Saturday, June 9, 2012

Private midwifery in the spotlight

Written by Joy Johnston, APMA Acting President

The release of the South Australia Coroner's report into the deaths of three babies in the care of a privately practising midwife has rightly led to a time of sombre reflection for the midwifery profession.

While APMA respects the statutory duties of the Coroner and other regulatory processes that exist in our society in the public interest, I would like to take this opportunity to reiterate principles of basic midwifery practice that can be applied to this and other similar cases.

The APMA position statement on planned homebirth with a midwife, which appears in the right column of this site, provides guidance on the consensus in the Australian private midwifery sector:

APMA supports home birth with a midwife in attendance for women who have uncomplicated labours.   
There are debates as to whether a labour with twins or breech presentation or a mother who has had previous caesarean surgery are uncomplicated.  The spontaneous onset of labour is essential for physiological progress in birth, and is the entry point to planned homebirth. 

We support and adopt the International Confederation of Midwives’ (ICM) Definition of the Midwife (2011), which is foundational to all midwifery practice, including homebirth. 
Home is a setting in which a midwife is able to work.  Home is the place where normal labour usually becomes established.

We support the right of every woman to access a midwife as the primary maternity caregiver who works in partnership with the woman throughout the episode of care, who is able to be the responsible professional in attendance at the birth either at home or hospital, and who is able to make appropriate referral and transfer of care when required. 
The need for seamless access to specialist services is fundamental to all responsible maternity care.

We support the right of a midwife to practise privately in a fee-for-service or funded relationship with the client, or to take up employment. 

We support only those regulatory restrictions that are able to pass the ‘public interest’ test: “How does this promote health and wellbeing in the mother and baby?” 
Regulation of any profession should not be excessively restrictive.  There is no public interest in driving homebirth underground!  
We support an expectation of equity, including equal pay for equal work throughout a midwife’s scope of practice. Midwives who provide primary maternity care are entitled to the same public funding, the same opportunity to charge a fee-for-service, the same access to hospital referral, and publicly supported indemnity insurance, as medical practitioners providing the same maternity services. 
And we look forward to that day!

We support processes by which midwives are able to gain experience and mentoring in order to commence and demonstrate competence in homebirth practice. 

We support seamless and reliable processes by which midwives are able to make hospital bookings for women planning homebirth, and arrange transfer to the hospital in a timely way when needed.

Those who have read the Coroner's report, as well as commentary on the matter (a few listed below) will appreciate the complexity of the issues.  The Australian maternity community must listen to the voice of women who say they feel traumatised.  We must also advocate for the interests of the innocent child(ren) in each maternity situation.  Choice and freedom are only parts of the decision-making process.

Croakey (the Crikey health blog) by midwife Hannah Dahlen, 8 June, 2012
Australian College of Midwives Media Release 6 June, 2012
Homebirth Australia Media Release 7 June 2012

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