shortages in Australia's maternity system have left mothers feeling like cattle being pushed through herding yards that put both their own and their babies' lives at risk.

A survey of 2792 mothers by Fairfax Media found that about half of those who had given birth in the past five years believed the maternity system was not coping well enough with soaring demand".

WHAT MOTHERS SAY

''There should be more continuity of care. Knowing your carer and trusting your carer removes the fear from childbirth and fear leads to more interventions.''
''There is a severe shortage of birth centre places available and in many areas it is not even an option.''

''There are so many time limits imposed on women which completely disregard the natural progression of labour in women's bodies. Doctors are too quick to intervene, too impatient to wait and allow the body to do its job.''

Chronic shortages in Australia's maternity system

A child is born

One to one midwifery care puts the woman at the centre of care and ensures that she feels valued, listened to and cared about. Nicola Roxon needs to listen to what women want and ensure that private midwifery is a viable option for those women who want individualised maternity care. The move to publically funded midwifery models of care is a welcome move, however, those models are unable to provide what a private midwife can provide and all models are needed to meet the individual needs of Australian women.

Social construction of Childbirth - how the media works

A new film called "Labouring under an Illusion"  shows the way that childbirth is portrayed in the media. The film makers juxapose the often comical, always fear inducing media perspective with normal, healthy, calm birth footage. The presentation of the two points of view provides an excellent reality check.

Here's the trailer for the video

Vicki Elson, a childbirth educator, explains her motivation for making the film during an interview with

Amie Newman  http://www.rhrealitycheck.org/blog/2009/12/14/laboring-under-an-illusion-rh-reality-check-talks-filmmaker-vicki-elson

"I was doing a workshop for nurse-midwives at a local hospital when a particularly ghastly and unrealistic (and Emmy-winning) episode of “E.R.” came out. The midwives said their phones were ringing off the hooks because moms were scared that they could die like the lady on TV. Meanwhile, Murphy Brown was America’s liberated TV mom who could anchor the news and stand up to Dan Quayle. But in labor, she was wilted and powerless, except when she was strangling men by their neckties. I wanted my kids and their friends to grow up with realistic, nourishing imagery about the power of their bodies to do normal things like have babies. I was working with midwives Rahima Baldwin Dancy and Catherine Stone on a workshop called “Empowering Women in the Childbearing Year,” and we started collecting clips to show childbirth educators what they were up against from the culture. It’s still a struggle to compete with compelling but unrealistic imagery that sticks in people’s minds. I expanded on that project to write my master’s thesis 10 years ago, and when the kids grew up I finally got around to updating the project and putting it on DVD so it’s more useful and accessible.”

Well done Vicki!  Resources like this are essential to counter the negative publicity that childbirth is subject to. For more information on the video or to order a copy, visit Birth-Media.com.

Amy Romano on Science and Sensibility blog has an excellent post on Childbirth Literacy that includes this video trailer and information. http://www.scienceandsensibility.org/

Breastfeeding is Normal

The women who made this video said:

"The purpose of our video is to encourage mothers to feed their child, no matter where they are! And to give encouragement to new and expecting mothers that breast is best, and nursing IS normal".

YouTube - NIN CHARLOTTE

Midwifery-led maternity care safe

HSE.ie - Health Service Executive Website - Presentation of the “MidU” study – a major trial comparing midwifery-led and consultant-led maternity care

"The 'MidU' ('Midwifery Unit') study showed that midwifery-led care, as practised in these units, is as safe as consultant-led care but uses less intervention in pregnancy and childbirth".

What's interesting is that the report says midwifery care is as safe as consultant care. My reading of the statistics means that midwifery care is safer than consultant care for that group of women.

Honoring Embodied Wisdom

I was exploring the peaceful birth project's wall (http://www.thepeacefulbirthproject.com/) on Facebook and came across the article about perineal integrity from Midwifery Today 2005.

