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Saturday, May 26, 2012

NETWORKS

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Since taking on the job of acting president of APMA, I have spoken with various organisations, including the Australian College of Midwives (ACM), Australian Nursing Federation (ANF), Midwives Australia (MA), Maternity Coalition (MC), Midwives in Private Practice (MiPP) and Homebirth Australia (HA) on behalf of APMA. 

Midwives have asked me why there are so many organisations?  And why would a midwife join multiple organisations?

That has led me to setting down the diagram above, illustrating the 'NETWORKS' that currently exist for Australian midwives.  At a first glance, you will see circles and lines that overlap, interconnect, and are often tangled.  A 2-dimensional drawing can only touch on the complexity of the interconnections and tangles that happen between and among groups that rely on membership from members of the profession for their funding, and on unpaid involvement of committed members in achieving their goals.

Each organisation is independent of the others, yet there are times when APMA, representing the interests of private midwives, will sit at the table with these and other groups representing the interests of midwives from an overall professional perspective, midwives and nurses who are employees within a unionised workforce, midwives and lay people who seek to improve maternity services, and highly committed activists promoting homebirth.

Within and between each part of the network are social networking options, including sites on facebook, blogs, Skype calls and email groups.  Today we have unprecedented access to each other.

Having worked in various roles in midwifery and maternity advocacy organisations for the past twenty years, I am convinced that we - those who have volunteered our time and skill, and paid our dues - have achieved a great deal.  We have, in many ways, helped to define our professional boundaries.  See ROADBLOCKS for examples.

The job is not completed.  In fact, I doubt that it will ever be completed; new issues will continually appear on the horizon, and will need people with vision and strength to work through whatever professional or legislative processes there are that present obstacles to what we believe is a reasonable standard of midwifery care, and in the interest of the health and wellbeing of mothers and babies in our care.

The current big issue is professional indemnity insurance (PII), which is mandatory for all health professionals, yet is not available for midwives attending women for homebirth.

Homebirth has for many years been the main practice setting for midwives practising privately.  Making something that is not available mandatory has the potential to wipe out private midwifery practice for homebirth; using the (profitable) insurance market as the de facto regulator of private homebirth midwifery. 

An exemption has been granted for midwives until June 2013.  We do not know what will happen when that exemption runs out.  Will the exemption be extended further? 

The situation is unacceptable.  If mandatory indemnity insurance is truly in the public interest, how can that tiny minority of women (<0.5%) who engage midwives privately for homebirth be excluded from what the rest of society is entitled to? 

The obvious question to ask is how does the public benefit from mandatory PII?


Without going into detail, many who have grappled with this question believe the mandatory PII requirement is not in the public interest, and should be replaced by a different scheme.  The model for such a scheme is already being worked on by our government, in a compensation scheme for people with disability.  We consider a no-fault insurance scheme, into which all regulated health professionals pay a proportion of their earnings, similar to that which exists in New Zealand, would provide better support for those who need it than does mandatory PII.  That means such a scheme would be in the public interest, and would provide more equity for midwives and the women who engage us privately for planned homebirth.

Monday, May 21, 2012

Midwives and Caseload Practice

PDU327: Midwives and Caseload Practice: Primary maternity care for birth in hospital and home

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Deakin University has announced a new learning package for midwives and students of midwifery, through the Professional Development Unit.  Learning packages are delivered via distance education over a 12-week period.  Each full learning package is equivalent to 0.5 credit points.

For information and an application form, please go to the PDU site or telephone (03) 9251 7776

Monday, May 7, 2012

Midwives and medicines

The Nursing and Midwifery Board (NMBA) has announced the approval the inaugural program of study which will lead to Endorsement for Scheduled Medicines for Eligible Midwives. This is a program of study will enable the existing 114 eligible midwives, once their study is completed, to obtain an endorsement to prescribe scheduled medicines, and, the Board claims, to practice to their full scope of midwifery practice.


The accredited program is within a Graduate Certificate in Midwifery at Flinders University (South Australia), and is comprised of 2 topics:
MIDW9009 Pharmacology for Midwives and
MIDW9010 Investigations and Diagnostics for Midwives.
They are both 9 unit topics and they are offered externally. The topics can be studied together in one semester of full time study or one topic a semester as part time.

Application for the course through SATAC and it will commence in semester 2 this year. The SATAC Code is 2GC087 Graduate Certificate in Midwifery and applications for a second semester commencement close on 25 June.

Midwives who have achieved notation on the Register as eligible for Medicare were required to make an undertaking to the Nursing and Midwifery Board of Australia (“the Board”):-
• That I will undertake, and successfully complete, within 18 months* of recognition as an eligible midwife:-
(i) an accredited and approved program of study determined by the Board to develop midwives’ knowledge and skills in prescribing; or
(ii) a program that is substantially equivalent to such an approved program of study, as determined by the Board.
I understand that until I meet the above requirement I will not be able to seek endorsement for scheduled medicines and will therefore not be prescribing medicines. I also understand that if I am not able to provide the Board with the necessary evidence of successful completion of the required program within 18 months, the notation as an eligible midwife may be revoked. I understand that a failure to comply with the above undertaking may constitute behaviour for which conduct proceedings may be taken under the Health Practitioner Regulation National Law (South Australia). 

* Note that this deadline has been recently extended by 12 months, as recently reported in this blog.


Midwives who have completed courses that have been recognised as substantially equivalent are not yet able to prescribe scheduled medicines.  The Victorian law (Drugs and Poisons) is yet to be amended to enable midwife prescription.

Midwives who are practising in primary maternity care, with or without participation in Medicare, have only minimal reliance on scheduled drugs.  We do not carry dangerous drugs, such as Pethidine, which is often used in hospital for obstetric analgesia.  Some midwives arrange with the woman's GP a prescription for prophylactic antibiotics for women who test positive to Group B Streptococcus. The scheduled drug that is considered essential for midwives attending births in the community is Syntocinon, a synthetic oxytocic, to be used postnatally to prevent or treat post partum haemorrhage.  Women obtain this drug, and sometimes a stronger oxytocic, Syntometrine, on a doctor's prescription, and their midwife takes responsibility for its administration.