National Alliance for Students of Midwifery

On behalf of the Department of Health, 3 Centres Collaboration is consulting on a framework for public hospitals in Victoria

The framework designed specifically for Victorian public hospitals, will provide guidance on the appropriate mechanisms to consider, implement or review collaborative arrangements with eligible midwives that wish to have arrangements to provide private services in public hospitals.

This forum is an opportunity for maternity care providers and consumers to learn about the scope of the framework and contribute to its development by identifying issues that may need to be considered

Who should attend?

• Managers and clinicians involved in maternity care
• GP’s, GP Obstetricians and Obstetricians
• Midwives
• Consumers
• Anyone interested in collaborative arrangements or this model of maternity care

Six Forums have been scheduled

Light refreshments provided….RSVP

Background

The National Maternity Services Plan  2010¹,endorsed by the Australian Health Ministers’ Conference (AHMC), sets out a five year vision for maternity care in Australia.  In year one, states and territories are required to…develop consistent approaches to the provision of clinical privileges within public maternity services, to enable admitting and practice rights for eligible midwives and medical practitioners. ¹The Plan is available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesplan

For more information contact the Project Manager, Colleen White at: Colleen.White@southernhealth.org.au

NEWS RELEASE
David Davis Must Intervene to Protect Mothers and Babies
Friday 28 October 2011
Contact:          Liz Wilkes:  0423580585  Jenny Gamble: 0404  080 518

Recent media has outlined a crisis in Victorian maternity units, with over 200 women giving birth in Accident and Emergency or on gurneys in hallways.

“Today Victorian Health Minister David Davis’ maternity crisis got worse as it has been revealed that due to a lack of funding 60% of newly graduated midwives have not been offered a ‘graduate place’ in maternity units across Victoria. How can this be when Nursing and midwifery are recognised as the highest priority area in the health workforce?” said Liz Wilkes, President of Midwives Australia a national education and professional body supporting midwives.

“These midwives are educated to international best practice in a three year bachelor degree, with extensive experience in providing continuity of midwifery care. This care is considered the gold standard and has been acknowledged by Federal Health Minister, Nicola Roxon as the future for midwifery in Australia.” said Dr Jenny Gamble, Professor of Midwifery at Griffith University.

Danielle Rose is one graduate who is without a job next year. As a mature age student, Danielle bought years of previous knowledge to her studies. She now has a $30,000 HECS liability and no employment, despite nursing and midwifery ranking as the highest priority area for health workforce recruitment and retention.

“Minister Davis has also not facilitated hospital visiting access to experienced Medicare funded midwives in Victoria. This creates undue strain on hospital staff and unnecessarily costs the Victorian state government.” said Ms Wilkes.

“Midwives groups have sought an audience with Minister Davis and despite a formal request and repeat phone calls a meeting time has not been granted.” said Ms Wilkes.

“Midwifery students educated through the Bachelor of Midwifery represent the future of care, these midwives have the capacity to reform the maternity system that is still a broken mess and provide much better physical and emotional safety to women across Victoria. We urge Minister Davis to guarantee a place for every midwifery graduate.” said Dr Gamble.

Midwifery Graduate Contact: Danielle Rose 0414 886 455

Attention: Tracy Martin – President, Australian College of Midwives

Dear Tracy,

Regarding Response to the Interim Homebirth Position Statement, the Interim Guidance to Privately Practicing Midwives, and the Literature review
The National Alliance for Students of Midwifery (NASM) was formed in August 2011. NASM aims to provide a nationally recognised, collective voice for Australian midwifery students.

We consider the Interim Homebirth Position Statement (IHPS) and associated documents to be deeply flawed and call for the IHPS and supporting documents to be immediately withdrawn.  We feel that the IHPS and supporting documents compromise a woman’s right to informed choice and her right to access midwifery care, and the midwife’s right to provide evidenced-based, woman centred care.

Many students feel that the ACM is failing to uphold their own stated values and midwifery philosophy by attempting to implement guidelines which fail to “recognise every woman’s responsibility to make informed decisions for herself, her baby and her family with assistance, when requested, from health professionals”.

By setting contraindications to homebirth, the guidance document is removing a woman’s right to informed choice, restricting the scope of midwifery practice and acquiescing to the medical model and control of childbirth.  This is deeply troubling considering that the ACM, as the peak professional midwifery body, have the stated aim of strengthening midwifery in Australia.

Furthermore, the IHPS and guidance document potentially narrows the definition of a midwife when stating that midwives providing homebirth services would ideally be eligible midwives (i.e. 3 years midwifery practice).  The International Confederation of Midwives definition of the midwife states that “a midwife is a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located” and that “a midwife may practise in any setting including the home, community, hospitals, clinics or health units”.  It is of very great concern to us as future midwives, that our peak professional body is seeking to limit our scope of practice on graduation, and is devaluing midwives who are not yet “eligible”.

