The Campaign Begins

Today I am beginning to coordinate a campaign in my local area to lobby to save the future of midwifery in private practice and homebirths. The Report of the Maternity Services Review failed to provide a provision for midwives attending homebirths nor to find a solution for professional indemnity insurance. As a requirement of national registration planned to be implemented mid 2010 - midwives will be asked to provide proof of professional indemnity insurance as to enable registration - as no insurance is available if midwives choose to attend a homebirth they will be practising illegally. Women have a right to a midwife attending them at home. More on my plans later. Enjoy this video produced by Homebirth Australia.

Photo and video editing at www.OneTrueMedia.com

Maternity Services Review

The date for submissions to the Maternity Services Review Discussion Paper has now past. I received the email below today to say my submission has been accepted. I now am waiting excitedly with the hope that real changes are going to occur such as midwives receiving Medicare rebates, professional indemnity insurance and that we'll have the ability order diagnostic tests and have prescribing rights.

Dear Jane

Thank you for your submission in response to the Maternity Services Review Discussion Paper, “Improving Maternity Services in Australia: A Discussion Paper from the Australian Government”.

Your submission, along with all other submissions and information, research and expertise assembled from other sources will be used by the Department of Health and Ageing in the development of a report to the Minister for Health and Ageing, the Hon Nicola Roxon, MP.

Thank you again for your contribution to this important process.

Yours sincerely




Rosemary Bryant
Chief Nurse and Midwifery Officer

Midwife-led versus other models of care for childbearing women

A friend has just emailed a link to this review from the Cochrane Collaboration (published October 2008) - I thought you might be interested:

Midwife-led versus other models of care for childbearing women
Hatem M, Sandall J, Devane D, Soltani H, Gates S.

Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

To read more visit: http://cochrane.org/reviews/en/ab004667.html

Proverb Translated from the Tao Te Ching

You are a midwife, assisting at someone else's birth. Do good without show or fuss.

Facilitate what is happening rather than what you think ought to be happening.

If you must take the lead, lead so that the mother is helped, yet still free and in charge.

When the baby is born, the mother will rightly say: "We did it ourselves!"

from The Tao Te Ching

Greater Roll for Midwives

Midwifery is on the national agenda today. There has been wide coverage on television and newspapers. Finally we are seeing a shift by the government towards midwifery care. This is long overdue. My fingers are crossed the government is serious about implementing the planned changes.

Here is the report in today's Sydney Morning Herald (on the front page).

Mark Metherell - September 10, 2008

Midwives would be given doctor-style responsibilities such as being able to order diagnostic tests and prescribe drugs under proposals being considered by the Federal Government.

With a shortage of nurses and doctors straining maternity services at a time of near-record birth rates, the Minister for Health, Nicola Roxon, will release a discussion paper today proposing a boost in the role of Australia's 12,000 midwives.

The paper cites fragmented services, professional restrictions, funding problems and a lack of affordable indemnity insurance as barriers to greater use of midwives. Australia's use of independent midwives compares poorly to other developed countries, including New Zealand and Britain.

To provide a comprehensive service similar to that of general practitioner obstetricians, the discussion paper says, midwives require rights in hospitals to enable them to visit and refer their patients to specialists, to order diagnostic tests, prescribe drugs and have access to Medicare payments for the work they do.

The proposals are likely to encounter resistance from the Australian Medical Association, which has previously raised concerns about patient safety - claims that have been rejected by the Australian College of Midwives.

The discussion paper is part of a comprehensive review of maternity services being led by the Chief Nurse and Midwifery Officer, Rosemary Bryant, to be completed by the end of the year.

The review will cover issues including support for a greater role for midwives; opportunities for women to have more birth-care options, including home births; the shortage of maternity staff and services, particularly in rural and remote areas; and rising levels of post-natal depression.

The paper says that as there is no Medicare benefit payable to midwives for management of labour and delivery, there is only limited support for midwifery services through private health insurance.

In most cases, mothers choosing to have their babies outside hospital pay the full cost of midwife services, which is typically more than $1000.

A key issue was expanding the scope within both the public and private sectors for women "to achieve greater choice and increased continuity of care.

The report states that Australian women often had a range of different health-care providers during pregnancy.

This was despite international studies which had consistently demonstrated that continuity of carers improved satisfaction for both patient and carer, and improved health outcomes.

Shellharbour Hospital gets new home birth service

Some exciting news has just published by ABC News. This adds to the growing trend of publicly funded homebirth programs in New South Wales.

New South Wales Health Minister Reba Meagher has announced a new home birthing service and family care centre for Shellharbour Hospital.

The family care centre will offer prenatal services and post-discharge midwifery support, such as help with breast feeding and sleep management.

The home birthing service will see publicly funded midwives offer continuity of care through a pregnant mother's labour, birth and postnatal care.

Ms Meagher says the new centre will add to the range of choices available to women in the Shellharbour region.

"This will mean those women who want to give birth at home will be able to do that with the support of a specially trained midwife. Increasingly women are choosing to have children at home," she said.

The home birth announcement has been welcomed by the New South Wales Midwives Association.

To read the complete article go to www.abc.net.au/news/stories/2008/06/13/2273925.htm

National Health and Hospital Reforms Commission

On 25 February 2008, the Prime Minister and the Minister for Health and Ageing announced the establishment of the National Health and Hospitals Reform Commission. The commission will provide a blue print for tackling future challenges in the Australian health system. Out of the blue I received an invitation to attend a focus group, which was one of many groups facilitated by the commissioners across Australia. They brought together a diverse group of front line health care providers such as midwives, physiotherapists, ambulance officers, dieticians, nurses, doctors, prison health care workers (and quite a few other professions). It was a very interesting few hours. We sat randomly at round tables and worked as a group to discuss what we wanted to see changed in the health care system. We each had the opportunity to present two changes. Then together as a group developed three changes for the future. Each table presented their ideas (there were five tables in all). Out of all the ideas collected we had to all agree on five changes. Then a table was assigned one of these changes and we had develop ideas on how to achieve these changes. It was a fascinating process and easy to contribute to. As health professionals I found we all have similar ideas of what was needed for the future. I had the opportunity to speak for improvements in maternity care and have some of my ideas included into the submissions to the commissioners. I spoke for the right of women to have publicly funded homebirths, for the care of well pregnant women to be available in the community (rather than by the hospitals), to change from an illness focus to a wellness focus in maternity care and for the need of midwives to have professional indemnity insurance. While I was only one voice - I did feel that I was listened to. I do commend the government for this initiative. However I hope the Australia Government doesn't just produced a blue print for the future, I hope they choose to act on it rather than filing it in the bottom draw. To find out more visit the National Health and Hospital Reforms Commission Website.