Honoring Body Wisdom - by Pamela Hines-Powell

Pamela has some wonderful insights including:

"... there are very few things I personally can do to really prevent tearing in a client, but there are a whole host of situations and instances where I could actually create an environment for perineal tearing".

Our role as midwives is to create the environment where a woman can find her own way, get in touch with her inner power, her inner intelligence and innate guidance system. A woman can find her own way when there is an atmosphere of loving, capacity building trust in the process of birth and the woman's ability that the midwife engenders by having a mindful approach to her role in creating that environment. A mindful approach for the midwife involves awareness of and congruency in her intention, focus, thinking patterns, body language, movement and words. A midwife's mindful approach also includes attention to those aspects of the woman she is working with. Such an environment optimises a woman's birthing psychophysiology. A woman's optimal birthing psychophysiology means her mind, body and spirit are in harmony, her brainwave patterns are in gamma, alpha, theta and delta wavebands (known as a 'flow' state) a relaxed, focussed mode; her brain's attentional networks are focused on her baby and her baby's impending birth; the woman is able to let go of her orienting and alerting brain networks with their beta brain waves. When a woman is able to be in that biobehavioural state, genetic switches are flipped to parasympathetic mode; oxytocin and endorphins flow and the woman is able to respond instinctively to her body cues; labour progresses and birth happens.

Pamela asks a really good question: "As midwives, are we finding ways to support women's instinctive behaviors or do we undermine their instincts by directing them?"

How we look, how we move, everything we do and say has an effect on the labouring woman.

Pamela writes:

"The birthing woman is highly susceptible to suggestion—even if very subtle. For instance, a midwife lays a chux pad on the bed. The message received is "sit here"—many women will follow the placement of the chux and reside wherever it is placed, even if there is no spoken direction by the provider. However, left to her own devices, a woman will rarely lie down to push her baby out".

There is so much wisdom in that information. The first job for a midwife on the learning curve of being 'with woman' is to understand and integrate that truth into their practice.

I'm reminded of the words of the wonderful Nicky Leap, a brilliant midwife. Nicky said "the less we do, the more we give". That 'doing less' has to come from a position of trust in birth, trust in women's innate capacity to give birth well as well as being mindful of what is happening with that woman, her baby and the labour process. 'Doing less' is not about being lazy or lassez faire about women and birth. Doing less, is actively mindful, fully present and conscious in the moment, actively aware of the ebb and flow of labour and birth; being a source of feedback for the woman when required; subtly monitoring the woman, her baby and her experience; ready to support adjustment if needed. 'Giving more' in this context means that a woman who is supported to be instinctive feels powerful, her capacity is strengthened, she emerges from labour and birth feeling amazing. Barbara Katz Rothman says that birth is about building strong, capable mothers as well as welcoming new life into the world.

As midwives, we can create a safe, nurturing, protective environment where a woman can express her individuality, her innate wisdom and feel free to make the changes needed in becoming a mother. We can provide a supportive environment within which a woman can empower herself, find her innate power and utilise it; we can't empower her. We can however, disempower. We can 'pull the rug' from underneath a woman, destabilising her so she doubts herself and loses her confidence.

Pamela's question is a good one. We can extend that question and ask ourselves "am I creating an environment where a woman feels safe to be herself and does she feel better about herself when she leaves my presence?" We need to ask ourselves that frequently. We need to ask the women we work with for feedback about that too.

Midwifery takes a northern look: UofA program supports Nunavit women to birth at home

U of A program supports Nunavit women to birth at home

By Jodie Sinnema, Edmonton Journal December 18, 2009

"A healthy community has to be one where women can give birth," said O'Brien, who has been travelling to Nunavut for three years to speak with traditional midwives, most in their 80s. They share stories of feeding the best cut of meats to expectant mothers and delivering babies in ice houses, or tents made of furs. That history is informing the new midwifery program"

The aim of the program is to train midwives locally so more Nunavut mothers can give birth in their home communities.