As Australia’s future midwives we are concerned that the College does not provide support for midwives who do feel competent to provide care to women who fall outside the “LOW RISK” basket.  We are therefore dissatisfied with the guideline that prohibits midwives from signing up and agreeing to provide care for individuals who fall into the broad categories of ‘risk’.

Obviously the rights of childbearing women is a key concern to us, but alongside that, and of equal concern to us, is our future midwifery roles and how the IHPS will impact on our ability to practice in a woman centred way, and be “with woman”.

We do not accept that the midwife is responsible for determining risk status – the woman should be informed and empowered to make decisions about her own care and what is appropriate in her individual and unique circumstances, according to her own sense of safety and risk.  When the midwife makes a decision to support a woman and provide care then the ACM needs to support the midwife.  The ACM setting contraindications and requiring midwives to refuse/decline care and will result in women being forced to birth in hospital against their will, or being forced to birth at home without a midwife, neither of which is optimal.

We believe the IHPS contradicts both ACM and APHRA documentation, which enshrines the woman’s right to make informed choice and informed refusal.

We would like to see the ACM as an organisation functioning very differently in the future.  Our hope that they will stand up politically and be a strong and determined voice that protects midwives to “focus on a woman’s health needs, her expectations and aspirations” – rather than bowing down to other organisations who do not have the interest or understanding of the whole woman in mind.

We ask how it was procedurally possible for the Nursing and Midwifery Board of Australia (NMBA) to endorse the ACM interim statement before the ACM sought consultation from its own members? We are also interested to know:

• Have the statistics of currently practising midwives in private practice been taken into consideration re: scarred uterus, twin pregnancies or gestation >42wks, regarding outcomes?
• Have midwives in private practice been consulted regarding the care they give?
• Have women who access midwifery care for their homebirths been consulted?

We ask that any document that seeks to in any way regulate a woman’s right to access midwifery care, and has the potential to impact on women’s birth choices be written by or in consultation with consumers.  Additionally any documentation or guidelines that seek to address any aspect of private midwifery practice should be written by or in consultation with currently privately practising midwives.

We ask that the ACM take great care in the future to maintain and strengthen the profession of midwifery, so that midwives of the future have the same or enhanced and expanded possibilities and options open to them upon graduation.

Yours sincerely,

National Alliance for Students of Midwifery

NASM response to the ACM interim homebirth position statement

RESPONSES must be received before the 23rd Sept  (close of business)
This page is available as a pdf to print and share

SIMPLIFYING THE ISSUES:
What is wrong with the ACM Homebirth Position Statement and Interim Guidelines?

Joy Johnston (A Fellow of the ACM since 1997) states:

The release by the Australian College of Midwives (ACM) of an Interim Homebirth Position Statement and guidance document has prompted discussion and debate amongst those of us who are interested in the boundaries of a midwife’s practice. Of immediate concern is the statement in the guidance that:

“There are some contraindications to a planned homebirth which women should be informed of at booking. These are:
• Multiple pregnancy
• Abnormal presentation (including breech presentation)
• Preterm labour prior to 37 completed weeks of pregnancy
• Post term pregnancy of more than 42 completed weeks
• Scarred uterus”
The word ‘contraindication’ means ‘NO!’… There is little room for movement in the word ‘contraindication’ which in any medical setting means that there is a reason to avoid using a particular treatment…
Village Midwife Blog: Refining and redefining a midwife’s boundaries

The only way in anyone’s book to approach vaginal birth after caesarean (regardless of the planned place of birth) is spontaneous onset of labour, which usually means at home, quietly and privately. The optimal situation as far as I can see is that the woman is able to call her midwife who will work with her in either setting – home and hospital. By ‘black banning’ the scarred uterus from HBAC, it is likely that some women will feel they have no option but to go it alone, or to engage unskilled help, with sometimes tragic and avoidable consequences.“
Midwives Victoria: A scarred uterus

“International Confederation of Midwives (ICM) POSITION STATEMENT ON HOMEBIRTH: The ICM supports the right of women to make an informed decision to give birth at home.
ICM GUIDING STATEMENT TO MEMBER ASSOCIATIONS (The ACM is one): Member Associations based in countries where women do not have access to a full range of options as to where they can safely give birth are encouraged to negotiate with their governments for this to occur.”
Any position statement of the ACM should usually be consistent with, and reflect, the Position Statement of the ICM. http://australianprivatemidwivesassociation.blogspot.com/

Homebirth Australia states:

