Update on Agnes Gereb

This report is from Donal Kerry
International Spokesperson
Campaign for Justice for Ágnes Gereb


The story of Dr. Geréb is one that has been played out in the Hungarian criminal courts for the last two years. On December 6th a further phase commences, when she will face a new set of five charges before one of the criminal courts in Budapest.

As you are probably aware Ágnes has been detained without trial since a birth incident of Oct 5th, 2010 (prison, 77days; house arrest, 710 days and counting!). In February this year she was sentenced to two years imprisonment connected to birth incidents occurring in 2006 and 2007. However, the enforcement of this sentence is still pending as the President of Hungary ruled on October, 10th (see his translated statement at http://www.szuleteshaz.hu/en/press-releases-of-the-clemency/) that Ágnes's request for clemency in this matter will not be decided upon by him until the December, 6th trial charges have reached a conclusion in the courts. This upcoming trial will deal with the birth incident of Oct, 5th, 2010, two further birth incidents and also two "administrative" matters.

The Campaign for Justice for Dr. Geréb would very much welcome your involvement and coverage of this new trial as it continues to raise issues around the situation of Ágnes which we consider important for her but also for the rights she is fighting for:

• her own human rights, 
• the rights of Hungarian birthing mothers, and 
• the rights of midwives in Hungary to be dealt in an equitable way with Hungarian hospital doctors with regard to their treatment when involved in adverse birth incidents. 

On December 6th it's her own rights which will first and foremost come under further intense pressure as she continues to deal with:

• concerns that conditions are not in place to offer her a real chance of a fair trial
• the fact that she should not be before the criminal courts, and like in other EU countries should have her actions assessed by a Midwifery Investigation Committee
• that despite or because of being Hungary's foremost defender of women's rights she has received uniquely aggressive treatment from the State Prosecution Service as exampled by the further fact that she has the full public support of the 3 mothers in the birth cases coming before the court and the 200 parents cited by the prosecutor in the 4th case. 

President Áder in his statement of October 10th acknowledged Ágnes's role in helping birthing mothers and home birth itself. This was an important positive comment for Ágnes coming from the highest office holder in the land but it needs to be built upon by receiving the backing of the Hungarian government as well. The President also highlighted the important place of justice and lawfulness in Hungary and to echo this vital point Dr. Geréb supporters both at home and abroad will be calling on the Hungarian government, through the Minister for Justice to review her case and also to closely monitoring her upcoming trial.

We know from our feedback that Ági's story has captured the attention of women everywhere and also of the many interested in human rights. If readers are in a position to move further on this story please let me know and I can provide u with more information on the 5 cases involved and I know Ágnes would be available to reply to written questions that u might wish to put to her.
Yours sincerely,
Donal Kerry
International Spokesperson
Campaign for Justice for Ágnes Gereb
mobile 0036309242190
email: donalkerry@hotmail.com

This message was received through Beverley Beech of AIMS UK.

Review of the ACM Guidelines

The College (ACM) has announced a review of the ACM National Midwifery Guidelines for Consultation and Referral (2nd Edition) (2008)
If you do not have a copy, you can download a .pfd version here.

Readers who are members of ACM will have received a message about this review.

The review questions are:

• Do you have any corrections or changes to be considered for the next edition? 
• Do you have any additions that should be considered? 
• Do you use appendix A? 
• Does appendix A work or how does it need changing? 

The guidelines are meant for all midwives, so even if you aren’t a member of ACM, please put your mind to these questions.
The APMA response will address the questions with private midwifery practice in mind.  Private midwifery practice has changed significantly since 2008, when the current version was published, for example:

• All midwives who practise privately are required to have professional indemnity insurance
• An exemption from the indemnity insurance requirement is in place until June 2013, and is expected to be extended to 2015, for midwives attending homebirths privately
• Many midwives are now able to offer Medicare rebates for a range of antenatal and postnatal midwifery services.  
• A few midwives are offering Medicare rebates for intrapartum midwifery services in hospitals where they have clinical privileges/visiting access.
• A few midwives have endorsement on the public register as PBS prescribers

"Endorsed as qualified to prescribe schedule 2, 3, 4 and 8 medicines required for midwifery practice across pregnancy, labour, birth and postnatal care, in accordance with relevant State and Territory legislation"(AHPRA)

• Many midwives are enrolled in university studies that will lead to endorsement as prescribers.

Readers are welcome to make comments in relation to this review, either directly to ACM, or via APMA.

Communique from Health Ministers

Standing Council on Health

COMMUNIQUÉ

10 August 2012

Australian Health Ministers met in Sydney today for a meeting of the Standing Council on Health (SCoH).  The meeting was chaired by Dr Kim Hames, WA Minister for Health.

Professional Indemnity Insurance for Privately Practising Midwives.

Ministers agreed to an extension of the professional indemnity insurance exemption for privately practising midwives until June 2015.  This will mean that privately practising midwives will continue to be covered by the national registration and accreditation arrangements.

The Commonwealth agreed to vary the determination on collaborative arrangements to enable agreements between midwives and hospital and health services.

