Midwifery care? An Uncertain Future.

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Houston, we have a problem.

At July 1, 2010 eligible midwives must work in a collaborative agreement with an obstetrician. This agreement must be signed by the obstetrician. It legitimises obstetric control over women’s choices. Even basic choices such as limited (or no) vaginal examinations in labour, refusal of continuous monitoring in women who are planning a VBAC, delayed (or no) induction and so on. Of course, it also depends on how reasonable the obstetrician is.

You see, in order for an eligible midwife to be insured for her practice, she must work collaboratively with an obstetrician and this is evidenced by a signed collaborative agreement. No signed agreement = no collaboration = insurance will not respond to any claims and therefore the midwife is working uninsured (and therefore outside the conditions of her registration) and may be de-registered.

Once in the collaborative agreement, the midwife, woman and obstetrician must reach agreement about the plan of care if the woman’s condition is classed as a B or C in the ACM Guidelines.

What sorts of conditions are listed as B in the Guidelines? Previous post-partum haemorrhage Hypothyroidism Weight over 100kg History of mental health disorders Mild asthma IVF pregnancy Previous forceps or vacuum delivery Having baby number 5 or more Previous shoulder dystocia VBAC Long labour (<1cm/hr progress) And the list goes on. These women must have a consultation with an obstetrician and the ongoing plan of care must be agreed by the woman, midwife and obstetrician.

What sorts of conditions are listed as C in the Guidelines?

Type 1 diabetes Coagulation disorders Lupus Twins Pre-eclampsia Breech in labour Gestational diabetes requiring insulin Prem labour And so on. These women cannot be cared for by a midwife; their care must be transferred to an obstetrician. The midwife’s continued involvement in the woman’s care must be agreed by the obstetrician. Even though the woman engaged the service of the midwife, has a contract of care with the midwife and has paid her midwife.

There is no right of refusal. The midwife will consult with an obstetrician on the woman’s behalf if the woman refuses to consult in person. If the obstetrician does not agree to the plan of care – the midwife cannot continue care of the woman because the woman’s condition is considered outside the scope of the midwife’s practice (and therefore outside of insurance and registration).

This system of collaboration is in place in other countries such as The Netherlands, NZ and Canada. The difference in those countries is the professional respect and standing of midwives that enables them to act as autonomous care providers to their women. Have you read The Birth Wars? Read it – it’s an eye opener and provides great insight into the current maternity system. Nicole Roxon wants obstetricians and midwives to work together. It seems she’s thrown us all into the bucket and simply said, “make it work!”. Unfortunately, entrenched attitudes and beliefs do not change quickly.

Collaboration will work when: Collaborative agreements are negotiated at College level, not local level. Obstetricians are mandated to require with collaborative agreements. At present they can refuse to sign a collaborative agreement. Midwives have an avenue for appeal if they - or their clients – are treated unfairly. Visiting rights are in place.

Melissa Maimann, Essential Birth Consulting 0400 418 448