our purpose

This statement of purpose has been drafted by the APMA committee, in discussion with members and supporters.

The (Draft) purpose of Australian Private Midwives' Association (APMA) is  
To represent and support midwives who practise privately in any setting

In functioning as the national body representing midwives who are in private practice, APMA seeks

• To respond to issues related to private practice midwives
• To present the needs of private practice midwives to the regulatory authority – eg to ensure that midwives’ peers are used as experts in investigations and hearings
• To lobby in the political sphere, in response to current issues
• To support and care for members in a non-judgemental way, with flexibility to respond to different people and situations
• To share information with members and the wider community

Note: Private midwifery practice encompasses the full scope of practice that is open to midwives registered in Australia, and is not limited to the setting of practice, such as homebirth, or funding for practice, such as Medicare-eligibility.

Your comments and discussion are welcome.

A new career pathway for midwives?

As more midwives take up the option of obtaining notation as Medicare-eligible, we are witnessing a series of changes in the career aspirations and practice choices that midwives make.
The ranks of the private branch of the midwifery profession have in the past year been swelled by a new group of midwives who have great hopes for a new career pathway. Many of these newly private midwives have come out of relatively senior positions in hospital employment, chosen a name for their new business, hung up a shingle (published a web page), and distributed pamphlets and business cards promoting their private midwifery care. There is new energy and enthusiasm as they spread the word that it’s a good idea for every woman to consider who will be attending her at the time when she labours and gives birth.

Judging by advertised courses and workshops, the new midwifery career pathway is a growth area for education providers and related services, including insurers.

 The newly self-employed midwife has plans to apply for clinical privileges in local hospitals when that option becomes a reality. In the mean-time, some have negotiated casual employment in hospital maternity units, so that they can provide personal labour and birth care for the women who have employed them privately in the antenatal period, and for whom they will provide private services postnatally.

The new private midwife may not use the title ‘independent’ - a problematic adjective in the world of politically correctness. The newcomer to the ranks of private practice is, in the world of new midwifery, a ‘team player’, who, in theory at least, acts in every situation within collaborative arrangements with the ‘team-leader’, the obstetrician, of course—not the woman!

The old-style ‘independent’ midwife, who has learnt autonomy and independence in practice and in decision-making from experience as the responsible primary maternity care provider for an individual woman, knows the value of working quietly and without fuss, in harmony with natural physiological processes, and enabling ordinary women to access their extraordinary strength and health in giving birth and caring for their babies.

APMA has received information from midwives who are at different places on the private practice spectrum: from those who have ceased midwifery practice since the maternity reforms were introduced; those who are under investigation by the regulatory authority; those who have invested their life savings into establishing and maintaining practices, rooms, and services; and those who work as solo midwife for births in homes that are scattered over vast distances. There is a big question mark over the future for private midwifery homebirth attendance, with the exemption from professional indemnity insurance for homebirth being limited to June 2013.

Although ‘new’ private midwives have invested time and money and a great deal of effort in achieving notation as Medicare-eligible, purchasing expensive indemnity insurance, and setting up their practices, with the hope of being able to provide expert continuity of care for women who give birth in hospitals where they (the midwives) have been awarded clinical privileges, there is little evidence in most of the country of progress on the part of hospitals—public or private— being eager to open up such options.

Maternity service provision must be based on the fact that professional care from a midwife is essential, not optional, for all pregnant women and their babies. When the current plan for maternity reform was being developed, midwives were told “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." (J Gillard 2005)

Joy Johnston

Thankyou for your comments.

too posh to push?

Apparently not, at least in sunny Queensland, where the statewide rate of caesarean births has soared to 34 percent of all births, and where private hospitals have the highest rate of caesarean section deliveries (47.9 percent) in Australia. [for the press release from University of Queensland Centre for Mothers and Babies, click here.]


Who is really responsible for the continuing increase in rates of caesarean births in this country?

• Are too many obstetricians greedy, seeing a surgical procedure as better $ return for their time? 
• Are too many obstetricians fearful of litigation, and thereby placing unrealistic risk-management boundaries on women in their care? 
• Are too many public and private hospital maternity units over-crowded, leading to pressure on staff to get babies delivered without what is seen as delay, but what may simply be giving the time that's needed? 
• Are too many midwives so de-skilled that they are unable to provide basic midwifery care, working in harmony with natural processes in labour? 
• Are too many women so trusting of professional care, so ignorant of their own natural ability in birth, that they allow interferences and interruptions in their pregnancies and labours, leading to the cascade of interventions? 