Ministers agreed that WA would develop a paper on longer term arrangements and that this would be presented at the November meeting of Ministers.

Media contact: Peta Rule, 0428 923 661 (Dr Kim Hames Office)

[This message has been copied from the SCoH Communique.] 

 

taking midwifery to the mothers

A blog announcement by Toowoomba's My Midwives

... we are commencing a midwifery service at Grand Central.  My Midwives will be in the Level 2 Parents Room every Wednesday morning between 9.30am – 12.30pm. Our accredited midwifery staff will provide a range of services including antenatal information and advice, blood pressure checks, education for women and comprehensive post birth checks for mother and baby up to six weeks after birth. These services are available as Medicare bulk billed visits. [Note: You must be pregnant or have a baby no more than six weeks old and hold a current Medicare card to receive a bulk billed service.]

That sounds like a great idea!

Congratulations, My Midwives.

NEWSLETTER August 2012

Midwife or support person? 
Joy Johnston

An opinion, for discussion.

When a midwife walks into a hospital with a woman for whom she is providing private midwifery services, that midwife may face a complex and often challenging work environment.

Recently I went to hospital with a woman who I will call Melissa, who was planning vaginal birth after a previous caesarean (VBAC). Melissa's first child had been delivered by emergency caesarean. This time Melissa was well informed, and intentional about all her decisions. Melissa called me when her labour became established, and I went with her as she was admitted to the hospital birth suite. Melissa laboured strongly, and together we considered any decisions that needed to be made.

There is nothing remarkable about this little account. However, the matter that has prompted me to write about hospitals and independent midwives is the question of what to call a midwife who goes to hospital with a woman in her care.

I call that midwife a midwife.

Others call that midwife a 'support person', or a 'birth support person', or even 'only support'!

Why?

Because the independent midwife does not have visiting access/ clinical privileges/ credentialling in that hospital.

This is true - maternity hospitals around the country have dragged their feet on this matter. Despite government-supported indemnity insurance for private midwives providing intrapartum care in hospital, there is no likelihood for most midwives of hospital visiting access in the near future.

So the question is, does a midwife cease to be a midwife, just because the hospital refuses to recognise her professionally? Of course not! A midwife is 'with woman': not with a setting for birth. The midwife's registration is with the regulatory body, which is not under the management of the hospital. And, let's remember that if a midwife acted in a way that was considered unprofessional, she or he would expect to be reported to the regulatory authority as a midwife, not as a 'support person'.

The ICM definition of the Midwife declares that the midwife's Scope of Practice is:

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures. 

'Support' is listed in the definition as one of the elements of midwifery. I do not want to seem to devalue support. But the point I want to make is that support is a part of the midwife's scope of practice: not an alternative to midwifery practice, and definitely not an alternative to the title 'midwife'.

 Research: Caseload midwifery 
Midwifery academics from LaTrobe University in Melbourne have published results of the COSMOS trial, which has been undertaken at the Women’s Hospital with funding from National Health and Medical Research Council (NHMRC). The paper, Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial has been published in BJOG, a prestigious international journal of obstetrics and gynaecology, by Helen McLachlan, Della Forster, Mary-Ann Davey, and others.

The research demonstrated that, besides having fewer caesareans, women allocated to 'caseload' arm of the trial were more likely to have a spontaneous vaginal birth, less likely to have epidural or episiotomy, and their babies were less likely to be taken to the special care nursery than those who received standard care. In the highly formal language of academia, the authors have boldly come to the conclusion that the midwives with caseloads "can make a difference by reducing the caesarean section rate."

Midwives and maternity services must be challenged to apply the evidence to practice. The usual practise of midwifery should be in a caseload model, enabling midwives to work autonomously in their scope of practice to promote, protect and support physiological processes in birth whenever possible ('Plan A'). Not as shiftworker nurses who work as assistants to obstetricians in hospitals. Only when midwives are willing to take action on evidence will we see improvements in birth outcomes: healthier mothers and babies.


Invitation to midwives to join APMA 
Membership is open to all current private midwives, midwives with previous experience in private midwifery who wish to remain informed, and midwifery students who wish to enter private practice after completion of their studies. www.privatemidwives.com.au/#!membership
Membership fees 
full membership $80
student or non-earning members $40.

Yahoo! Groups – members who would like to join one o0r both of our ‘groups’: ‘privatemidwives’, and ‘apma_medicare’, please contact joy@aitex.com.au

Marg Phelan: Go Girl!

Marg Phelan is an amazing, inspirational midwife, who has just completed an epic bicycle ride around Australia.  Marg set out from her home in Darwin NT in May 2010, cycled 20,000 kilometers, and arrived back in Darwin last week.

Go Girl! website
Find Marg on Facebook

for more pix, and the whole story, go to http://gogirlaustralia.net.au/

Congratulations Marg, and all you team. We admire your courage and tenacity, and we are inspired by your efforts to promote midwifery and raise funds for the ACM Scholarship Fund, "The Rodanthe Lipsette Trust" to support Aboriginal and Torres Strait Islander women to become midwives.

From the committee and members of APMA.