Midwifery: Midwifery: ways we can workways we can work

Dr Belinda MaierDr Belinda Maier

Maier.Belinda@yahoo.com.auMaier.Belinda@yahoo.com.au

internationallyinternationally

Midwife• A midwife is a person who, having been regularly admitted to a midwifery

educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.

• 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.

• The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.

• A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

• Ado p te d by the Inte rna tio na l Co nfe d e ra tio n o f Midwive s Co unc il m e e ting , 1 9 th July , 2 0 0 5 , Bris ba ne , Aus tra lia Sup e rs e d e s the ICM “De finitio n o f the Midwife ” 1 9 7 2 a nd its a m e ndm e nts o f 1 9 9 0

Australia 2010…..Australia 2010…..

Eligible MidwifeEligible Midwife• What is an ‘eligible’ midwife?• An eligible midwife is a midwife who meets further professional criteria that enables them to work

in private practice and may obtain a provider number. By having a provider number their private clients may access Medical Benefits Scheme and Pharmaceutical Benefits Scheme.

• This is legislated under section 38 (2) of the National Law.• How do I gain registration as an ‘eligible’ midwife?• The standards are documented on the Nursing & Midwifery Board of Australia website, available

at:• www.nursingmidiwferyboard.gov.au.• Summary of Requirements for Eligibility:• A current general registration as a midwife in Australia with no restrictions on practice• Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as

a midwife• Current competencies to provide pregnancy,labour, birth and post natal care to women and their

infants• Successful completion of an approved professional practice review program for midwives working

across the continuum of midwifery care• 20 additional hours per year of continuing professional development relating to the continuum of

midwifery care• Formal undertaking to complete, within 18 months of recognition as an eligible midwife, or the

successful completion of recognised prescribing course.

• Expanding women's access to Medicare relatable midwifery services

National attention to what National attention to what women want?women want?

• National Maternity Services Review – Commonwealth government response

National Maternity Services PlanNational Maternity Services Plan

•Five year vision• Maternity care will be woman-centred, reflecting the needs of

each woman within a safe and sustainable quality system. All Australian women will have access to high-quality, evidence-based, culturally competent maternity care in a range of settings close to where they live. Provision of such maternity care will contribute to closing the gap between the health outcomes of Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Appropriately trained and qualified maternity health professionals will be available to provide continuous maternity care to all women.

National ReformNational Reform

• Scope of practice• Professional identify• Private practice• Access for your clients to have MBS/PBS

rebates• Models of care – High risk, low risk, all risk• Woman centered

• So is a midwife a midwife or is there better midwives than others?

• If I work in homebirth today, shift work model tomorrow, birth centre the next, public model or private model; has my midwife self been compromised? Am I having differing values depending on where I work and how does that fit with our philosophy of midwifery – our woman centeredness?

What are the options and what What are the options and what shapes how maternity care is shapes how maternity care is

provided to women in Australia? provided to women in Australia?

Why do Australian women have different options to New Zealand women or Dutch women or Italian women…? •Political imperatives•Patriarchal medical dominance•History•Culture•Assumption of equity –

– Aboriginal and Torres Strait Islander women and babies– Rural and remote women

•

Employment as a midwifeEmployment as a midwife

• Public• Private• Self employed• Hybrids of all of the above• What else….?

My pathway into and through My pathway into and through midwifery 1989 – 2013……midwifery 1989 – 2013……

• Personal experience of birth and breastfeeding first• Hospital trained post nursing• Lactation consultant • Agency• Homebirth • Birth centre• Honours then PhD• South Australian Department of Health – Aboriginal and Torres Strait

Islander antenatal guidelines• Research • MGP• Midwifery Advisor QLD• Project Manager MyMidwives

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• My daughters will……

• Expect their dignity will remain intact regardless of where when how or with whom they give birth

• http://www.youtube.com/watch?feature=player_embedded&v=K105F9o3HtU

Hollywoodisation of birth – less Hollywoodisation of birth – less of this of this

More of this….More of this….

So what attracts you, what So what attracts you, what stimulates your passion for stimulates your passion for

being a midwife?being a midwife?

"The personal is political" "The personal is political"

• Are we living in an enlightened and equal society?

• Risk has become the norm even normal is only normal because there is as yet an absence of risk!!!!!

RiskRisk• Everything or nothing

• Why is it ok to assume medicine or midwifery can determine what is good or bad for women?

• When did it become ok to take women out of their personal context and frame everything for them in a medical context

Risk in contextRisk in context

• Amniocentesis versus VBAC

• Children drowning versus relocation for birth

Fundamentally why is it even ok for Fundamentally why is it even ok for anyone to decide anything for anyone to decide anything for

women?women?• Water birth• Pain relief• Homebirth• Cesarean section• Sex???????

• • The challenge now is to practice The challenge now is to practice politics as the art of making what politics as the art of making what

appears to be impossible, possible.appears to be impossible, possible.Hilary RodhamHilary Rodham

Ways midwives work for women Ways midwives work for women and midwivesand midwives

• Advocacy• Lobbying• Government• Research

futurefuture

• Greater access to visiting rights, indemnity insurance, credentialing…

• Negotiated contracts….• More public models…• More rural and remote models that utilise

midwives to full scope of practice….• Rural/remote midwives with maternal child

health, sexual health and immunisation qualifications….