Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
The Federal Government has been grilled at its latest community cabinet meeting over its proposed changes for midwives and maternity services.
The Government wants to make midwifery services eligible for Medicare rebates, but only if homebirth midwives work in consultation with a doctor.
Several women at last night’s meeting … told the cabinet ministers that the changes would restrict the choice of women who only want to give birth with a midwife at home.
But Health Minister Nicola Roxon says the Government is simply taking a cautious approach.
“To make sure we’ve got some backup protocols in place, so if something does go wrong that there are agreements with the hospital or doctor to be able to step in quickly,” she said.
“And that is a conservative approach, but it isn’t a conservative approach to say midwives are doing good work, have never been recognised in the history of providing Medicare for the last 50 years and we’re going to actually change that.”
She told the meeting that medical professionals should be working together.
“I’m unapologetically on the record as saying let’s encourage people across the health services spectrum to work together and make sure that women can safely choose options that are good for them and suit them,” she said.
Women who access private midwifery services will be able to access Medicar benefits. As well as this, midwives will be able to order medications via the PBS.
The maternity reforms provide women with greater access to continuity of midwifery care. The standard care in a public hospital is for women to see one group of midwives in the clinic, another group in the delivery suite (who work shifts) and then another lot of midwives when they are being cared for with their baby. The maternity reforms will make it possible for more women to be cared for by their own midwife, whom they have chosen. The same midwife will provide care from the first antenatal consultation right up until about 2-4 weeks after the baby is born.
This is a huge step forward for Australian maternity care. For the first time, women will be able to birth in hospital under the care of a private midwife. Private midwifery care will also be available for home births (as is currently the case). We are continuing to book women for home births beyond July.
Melissa Maimann, Essential Birth Consulting 0400 418 448
How is this going to help when the hospital steps in during the birth and vetos the women’s decisions? As in 1 cm dilation per hour? Refusal of VE’s? Walking during labor? Continuous EFM? How will midwives be able to stand up for their clients while their insurance is on the line?
Women are now at the bottom of the slippery slope and are being preempted from exercising informed refusal.
I’m not sure that the hospital would step in, as the midwife would be the primary care provider and s/he would have already worked with the hospital and the woman to ensure that the woman is treated respectfully. Hospital staff have no business barging in on the midwife and woman unless they’ve been invited to do so.
If the woman declines VEs or continuous monitoring etc, the midwife would not be able to do the VE or monitoring as it would be assault and battery – women still have the right of refusal.
The only time we would be in breach is registration / insurance is to support high risk women wihtout consulting with an obstetrician. The guidance that has been developed for collaborative care specifies the way collaboration ought to work … It might be ideal, but if it doesn’t happen that way, the midwife has an avenue to pursue and an escalation channel.
I think that “system” hospital birth is very different to hospital birth with private midwifery care. There’s no reason why it wouldn’t be more like a birth centre sort of approach.
Funny that private OBs have to work within hospital protocols to the detriment of women’s choices, yet private midwives will not be subject to this “system”. LOL.
I see where you’re coming from … here’s my take on it: the conversation between the midwife and woman could go something like:
“I need to let you know that the hospital policy says that I have to put a monitor on you now because xyz. The reason for this policy is that it’s felt to be safer for the baby to be continuously monitored now that xyz has happened. It’s been my experience that when women are cared for by a midwife who does not leave them, women can be safely monitored with a doppler, maybe every 10-15 mins. The CTG will mean that you can’t labour and birth in the water, but if I use a doppler you can use the bath and shower and move around better. What would you like to do?” (remembering that most likely the woman has a birth plan and this has been discussed with the collaborating obstetrician ahead of time … the ob can speak with the woman in the pregnancy if s/he’s concerned about anything in the birth plan to avoid any harassment of the woman in labour)
And when the woman says, “I want you to use the doppler … do it every 10 mins if you need to, but I really want a waterbirth!”, the midwife documents: discussion with woman re: CTG. Woman advised of hospital policy to monitor continuously in view of xyz. Woman has considered this advice and has refused same but is accepting intermittent auscultation. Team leader / obstetrician informed of woman’s decision. Plans will be reviewed if any decelerations or reduced variability.”
Done!
How do you see it?
I see that the forces against midwives have been vastly underrated. All those times formal complaints have been suppressed against OBs who bully women so midwives could keep their jobs! *They* are 2 steps ahead of you, and *we* will bear the scars to prove it.
http://www.abc.net.au/news/stories/2010/02/18/2823018.htm?site=canberra
Dr Foote says more Canberra obstetricians would work at the hospital if the conditions were better.
He says many of the doctors and registrars who have left the hospital in recent years complained of a toxic workplace and uncooperative relationships with some midwives.
Five staff specialists who have worked at the Canberra Hospital in the past four years have told the ABC, they were concerned some midwives raised the alarm too late in emergency situations with potentially disastrous consequences.
“One of the cultural concerns I have is that there’s this ‘I’ve failed if I have to call in a doctor’, both at the patient level and at the midwife level,” Dr Foote said.
“Now there are many, many good midwives in this system and a good midwife will say to an obstetrician ‘look I’m worried you better come in’.
“The concern is that this doesn’t happen as often as it should. It’s almost a badge of honour, ‘I’ve kept the doctor away’.”
Obstetrician Dr Peter Bland worked at the Canberra Hospital in 2005.
He says he found a lot of tension between sections of the midwifery and obstetricians.
“There were patients who should have been elevated to medical care but were maintained under midwifery care,” he said.
“When the medical people tried to become involved they were specifically and literally obstructed from entering the room.”
Dr Bland says there is a wider push from factions within midwifery to take clinical grounds from obstetricians.
“This concept has been built up and perhaps sold to the public that it is possible to have a pregnancy unencumbered by any medical staff,” he said.
Maybe I sound harsh. I apologise. It’s just so funny (as in strange) to think that private midwives are going to be able to refuse *just in case* obstetric involvement, and all the interventions that go along with it, especially since attending rights will be tied to compliance with policy.
Hi, you don’t sound harsh at all and maybe I’m being naive. But … a woman’s right of refusal is protected by law. She might not be able to have a homebirth if she’s high risk, but in a public hospital she can refuse whatever she wants. The mw and ob will want to know that she understands the risks, that she’s not been coerced into the decision and that she’s conpetent to consent.
I don’t think midwives will be able to refuse to offer just-in-case intervention, but once offered the woman can decline. If she declines, we would need to let the ob and senior midwife know (collaboration) but no-one can force a woman to do something she doesn’t want to do.
The ACM guidelines have a pathway through which a mw can continue to support a woman who declines the advice she has been given.
I’ve had several women who have had “high risk” natural births in the system, no monitoring, no VEs, no ABs, waterbirths “against” advice etc – it hasn’t been an issue but it has included a lot of discussion and up-frontness during the pregnancy. I’m currently supporting a woman to have a HBAC and the hospital actually support it! She’s booked in, has seen an ob, has discussed with me reasons for transfer, lives close to the hospital etc … the hospital is fine with it.