If you said 'yes' to all, go to the top of the class.

There's lots of information on the www about caesareans. For a summary of pros and cons that may assist women in making informed decisions about births after caesarean, you can download a .pdf file Maternity Coalition INFOSHEET.

and, btw
What do you think can be done to reduce the rates of unnecessary caesarean births?

Survey on prescribing courses for midwives

The following message has been forwarded by Liz Wilkes, a leader in APMA and Midwives Australia

Re: Prescribing courses for midwives

From 1 Nov 2010, Eligible Midwives are able to prescribe certain medicines under the PBS. One of the requirements to become an Eligible Midwife is the completion of a “program of study or equivalent — prescribing” meeting the requirements of the Nursing and Midwifery Board of Australia (NMBA).

The Department of Health and Ageing (DoHA) has asked NPS: Better choices, Better health to undertake a project to look at the feasibility of prescribing courses for midwives to prepare them for this additional role. As part of this project, we have designed the following survey to help us better understand the perspective and expectations of potential students of prescribing courses. Below is some information about the survey.

What is the purpose of the survey?
The purpose of this anonymous survey is to consult prospective students who may be thinking of undertaking a prescribing course to fulfil one of the requirements in becoming an Eligible Midwife. We encourage you to complete the survey if you are currently practising as a midwife, or you have a midwifery degree and you are planning to practice as a midwife. This information will be invaluable to the Department of Health and Ageing and NPS in considering how best to support and assist midwives and/or potential course providers in the future. The idea of a survey came from the project reference group comprising representatives from the NMBA, the Australian Council of Nursing and Midwifery, and the Australian College of Midwives, as well as representatives from groups with expertise in prescribing education and drug therapy education.

Why has the survey come to me?
We are seeking to understand the perspective and expectations of potential future students of prescribing courses. This is an emerging area of practice and it is important to gain as much information as possible to assist midwives and/or potential course providers.
The Australian Private Midwives Association has kindly agreed to assist us by sending the survey to its members.

Who should complete the survey?
We invite all currently practising midwives, or those with a midwifery degree who are planning to practice as a midwife to complete the survey. Feel free to pass on the survey to relevant colleagues. We ask that each person only completes the survey once.

How do I access the survey?
Please click on this link
(http://www.surveymonkey.com/s/nps_midwives_survey_students) and you will be taken to the survey directly.

What is the timeframe for completion?
The survey will take approximately 15 minutes to complete. The survey is open from now until 10 January 2011. We would appreciate it if the survey could be completed as soon as possible.

What will happen to the findings from the survey?
The data will be collated and analysed by NPS, and the findings will be reported to DoHA.

Who do I contact for further information?
If you would like further information, please contact Dr Michelle Koo, Manager, Educational Design and Support, NPS on 02 8217 8742 or via email at mkoo@nps.org.au.

Who is NPS: Better choices, Better health?
NPS is a not-for-profit organisation funded by the Australian Government of Department of Health and Ageing to enable better decisions about medicines and medical tests. For more information, visit www.nps.org.au

Thank you and kind regards,
Dr Michelle Koo
Manager
Educational Design and Support team
Innovation and Learning

Collaboration for homebirth with a General Practitioner

A well known Melbourne GP, Peter Lucas, has attended homebirths with midwives for many years.

An excerpt from his website:

“For some 35 years Dr Peter Lucas and Wattle Park House has offered collaborative care with home birth families and the midwives they have chosen to assist them with their experiences.
"This will continue but assumes that the Wattle Park House medical practitioner attends the birth.
"Until midwives obtain full indemnity cover which includes the labour and delivery, collaboration at a distance is fraught with uncertainty in a medico-legal sense, and cannot be seriously entertained.”

Midwives are concerned that although this doctor is willing to enter what has been called a "collaborative" arrangement with a midwife, he (or his insurance company) are setting conditions on his collaboration and transferring the primary carer role from the midwife to himself. If midwives were to enter into agreements with Peter, they would no longer be the primary carer for their own clients. The arrangement negates the notion of continuity of care from the midwife who practises on her own authority, and renders useless the process of applying for Medicare/PBS eligibility for these women for their antenatal care, as the doctor will be providing that.