Maternity Services Review - the report

Well, what can I say apart from I am hopefully distressed. Yes, the two don't really go, but I am torn. On one hand I am pleased to see the mention of midwives being extended the ability to access Medicare and the PBS, which to me spells out practicing rights in hospitals. On the other I am really down seeing that home birth has not been recommended to be funded by the Commonwealth- really, how much will it cost? A pittance in the scheme of costs that are generated by hospitals admitting healthy pregnant women and managing her pregnancy/birth.. Admittedly the numbers of women actually home birthing are small, but if it was funded, more would use it. Look at the waiting lists for birth centres and MGP type models, the women waiting would be the ones who would investigate home birthing. *sigh* And what about PI??

The term 'collaborative team' is splashed through the report. It isn't defined. Does it mean a team of birth professionals are on record saying they are a collaborating in order to satisfy the birthing woman's needs? Is it a midwife who has a transfer policy lodged with a hospital, or an obstetrician? Is it an OB who has a midwife in his employ with a GP/OB who refers to the Midwife/OB team as per the womans needs? Is it as simple as a woman chosing who her care providers are and filling out a form saying who she has chosen to deal with ear infections during pregnancy (GP), who will be her lead care provider (midwife) and who her preferred obstetric specialist is in the unfortunate event that she needs medical intervention? Or is it a health service of an area, allocating an OB to oversee the practice and client load of a (hoop jumping) midwife..

Collaboration already occurs, though it is very top heavy and backwards, with the majority of midwives basically employed as glorified nurses. OB's make the policies, OB's employ the midwives, hospitals employ the midwives to be with woman during her labour but (in the case of private hospitals) the OB is the one to oversee the birth. It is a rare hospital indeed, that has a working relationship with a midwife in the community, who, if required by the woman, will transfer in for assistance, while still retaining her position as lead carer, working in collaboration with the necessary specialist. The number of times I have heard anaesthetists and hospital midwives talking about the trainwreck or horrendous transfers that come in. Instead of welcoming and attending with a professional manner to the midwife and transferred woman, passive aggressive and disdainful attitudes poison the collaboration. So what does the report's 'collaborative team' mean?? Turf wars are in evidence every single day, in every single hospital, with the turf being the woman, baby and their health.

The report is also sounding the death knell for true private practice midwifery. Depending upon the term 'collaborative team', it could mean that a private practice midwife (who does not want to fit with that definition, which will most likely be a medically heavy one) will be unable to access PI insurance that is subsidised by the Commonwealth. In July 2010, a National Registration and Accreditation System (NRAS) will be implemented, which will include all health professionals Australia-wide, including midwives. Part of the registration clause is that the health professional have current PI insurance. If a private midwife can't access PI, then she will be unregistered and unable to practice legally. At present the wording enables a midwife to be registered without proof of PI and the state regulatory bodies have usually turned a blind eye. All women who privately employ a midwife to attend her in the home, are well aware of the lack of affordable PI for private midwives. I wonder how many women have attempted to sue their midwife for negligence since July 2001, when PI was withdrawn from the reach of private midwives. I know a lot have been reported to their governing state nursing federation/union/body, yet the majority of reports are by other birth professionals who think that the private midwife needs to have a lesson taught to her.

The MSR report mentions freebirth as being undesirable. If home birth becomes more difficult to obtain, either through expenses rising, or it becoming a crime for the midwife to attend, then more will occur. I am sure this isn't what the MSR team want to happen. Though the thought has been put out there that it is simply a stepping stone to legislating that freebirth is child abuse with the involvement of child protection being imminent. Whatever happened to a woman's right to choose her reproductive actions??

I was browsing a blog yesterday and the point was made that the medical fraternity/government are happy to 'allow' GP/OB's, nurses and midwives to be the funded care providers for rural and outback women (majority of indigenous women are outback), due the the undesirable locations. Surely you would think that because indigenous women and children have disgustingly high death rates compared to urban white women and children, specialist obstetricians would be racing out there to offer their life saving services instead of leaving them in the hands of midwives.. *shock/horror*

Hhmm, well, I'm going to put my head down and bum up to get my degrees. Maybe this MSR will amount to nothing, with nothing new being implemented except private midwifery being outlawed. I have till 2013 till I am going to be directly affected by the state of play. Though I do promise, while studying, I will keep writing letters and being involved with Maternity Coalition and Australian College of Midwives, to try and salvage my opportunity to become a registered and insured privately practicing midwifery professional, working with women in all places of birth.