Kango, a traditional midwife who learned her skills from her mother-in-law, sister-in-law and other northern elders, is now sharing her knowledge through Nunavut's first midwifery training program.
"Before colonization", Kango said "there were no doctors or nurses in Nunavut, so men and women stepped forward to be midwives. But in the 1960s and '70s, when western medicine arrived full force, mothers had to leave their homes, husbands and children six to seven months before their delivery to give birth in distant hospitals".
"With this kind of method of hospitals to send the mother out without husband or parents to attend, it was hard for the mother," Kango said. "With increased stressed, they would smoke more, lose their appetite and lose interest in looking after themselves. Oftentimes, health professionals couldn't speak any Inuit languages, leaving the women isolated in pain".
Midwifery takes a northern look

More women choose do-it-yourself births - Pregnancy- msnbc.com

By Linda Carroll

msnbc.com contributor

updated 1:05 p.m. ET Dec. 6, 2009

"Jennifer Margulis thinks birth should be a private party — no doctors or midwives invited. So when her daughter Leone Francesca was born at home last month, only Margulis and her husband, James, were in attendance.

“My husband and I were the only ones there when she was conceived,” says the 40-year-old writer from Ashland, Ore. “I thought we should be the only ones there when she was born.”

Margulis is part of a very small but growing number of women who are choosing to deliver their babies at home without the presence of health professionals. Some choose to have a husband or another family member help, while others opt to deliver their babies completely on their own."

Jennifer Margulis, 40, of Ashland, Ore., gave birth to her daughter Leone Francesca at home Nov. 4 without medical or midwifery help.

I can understand why women would choose to birth on their own or with their loved ones in this modern climate around birth. These women are telling us in the health care industry that they are not happy with what we are doing. If we want to have a place at birth with intelligent, self aware women who understand the process and feel comfortable with their bodies then we have to pay attention to what they want.

I personally love it when I am redundant at birth. When the women are fully present and aware and confident. They manage their labours beautifully, they breathe their babies and their placentas out easily; they and their babies are well and healthy. When I've sat on my hands and enjoyed the process and the woman's sense of self mastery, that's my idea of a good days/nights' work.

Unattended births can be problematic, that's true. So can attended births.  The issue, no matter where or with whom women chose to give birth,  is how does the woman feel, what does she know, is she well nourished, does she love her partner and how is their relationship, how confident is she in herself and what else is going on?

For women in developing countries it is often a very different situation. The problems for birthing women in developing countries are multifactorial.  These women are usually anaemic, have no birth control and therefore too many babies already, they are tired and poorly nourished. They usually work too hard and don't have any support of any kind. These women often don't have the stamina and energetic resources to stay mindful and present to the birthing process to keep safe.

Let's listen to women, find out what they want. Rather than seeking to undermine their confidence to get compliance with our agendas, let's listen and change what we are doing to be more likely to be invited to be part of the most amazing experience on earth. 


More women choose do-it-yourself births - Pregnancy- msnbc.com

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

From the Senate hearing

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

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

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


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

Community Affairs Legislation S12666.pdf (application/pdf Object)

Proof Committee Hansard

SENATE

COMMUNITY AFFAIRS LEGISLATION COMMITTEE

Reference: Health Legislation Amendment (Midwives and Nurse Practitioners) Bill

2009; Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill

2009; Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009

THURSDAY, 17 DECEMBER 2009

CANBERRA

CONDITIONS OF DISTRIBUTION

This is an uncorrected proof of evidence taken before the committee.

It is made available under the condition that it is recognised

as such.

BY AUTHORITY OF THE SENATE

[PROOF COPY]

TO EXPEDITE DELIVERY, THIS TRANSCRIPT HAS NOT BEEN SUBEDITED

Great work by everyone at the Senate Committee hearing yesterday! Rachel Siewart (Green's senator) asked insightful questions.

Some comments below, from members of Maternity Coalition around the subject of safety - dynamic Dr 3am's catchcry - where was he when The Butcher of Bega was out and about?