Many women choose homebirth because they have previously had a traumatic hospital birth.  Many have had previous caesareans. Their right to make this safe, legitimate choice must be protected.
http://homebirthaustralia.org/save-hbac-australia

Lisa Barrett’s blog states:

The college have not affected the women’s right to birth wherever they please but the midwife’s right to attend them.  They have listed a number of situations where a midwife should not attend a woman at home, leaving her high and dry and without a care provider. twins,  abnormal presentation including breech – Prior to 37 weeks and after 42 weeks, and most interestingly slipped in there is VBAC, however they have dehumanised it by calling it a scarred uterus. http://www.homebirth.net.au

The problem here is not whether you (or the ACM) think that homebirth is a good option in situations such as these, but rather that the professional regulations MUST respect  a woman’s ability to make her own informed choices, and protect midwives’ ability to legally  provide care to them.

Midwife Thinking Response- main concerns with the statements:

* The expectation that the midwife, rather than the woman, determines risk status, and then actively blocks access to birth options based on this assessment.
* The assumption that birth will not be normal because the woman has a uterine scar, is over 42 weeks, has twins, etc. does not reflect a trust in the birth process, and is not evidence based.
* The guidelines contravene the right to self-determination and bodily autonomy.
* True evidence-based practice blends the research evidence, with the expertise of the practitioner and the individual requirements of the ‘patient’ (or woman), rather than universally applying research findings to practice (Sackett et al., 1996).
* Regarding “Consultation is mandatory for the midwife providing care” (Interim Guidance doc. p.2), the midwife should recommend consultation and referral – but to enforce it does not respect the woman’s choice (and breaches confidentiality).
* The ACM guidelines are not aligned with the Code of Ethics for Midwives, Code of Conduct, and Competency Standards (Australian Nursing & Midwifery Council)

The college should support privately practicing midwives who decide NOT to withdraw care and instead support the woman’s decision to homebirth despite any risks involved. The alternative is to leave the woman without a care provider who can identify any deviations from safe process and transfer if necessary. http://midwifethinking.com

Australian College of Midwives:
“There is no evidence that shows an increase of risk of maternal morbidity or mortality in relation to homebirth” (p.19). ACM Homebirth Literature Review
The interim guidelines contradict the ACM’s own ‘Philosophy of Midwifery’ which says that midwifery:
* recognises every woman’s right to self-determination in attaining choice, control and continuity of care from one or more known caregivers
* recognises every woman’s responsibility to make informed decisions for herself, her baby and her family with assistance, when requested, from health professionals. www.midwives.org

RESPONSES must be received before the 23rd Sept  (close of business)
Send submissions:
‘To the Australian College of Midwives Board of Directors’
By post to PO Box 87, Deakin West ACT 2600.
Or by email to info@midwives.org.au
Only submissions with identified senders and a return address will be considered.
There are members of the ACM Board who are keen to hear and represent YOUR voice – so let them hear it!

Remember:

• The ACM will collate the responses according to THEMES, keep it simple.
• The ACM want midwives and consumers to be WITH them, so encourage them to be strong and tell them HOW they CAN GAIN your support.
• The ACM have regulatory power, so it’s no good to us if they feel threatened/ attacked & react defensively.
• Be practical and proactive in your response – what DO you want to see?

Tips for a Powerful Letter:

• Make it short and snappy (try to get it on one page) – it doesn’t need to be fancy.
• ...To the ACM Board of Directors
• Introduce yourself…i.e. I am a midwifery student, a consumer, or a student member
• Say why birth choices and a woman’s access to her chosen care are important to you
• Briefly outline your concerns- what most concerns you about the interim guidelines? (e.g. blanket contraindications)
• Tell the ACM you consider them responsible to show leadership and protect women’s access to qualified care where THEY choose; ask for more consultation & transparency.
• Do it NOW! Leave enough time to send your repsonse via the POST (preferably)
• You must leave a return address for your submission to be considered.

IDEAS:

1. That ACM withdraw the current position statement on homebirth and formally consult widely with homebirth midwives and consumers, their representative groups such as APMA and HBA, before reformulating this statement.
2. That ACM formulate a guideline that unequivocally endorses and describes the process for a woman’s right to informed refusal, and the midwife’s right to legally provide care for her in pregnancy, labour, birth and postpartum, irrespective of the woman’s risk status
3. That ACM stand up for women, rather than sacrifice aspects of midwifery care and women’s birth options in an attempt to cater to the  insurance companies. Keep the woman and her ‘responsibility to make informed decisions for herself’ at the centre of midwifery care.

This page is available as a pdf to print and share
Document prepared by the National Alliance for Students of Midwifery (NASM).