The Australian college of midwifery guidelines have been out for comment after updates (they closed today). The South Australian branch along with lots of others, put in a great submission for update. Nothing however has changed. The guidelines are so full of anti-midwifery propaganda that it’s hard to support the college at all. (I am at the moment vice president of SA branch, a lot of good that did).
In the initial part of the guidelines they struggle to try and say the obvious. Midwives are and should be the primary carer for a pregnant/birthing/nursing mother. All collaboration should keep the woman at the heart and protect her right to birth as she pleases.
This is where they start to fall.
CONSULT
4.2. 7. After consultation with a medical practitioner, it should be clear whether primary care and responsibility:
a) continues with the midwife, or
b) is referred to the medical practitioner*.4.2. 8.
The midwife maintains overall responsibility within her scope of practice collaboration with the medical practitioner * and remains responsible for, a discrete area of the woman’s care.
How contradictory can you be? Can you imagine any Obstetrician who has had an official consult in the public unit agreeing to leave primary care and responsibility to the midwife? If They can use it against us they will.
4.2.8 Could however see us through when they throw the rest of the crap in there at us. A discrete area of care. I wonder what that is? I’m sure it is what I do though.
REFERRAL
4.3.1. When primary care is referred, permanently or temporarily, from the midwife to another health service provider*, that professional in consultation with the woman assumes full responsibility for subsequent decision-making. 4.3.2. When primary care is referred to a medical practitioner, the midwife may continue to provide midwifery care within her scope of practice, in collaboration with the medical practitioner.
4.3.3. Areas of discussion and involvement must be agreed upon and clearly documented.
I would never refer a client permanently from my care. I don’t think they have thought through midwives in private practice when discussing these guidelines.
The above comments are the best of the guidelines. Our greatest opportunity when presented with the rest, to support our clients decisions. The system are using these guides against our practice. Are we better off not being members?
These are the rest of the new guidelines and can be found on the Australian college of midwives site. They are the standard compliance regulations that can be wheeled out of any policy/procedure and guideline file. Breech, twins, VBAC, over 100kg, diabetes and all other ailments need referral. I’m happy with collaboration but their idea of the woman getting referred, a new primary carer and a steam roller hospital birth is not my idea of protection and support of the woman centred philosophy of care.
I don’t understand why we need these. Hospital midwives have enough rules as it is and there are no guides in there for Independent midwives to use to support their practice. Maybe they are made for the middle ground. The wannabe midwives who are in group practice and are looking for that extra guideline before they step over the protocol. I’m glad they have their official nod.
As ever the real midwives are left standing in the rain with a white cotton t-shirt on!
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Thank you for discussing this. I am particularly stunned by the assumption that “that professional … assumes full responsibility for subsequent decision-making”. I am sad that they would think (even with “consultation with the woman”) that a professional should assume full responsibility for decision making about a woman’s birthing experience. Shouldn’t the woman be the one in control of the decision-making no matter who the primary carer is? Thanks again for presenting this information.
Why do we need to be “referred”??? Aren’t we capable of making our own decisions……. when I was booked into the hospital I asked the OB I was under about a homebirth and he told me how dangerous it was and that he wouldn’t recommend it – so he wasn’t going to refer me to a midwife at all. I was smart enough to ignore him completely but unfortuneately there are a lot of women who would feel they’d have to stick with him! I can see how you get so frustrated Lisa!
I’ve also nominated you for an award, check my blog for details!