"Mrs McIntosh —The way we see it is that the woman should be at the centre of that—her choices be
respected; all the information given; and safety looked at, not only physical safety for her and the baby but
also emotional and psychological safety. They are paramount not only to a woman’s experience through
pregnancy, labour and birth but also to breastfeeding, postnatal depression, relationships, bonding and ongoing
issues with siblings. They are all so intertwined that, if a woman is not right at the centre of the collaboration,
it is probably not going to be all that effective.

Ms Catchlove—Nobody has more interest in the safety of a baby than the mother of that baby. I make a
decision for my baby and myself, and I am absolutely 100 per cent motivated by safety. And I am the only
person who can weigh up what is a safe choice for me and my family.

Mr Teakle—Safety is about being comfortable with the risks. There is no way of defining something as
being safe or unsafe. We have a bunch of different people here who are going to have different feelings about
what risks they are comfortable with. Some doctors might be comfortable with the risks of a caesarean,
because that is something they are familiar with and they feel in control of it; a midwife might feel
comfortable with something else. Once we get into an argument about other people deciding what is safe for
the woman, then we have lost focus. The woman needs to decide what she feels safe with, on the advice that is
provided to her by experts who can give her really good advice about that. That is why in other countries
informed choice has been understood as the way of getting out of these arguments.
It is terrible to have arguments going on in the media about what choices women should make. That is not
about safety; that is about control".


S12666.pdf (application/pdf Object)

Midwives damn AMA-induced amendments to maternity reform – Crikey

Midwives damn AMA-induced amendments to maternity reform

by Professor Lesley Barclay and Professor Sally Tracy

A wonderful piece of writing by two of our leading midwifery professors. Clear, reasoned, succinct and accurate in the description of the threat to women's self sovereignty and midwives and nurse practitioners' right to practice unimpeded posed by the power laden antics of the likes of dynamic Dr 3am and his union.

Midwives damn AMA-induced amendments to maternity reform – Crikey

Chloë's Birth Story

Thanks so much to Emma for permission to share this precious time. The images are beautiful, the words are precious. The experience is something those of us who work with women wish for all birthing women and their babies.

Chloë's Birth Story

Planned-Home-Births.pdf (application/pdf Object)

Amidst all the predictable power based rhetoric about birth place and care provider from the Australian doctors' union, led by the self appointed arbiter on women's choice and midwives' freedom to practice, Dr Andrew Pesce, there is a beacon of light on the subject from British Columbia

The College of Physicians and Surgeons of British Columbia have just released their position statement, which says:

The College’s Position

The College supports a woman’s right to personal autonomy and decision making in obstetrical care.

Planned-Home-Births.pdf (application/pdf Object)

Updated November 2009
Board Approved December 2009

Although this statement does not go as far as saying that homebirth is safe and that homebirth is a wise choice, as the evidence from around the world clearly demontrates it is, the statement does provide an indication that at last (some) doctors are officially recognising that women are autonomous and have rights. This recognition of women's rights is a step in the right direction for a profession which has traditionally, well, at least for the last couple of hundred years or so, positioned itself as the powerful elite.

This statement is refreshing news and makes Dr Andrew Pesce's posturing on his ability to influence The Australian Minister of Health, the Honourable Nicola Roxon to remove and restrict choice in both birth place and practitioner for childbearing women and limit the practice of midwives, appear as sad, pathetic and out of step with evidence informed practice as it is.

Not only has Dr Pesce got his sights on controlling midwives and birthing women, he and his other unionists are also seeking to deprive the Australian public of another group of excellent health professionals, the Nurse Practitioners. Australia has seen the 'turf wars' raging for several decades now, as doctors use power tactics to keep control of the health system and ensure nurses, midwives, patients and childbearing women remain subservient.

However, the winds of change are blowing.

