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Monday, March 19, 2012

Where are the midwives?

[For a rough estimate of distance, think of a red dot as 100Kilometers]
























Several years ago the Federal Opposition Health spokesperson made a speech to midwives. She said that midwives have:

“limited opportunities to practise as primary carers and provide continuity of care to women” and

“Unless and until the Government is shocked and shamed into realising that Australian women … ” and

“I believe that midwives … are key heath care professionals whose role in the care of women and their babies has yet to be fully realised in the Australian health care system” 

The speech was to the Annual conference Midwifery By The Sea - Riding The Waves Of Change of the New South Wales Midwives Association, 20th October 2005.  The speaker was the woman who went on to become Prime Minister, the Hon Julia Gillard. Here's a little more from that speech:
"Clearly this is no time for turf warfare between doctors and midwives, but it is time for all health care professionals involved in delivering obstetrics care to mount a combined attack on the Howard Government to force them into action to address this situation. Unless and until the Government is shocked and shamed into realising that Australian women are now scrambling to find the birthing centre of their choice, and in some cases scrambling to find any professional who will deliver their child, the situation will not improve."
The [Rudd-] Gillard government have brought in maternity reform, as readers of this and other maternity-related sites will know all too well. Ms Gillard declared in 2005 that "this is no time for turf warfare between doctors and midwives ..." YET this government delivered the virtual control of private midwifery practice to doctors, in the form of a piece of legislation called the Collaboration Determination.

The words (mainly) of the PM herself ring true:
"it is time for all health care professionals involved in delivering [maternity] care to mount a combined attack on the [Gillard] Government to force them into action to address this situation." 


This month, APMA has conducted a brief review of private midwifery services, asking midwives and maternity consumers to tell us what's on offer where they live.

Here are the current trends:
  • Areas with access to private midwifery services are mainly the [more densely populated] capital cities and a few regional centres, as demonstrated on the map. 
  • Established midwifery practices that have taken up Medicare rebate options since November 2010 continue to provide homebirth services. 
  • Homebirth, which has been predominantly the domain of private midwifery practice in Australia for many years, is increasingly being made available through publicly funded hospital-based programs. 
  • Established midwifery practices that have continued without Medicare rebates are providing homebirth and other private services in their communities. 
  • The emergence of new private midwifery practices with Medicare includes some providing midwifery care across the prenatal and postnatal periods, with hospital births, while others a focus on postnatal services. 
  • Progress towards hospital visiting access for private midwives has been noted in Toowoomba (Qld) and Sydney (NSW). 
  • Unregulated birth attendants are reported to be available to provide homebirth services in some areas. 

In many areas, women are still "scrambling to find the birthing centre of their choice, and in some cases scrambling to find any professional who will deliver their child." 

The new rules present midwives and the women who employ us with unnecessary obstacles when attempting to comply with legislated requirements for collaboration.  There is no public interest in these new rules.  The health and wellbeing of women and their babies is not improved by the hurdles they are now required to jump.  Some women are choosing to forgo the Medicare rebate than have to go to an unsympathetic doctor, cap in hand, requesting a referral to their chosen midwife.

It's time for women and midwives to take Julia's own advice, and  "mount a combined attack on the Gillard Government to force them to address this situation."

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