Birthing Spirit

Today hundreds of people in NSW, QLD and VIC rallied outside the offices of Kevin Rudd (Prime Minister), Julia Gillard (Deputy Prime Minister) and Tanya Plibersek (Minister for the Status of Women) to protest the proposed ammendments to the new health legislation. A clear summary of what these ammendments mean for women and midwives can be found HERE. Below is the Australian College of Midwives media release and HERE is an article from the Sydney Morning Herald.

MEDIA RELEASE 9 November 2009

Midwives reject doctors’ veto over their ability to enter private practice and provide care to women.

The Australian College of Midwives has grave concerns that the proposed amendment to the Health Legislation (Midwives and Nurse Practitioners) Bill, proposed by federal Health Minister Nicola Roxon last week, will do nothing to improve women’s access to collaborative midwifery and obstetric care – the objective of the reforms.

The proposed amendment will require a Medicare eligible midwife to have a collaborative agreement with a medical practitioner(s).

“It’s hard to see the amendment as anything other than an attempt by the medical lobby to ensure doctors have a power of veto over the regulated professional practice of a midwife” said ACM President, Assoc. Professor Jenny Gamble.

“Insisting on agreements with individual privately practising doctors is simply not workable.” Gamble said. “In rural and remote Australia sometimes there is no doctor available within hundreds of kilometres and those available are often locums who change every three months or so, making collaboration with a single doctor impossible.”

“Even in the cities, if a woman’s midwife has an agreement with a particular private obstetrician, that doctor may not be available when the woman requires medical care, such as a caesarean section.”

“Maternity hospitals have many different doctors, so is the midwife to have agreements with 12 different doctors on 12 different terms? There has to be a system of care that supports each midwife and the women she cares for in evidence based collaborative arrangements regardless of the individuals involved.”

“The proposed collaborative arrangements, are not just unworkable, they are potentially unsafe and undermine regulation of the midwifery profession.” Gamble said.

“Midwives are committed to collaboration with doctors in the interests of pregnant women and their babies. Such collaboration is already a daily occurrence. Midwives’ competency standards, against which they are registered every year, require collaborative practice. Failure to practice in accordance with these and other professional standards can lead to disciplinary action by the Board.

The proposed amendments will give power to medical practitioners to essentially decide which midwives will be able to practice privately or not, have insurance or not and access Medicare or not. Instead of the regulatory authority – the Nursing and Midwifery Board of Australia – determining safe and competent practice by midwives, it will be down to the whim of individual obstetricians. This will not pave the way to safe, high quality, collaborative care for women and their babies”

“There is no argument that women who choose an MBS eligible midwife to provide their care will need timely and seamless access to medical care if and as they require it. An agreement between a midwife and a private obstetrician (GP or specialist) may be one option for some midwives and women. But this must not be the only way. It is essential that midwives can forge agreements with public maternity services as an alternative way of working collaboratively and meeting the requirements of the Act. We are concerned that the proposed amendment does not provide for this.” Gamble.

The World Health Organisation recognises the midwife as “a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.”

Midwifery care has received the highest scientific endorsement in the past year, with a systematic review of 11 randomised controlled trials involving over 12,000 women from around the world demonstrating that outcomes for women receiving continuity of care from known midwives were better than for women who received fragmented care from multiple midwives and doctors. Midwives can be trusted to refer and consult when needed.

“This amendment will be especially problematic for midwives providing homebirth services, as medical organisations are publicly opposed to woman’s choice of birthplace. They need only urge their members to refuse to collaborate with midwives if they provide homebirth services. Homebirth will go underground and midwives will not be able to register to provide current and accountable care to these women. This is a serious safety concern for Australian women wishing to make this choice.”

“Collaboration is about mutual trust and respect and professional cooperation focused on the needs of individual women and babies. It’s not going to work if it’s a forced relationship with someone who holds all the power and can choose whether or not to collaborate. It’s like one hand clapping”.

“The ACM urges the Rudd Government to consider the interests and safety of women and babies and to leave the collaborative arrangements in the regulations or at the very least to change the amendment to make clear that midwives can have agreements with maternity services, as an alternative to having one with an individual private obstetrician.” said ACM President, Assoc. Professor Jenny Gamble.