The disgraceful thing is that while some Australian doctors seek to live in a time warp and glorify the days when doctors were gods, nurses and midwives were handmaidens and patients and childbearing women were subservient by undermining initiatives to improve choice and access to optimal health care, they will unnecessarily hamper true progress in health and health care provision.

Meet Mr 3am: the nation's dynamic top doctor

Known for his candour and willingness to speak his mind, the 49-year-old has made his presence felt at the negotiating table as the Federal Government attempts to push through health reforms.

He successfully lobbied Health Minister Nicola Roxon to make amendments to home birth legislation, ensuring that midwives would be denied Medicare payments unless they could prove they were working collaboratively with doctors.

The home birth lobby claimed the changes curtail a woman's right to choose how she gives birth, but Dr Pesce cites it as his greatest achievement so far as AMA president.

Meet Mr 3am: the nation's dynamic top doctor

AMA welcomes amendment to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 | Australian Medical Association

The Medical Union crows victory over the right of women to choose where to birth and who with! Roxon and Rudd pawns in the AMA's game of control and domination

5 November 2009 - 3:05pm

AMA President, Dr Andrew Pesce, said today that the AMA welcomes the Government’s decision to amend the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 to specify a formal requirement that midwives and nurse practitioners must work in collaboration with medical practitioners.

Dr Pesce said the AMA has been negotiating with the Government for this vital change to the legislation for some time, and the AMA had received recent support from other medical groups, most notably the Royal Australian College of General Practitioners.

“We made it clear to the Government that without a requirement in law that there be collaborative arrangements between midwives, nurse practitioners and doctors then the legislation did not have any safeguards to ensure continuity of patient care, nor did it have any protections against the fragmentation of patient care services,” Dr Pesce said.

“I repeat – the amendments impose a legal requirement for collaborative arrangements between medical practitioners and midwives or between medical practitioners and nurse practitioners.

“The AMA has worked cooperatively with the Government on these amendments to the legislation.

“These changes create a framework of quality primary care delivery that supports team-based care and ensures that the role of medical practitioners, particularly the patient’s usual General Practitioner, is not undermined.

“Evidence shows that patients enjoy better health outcomes when they are treated in a model of care that provides coordinated, continuous, and comprehensive patient-centred care that is delivered by appropriately trained health professionals.

“The AMA commends the Government for recognising and accepting amendments that are in the interests of patient care.

The AMA will continue to work with the Government as further regulations and guidelines are developed to ensure that collaborative arrangements are based on best practice standards of medical care,” Dr Pesce said.

The AMA’s position was part of its submission to the Senate Community Affairs Committee on 22 July 2009. AMA President, Dr Andrew Pesce, appeared before the Committee on 6 August 2009.

5 November 2009

CONTACT:

John Flannery 02 6270 5477 / 0419 494 761

Peter Jean 02 6270 5464 / 0427 209 753

AMA welcomes amendment to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 | Australian Medical Association

Doctors to gain veto powers over midwives and birth choices

Maternity Coalition sent out a press release which explains the current legislation changes very clearly.

Doctors to gain veto powers over midwives and birth choices

On 5 November the Government announced that the “Medicare for midwives” Bills
would be amended to require midwives to have “collaborative arrangements” with
“medical practitioners” before being eligible for professional indemnity insurance or Medicare rebates:
*before the midwife can access professional indemnity insurance, and
*before women can claim a Medicare rebate for midwifery services.
Doctors must approve each midwifeʼs entry to private practice:
*Midwives will be required by Commonwealth law to have “collaborative arrangements” with
“one or more medical practitioners” before being eligible for Commonwealth-subsidised professional indemnity insurance (PII).
*PII will be a prerequisite for a midwife to enter private practice, under new national registration laws, being enacted state by state.
*Doctors will be able to unilaterally withdrawal from collaborative agreements with a midwife, rendering her uninsured, and legally unable to practice in a private professional capacity.
*This legally mandates medical control over midwives’ ability to register and work in private practice.
*This will be set in Commonwealth law, which can only be changed by Commonwealth
Parliament.
*These provisions are contained in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009.
Doctors must approve womenʼs access to Medicare rebates for midwifery care:
*Midwives will also be be required by Commonwealth law to have “collaborative arrangements” with “one or more medical practitioners” before their services are eligible for Medicare rebates.
*This puts women’s access to private midwifery care under medical control.

