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.

Radical Midwifery in Holland

Rebekka Visser is a Dutch midwife who gave a presentation on 'Birth: a Human Rights issue?' at the Human Rights in Childbirth conference, convened a few weeks ago in The Hague.

Rebekka has posted the content of her presentation on Responsible Care (in English) at her blog.

It's worth a read! Rebekka explores why midwives seek to control birth.

Now should this mean that to my opinion all midwives must be willing to assist breech births at home? Or that all women must be willing to have their breech baby at home? 
Definitely not!
We need to open the dialogue about our own fears, work with it, finding solutions.

This conference brought together midwives, ethicists, lawyers, obstetricians, mothers, and others for two days, to consider and debate human rights in childbirth.  The event which drove the conference was the imprisonment of midwife Agnes Gereb, from Hungary, a signatory to the European Convention on Human Rights.  Agnes was not present at the conference: she is under house arrest.

Australian midwifery is going through huge changes, and many midwives fear the escalation of authoritarian control over midwifery, and consequently, over women's rights in childbearing.

Regulation of midwifery can only be in the public interest when the system also promotes and protects the midwife's scope of practice professionally.  It's a balance that our society must continue to work towards.

Scholarships for prescribing course

Midwives can now apply for scholarships to undertake the Graduate certificate in Midwifery at Flinders University, 
Application is online at the RCNA website.

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

Newsletter June 2012

APMA is working to represent and advocate for private practice midwives at federal and state/territory levels, and provide support and encouragement for our members.

Private midwifery today 
Midwives have experienced enormous changes in the past few years, and no-where more so than for those who practise privately, with national regulation and the government’s reform package.

The National Maternity Services Plan, an outcome of the Maternity Services Review (2008), was endorsed by the Australian Health Ministers’ Conference in November 2010. This Plan provided governments with a strategic national framework to guide policy and program development.

One focus of the reform package is private midwifery practice, extending options of primary maternity care for women who expect to be able to give birth in the care of a midwife – often referred to as 'low risk', or 'normal risk' women.

We are seeing trends in private midwifery, as more midwives access notation for Medicare eligibility. Midwives joining APMA today are less likely than in previous years to be working in the private homebirth scene.

Highlighting a few points of interest

• Prescribing course: 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 eligible midwives, once their study is completed, to obtain an endorsement to prescribe scheduled medicines. The accredited program is within a Graduate Certificate in Midwifery at Flinders University (South Australia).  See previous post.
• Attempts by midwives to achieve admitting rights in hospitals have been met with little encouragement, and a great deal of discouragement. 
• Midwives who have achieved Medicare eligibility and set up private practices, with the intention of attending women for birth in hospital, express great concern over the obstructions and restriction of trade that they face in practising their profession. Perhaps an unintended outcome of the reform process will be increased numbers of private homebirths and increased numbers of midwives upskilling to private homebirth practice! 
• The College of Midwives (ACM) is setting up a private practice committee, to advise its governing Board on private practice matters. APMA expects to receive an invitation to nominate a representative for that committee. 
• Private practice and homebirth have in the past often been referred to interchangeably. This is no longer the case, and APMA is clear that we represent private practice midwives. 
• The need for regulation of midwives by midwives (ie a Midwives Board) is obvious.

Professional Indemnity Insurance 
APMA and other midwifery organisations (including ACM, Midwives Australia) have met with representatives of the Department of Health and Ageing, and insurance group MIGA.

APMA’s position is that we consider the current available options for professional indemnity (PII) to be inadequate for midwives, and therefore not in the public interest, with the potential that midwives will be prevented from lawfully practising midwifery because they are unable to obtain suitable insurance. This is unacceptable.

We have been told that the lack of PII cover for intrapartum care has already led to some midwives not renewing their registration and working as unregulated birth attendants.

Issues include the indemnity cover for

• a midwife who is called at short notice to work as locum for another midwife 
• the midwife who attends a homebirth as second midwife 
• cost and sustainability, especially in setting up 
• a midwife joining a group practice 
• students and mentoring of midwives entering private practice 

APMA strongly recommends the introduction of a no-fault compensation scheme to replace or reduce the impact of mandatory PII requirement for midwives. The statutory regulation of midwives should be the point of entry into the midwifery profession, not the availability or affordability of indemnity insurance.

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 that wish to enter private practice after completion of their studies.
If you wish to become a member, please email details of your private midwifery experience/aspirations. Membership fees Renewal of membership is now due:
• full membership $80
• student or non-earning members $40.

NETWORKS

click to enlarge

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.