Thursday, June 17, 2010

Glad to be home

I have just spent a week in Australia catching up with midwifery friends and colleagues. There are a number of changes happening in the maternity system in Australia including national registration of midwives and the ability of midwives to claim funding so they can practice independent of hospital employment. These changes will put the maternity system more in line with that of New Zealand.

I have to say that I have come home very confused by all the different rules and regulations, and totally exhausted after listening to what midwives are saying about all the politiking that is going on both in the profession itself, and with the medical profession and government.

What it has made me realise is the beauty of the simplicity of midwifery regulation in New Zealand.  I won't deny that there are things that I do not agree with, but here in New Zealand, a midwife is a midwife is a midwife. We are educated to be autonomous midwives as soon as we qualify and supported by legislation and insurance to be self-employed practitioners.

I wish my midwifery colleagues in Australia all the best as they move into a new era, and would like to say how much I respect and admire the work they are doing to move the profession forward. But boy, am I glad I am a midwife in New Zealand because I don't know if I would have the emotional energy to fight the battles they are fighting or go through the processes that are demanded of them before they can practice as self-employed midwives.

I'd love to hear from any Australian midwives or pregnant women. What is your take on the changes that are happening now? How will the changes affect you as midwife or mum-to-be?

10 comments:

Janet Fraser said...

Women who want to be respected and treated like adults with bodily integrity are angry. Very angry, very sad, betrayed and distressed.

http://janetfraser.id.au/blog/2010/05/17/quality-and-safety-and-other-lies-were-being-told/

http://janetfraser.id.au/blog/2010/05/16/the-real-birth-wars/

There is no improvement in this legislation for midwives whether they work independently or in hospitals. And there is _nothing_ in this for birthing women, nothing whatsoever. Our human rights have been stripped from us with barely a whisper in the press and less care from the rest of Australia.

Sarah Stewart said...

I'll be honest with you Janet, and admit I don't know the ins and outs of what's happening in Australia. I do believe there is an opportunity for midwives to make a difference but I am concerned that under the surface there are so many barriers such as the cost of insurance that will hugely stymied any great progress.

Claire Hall said...

Hi Sarah - I am a simple midwife. I live in a country town, and apart from a wonderful TBA colleague, I am the only midwife assisting women birth outside of the meidical system for 6 hrs north and 3 hrs west - and 1 hr south there used to be quite a few ( I am not sure now.)

The new legislation has completely and utterly gutted my practice and destroyed the limited choice that the women I served once had.
Previously, it was their choice whether or not to seek medical assistance and tests during their pregnancy - many did, some did not, and there was no law preventing them from having a homebirth with my assistance.
In a few short days, there will be such a law. To attend the women that I have been attending, they have to promise to see a doctor, not once, but several times during their pregnancy. They have to promise to have a singleton, head down baby. They have to promise to undergo all testing that said medical profession deem necessary and they have to pass all these tests - of which many are questionable. They have to promise to have a baby not too big, and not too little, and not to late.

And then I have to promise to submit to medical rules and "guidelines" and not use my own clinical assessment and intuition. I have to find nearly $7 000 a year for insurance (that doesn't even cover the birth) from a practice that wasn't really making any money anyway. Oh - I forgot - I have to promise to abandon any woman who does not fit into afore mentioned boxes (and many more) or I will not be insured, and if not insured I will not be registered. I have to promise to transfer any woman who steps outside the partogram - which over 54% of women do and subject them to the very procedures they were seeking to avoid in the first place.

You seem to carry hope in your blog that this somehow (while hard fought for and exhausting) is the dawning of midiwfery like it is in NZ. Well, to have my clients birth in a hopsital with me as primary caregiver, all above boxes must be ticked. AND I have to have INSURANCE - currently unaffordable; visiting rights at the hospital - currently unavailable; a collaboration agreemnt with a doctor - currently unavailable; and I have to promise to be a good girl and not stand with any woman who wants to exercise her basic human rights and have autonomy and choice over her birth experience.

Let me see - have I left anything out? Yes, probably I have left an enormous mount of issues out, but I don't want this comment to be too long. so many people think this is a positive thing. I cannot see it. What this legislation is doing is removing choice and forcing women to submit to a medicalised pregnancy and birth regardless of choice of place of birth. If a woman does not wish a medicalised pregnancy and birth, she, under NO CIRCUMSTANCES, should be forced to comply. there is much anecdotal and scientific evidence to suggest that a natural approach to childbirth is the safest with the least adverse events. There is no evidence to suggest that railroading women into forced medical births is in anyway beneficial - but that is what is happening.

Sarah Stewart said...

Ummmm...Clare....what can I say.

Where does the Australian College of Midwives fit into all this?

Claire Hall said...

The Aust college of Midwives is an organisation that is out for the betterment and development of midwifery. Their primary aim is to have midwives seen as a professional group, on equal footing with other professional groups with themselves as the governing body. They are not a group serving women's best interests, and have no difficulty adhering to medical childbirth.

They see these laws as a good thing - admittedly with a few hiccoughs, but nothing that can't be sorted. They fail to see the collaborative parts of the new legislation as making midwives yet more of a handmaiden to obstetricians, hoping that "eventually" it will lead to more autonomy. Knowing the power the AMA has in this country, I do not hold a similar hope.

Sarah Stewart said...

I am going to a joint midwifery/obstetric conference in a week in Australia that is designed to encourage collaborative work between midwives and doctors - I'll be interested to hear what is talked about there.

Claire Hall said...

This is interesting - http://www.birthspirit.co.nz/Articles/Articles/A%20Letter%20To%20My%20Midwife%20Sisters%20-%20HBBound.pdf

Sarah Stewart said...

Hi Clare thanks for the reference.

There's some very powerful research coming out of New Zealand that shows you are 6 times more likely to have a caesarean section if you birth in a secondary hospital than primary unit/home. When it is published I'll blog the link etc.

Lewis said...

I totally disagree that in NZ "a midwife is a midwife is a midwife". There is a huge range of differences in individual practices with an unacceptable level of medwifery and the vast majority of midwives far from the ideal statistics that are possible to achieve. There is a truly amazing minority who are real guardians of the birth space and with woman, but they are consistently persecuted and witch-hunted, often by medwives.

Re Australia. Briefly, the bottom line is that the new legislation means that about 80% of women who want to birth at home and could birth at home under the care of an independent midwife are now excluded from homebirthing with a legal midwife due to the very narrow constraints of 'normal'.

Sarah Stewart said...

Thanks Lewis for your comments.

What I meant by my comment was that a midwife can go into independent practice as soon as she qualifies, as opposed to Australia where she will have to have been qualified for at least 3 years and fit an 'eligibility' criteria.