This is potentially defacto “parallel regulation” of the midwifery profession:
*Medical practitioners will control the registration status of midwives, despite their being a discrete, separately regulated profession.
*Medical professional organisations could set guidelines for collaborative arrangements,potentially forming defacto regulatory standards for midwifery endorsement and practice.

This gives doctors right of veto over womenʼs choices in birth care:
*Any birth care choice using private practice midwives, or developed under the
Commonwealth’s new arrangements, will be subject to medical control or veto.
*This gives medical practitioners unprecedented control over women’s choices and access to care.

“Collaborative arrangements” may be legally restricted to privately practicing doctors
*The amendments do not specifically include hospitals as able to form collaborative
arrangements with midwives. They require medical practitioners to be “of a kind or kinds specified in the regulations”.
*It is unclear whether a hospital, health service district or authority may be included within the definition of “one or more medical practitioners”.
*Doctors who are employees of public hospitals can’t make “collaborative arrangements” as employees of the hospital they work for. They work for the hospital, attend their workplace when rostered on and collaborate in line with hospital policies.
*A range of very serious consequences would flow if these arrangements were restricted to privately practicing doctors. Consequences could include:
o No new midwifery models in public hospitals.
o No private midwifery practice.
o No homebirth care from midwives in private practice.
o Practice midwives in private obstetricians rooms could be the only viable model of private practice or Medicare-funded midwifery.
This brief represents the best information available to Maternity Coalition on 8 November 2009. We are actively seeking ongoing clarification and dialogue with Government in order to ensure women and families have access to accurate information.

For full text of amendments go to:
http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;adv=yes;db=;group=;holdingType=;id=;orderBy=priority,title;page=7;query=Dat
aset%3AbillsCurBef%20Dataset_Phrase%3A%22amend%22;querytype=Dataset_Phrase%3Aamend;rec=11;resCount=Default

For more information contact: Bruce Teakle 07 3289 0231, teakle@maternitycoalition.org.au

Who's behind Roxon's betrayal of Women's Birth Choices?

I wonder who?

This report in the Medical Observor might give some clues?

Government to mandate nurse practitioner teamwork

Andrew Bracey and Shannon McKenzie - Friday, 6 November 2009

AFTER months of intense lobbying, the Government has bowed to GP pressure and amended proposed legislation to ensure nurse practitioners must work in collaborative partnerships with doctors.
In what is being heralded as a win for the profession, Health Minister Nicola Roxon last week announced the new stipulation would be built into legislation that will grant nurse practitioners access to the MBS and PBS from November 2010.
However, the victory has been tempered by the news that legislation effectively handing politicians’ control of medical education and training standards has been passed by the Queensland Parliament, and will now begin its national rollout.
AMA Queensland president Dr Mason Stevenson said it would be “doubly hard” to win concessions now, and added the lack of outrage from grassroots doctors had made the lobbying efforts of the organisation more difficult.
The amendments to the nurse practitioner legislation will come as welcome relief for doctors, who feared that without mandated collaborative arrangements in place nurse practitioners would work independently and fragment care.
AMA vice-president Dr Steve Hambleton, who sits on the Government’s Nurse Practitioner Advisory Group (NPAG), said the crucial amendment would ensure nurse practitioners were not supported to work in competition with doctors.
“It clarifies the Government position – their [intention] was always there, but the clarification was not, and the fact the Government has brought this amendment forward is a good sign,” Dr Hambleton said.
In a statement Ms Roxon said the amendment had come “following requests for clarification” on the legislation. She told MO the Government had always been committed to ensuring team care. “I think everyone can recognise the skills of other professionals without fragmenting care.”
RACGP president Dr Chris Mitchell welcomed the news and said he was confident that NPAG would develop satisfactory frameworks.
Meanwhile, the fight for amendments to the national registration and accreditation scheme is set to shift into state parliaments. The Health Practitioner Regulation National Law Bill 2009 passed by the Queensland Parliament will now be adopted by all states and territories.
After failing to gain amendments to the initial legislation, doctors’ groups are now lobbying for changes at a local level.
The NSW, Victoria and WA state branches of the AMA are all calling for the insertion of a “public interest test” into the legislation, which would have to be satisfied before politicians could change medical education or training standards.
There will also be a last-minute push for further exemptions to the legislation’s mandatory reporting clauses, which will force doctors to report their spouses for any professional misconduct.

Julia Gillard's 2005 speech about the importance of choice for childbearing women

In 2005, Julia Gillard was the Shadow Minister of Health, Manager of Opposition business in the House of Representatives. Ms Gillard spoke at the following conference: 

Midwifery By The Sea - Riding The Waves Of Change

Speech - ANNUAL CONFERENCE OF NSWMA

20th October 2005 
Following are excerpts from Ms Gillard's speech

"Thank you very much for your invitation to join you here today at your annual state conference by the sea.

The best start in life

It will not surprise this audience - I'm sure you will all agree - if I now say that I see the pregnant woman as the best focus for early intervention.

Between us we could draw up an impressive list of perinatal programs that would boost the health of the mother and her baby, and improve outcomes, and give all our kids the best start in life. 

Obstetric services and workforce shortages

In the middle of this is the big event - the birth.

I know that midwives - as a group and individually - have strong ideas about what should be provided in terms of birthing services. 

But shockingly, it is increasingly the case that for some women the idea of having a choice of birthing services and having continuity of care throughout their pregnancy, the birth and in the post-natal period is an impossible luxury - not just unaffordable, but unobtainable in their local area.

The shortage of midwives is also a problem. The Australian Health Workforce Advisory Committee estimates a current national shortage of 1850 midwives, and this is expected to increase over the remainder of the decade.

Midwives face additional concerns about the lack of professional recognition as well as limited opportunities to practise as primary carers and provide continuity of care to women. 

The need for a concerted approach 

Clearly this is no time for turf warfare between doctors and midwives, but it is time for all health care professionals involved in delivering obstetrics care to mount a combined attack on the Howard Government to force them into action to address this situation.

Unless and until the Government is shocked and shamed into realising that Australian women are now scrambling to find the birthing centre of their choice, and in some cases scrambling to find any professional who will deliver their child, the situation will not improve. 

It seems to me that we need a variety of solutions to fit all the circumstances that arise.  There is no 'one size fits all' way to solve the problems that present so differently in metropolitan Sydney, the isolated community of Wilcannia, the growing town of Byron Bay and the multicultural suburbs of Western Sydney.  The one common factor is the pregnant woman and her child - they must be at the centre of the solution.

… I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system.

We need to realise that potential so that mothers have real choice in their birthing experience, and their babies have the best start in life".  

Beautiful and true words. However, now we are finding that it is no longer the Howard government standing in the way of women's choice, it is now the Labor Government.  Right now, Nicola Roxon  is seeking to abort women's choice in birth place and birth attendant.  Ms Gillard, you need to ensure that your words in 2005 were not empty rhetoric and politically driven spin to win brownie points in opposition. 

The time for action on your words is now. 

1. Ensure the needs and choices of all childbearing women are at the centre of any  goverrnment, health /maternity  service or policy action. 

2. Ensure that midwives are able to work unhampered by politics in the way that the World Health Organisation recommends.  

3. Provide a level playing field for health care providers (midwives , lactation consultants (IBCLC) and doctors) who work with childbearing women (access to Medicare, insurance and PBS)

4. Remove professional silos and institute true dialogic conversations and interactions for those situations when childbearing women require a multidisciplinary approach for their situation).