I know there were going to be no more posts until my new blog was live but computer geeks are so slow, deadlines are things to be missed by them while they look doey eyed at you and say “we don’t want it go to live and get lots of problems where we will have to take it down”

To the quality and safety framework and the eligibility criteria.

These papers are confidential and not for the public eye, yet have been out for private consultation with whoever the government wanted to give them to. Important people, highly regarded by the government but unconnected with the ground troops so as not to stir up a hornet’s nest.

Eligibility

Its not compulsory to be eligible and the rules are made so that hardly anyone will be eligable. The government has never had any intention of paying for homebirth, how better than to make the rules impossible to follow? This was supposed to fox us as I am sure the government’s insurance policy will say we have to be eligible midwives to get it, effectively making registration impossible. However there are insurance companies happy to offer us insurance, this will mean we can bypass these impossible hurdles and move closer to the “go square”.

So a midwife has to demonstrate the following to be eligible:

1. Current practicing certificate.
   • This is going to be possible as we can access outside insurance that we need to get on the register (if we can meet the QSF for an exemption)
2. Practice for 3 years within the last 5 throughout the scope of midwifery.
   • To prove this they suggest that 30-40 clients a year is considered a reasonable measure of this. WTF? So you can’t be a homebirth midwife unless you have been qualified for 3 years and worked full time in the hospital and then you get a 30 to 40 case a year practice. This alone would make you be fairly sure they don’t want many people jumping this high!!!
3. Mid practice review. This is a whole post by itself that makes me so sick I won’t mention it today.
4. Continuing professional development.
   • This is of course really important apart from the fact they want an extra 20 hours (over general registration requirements) across the spectrum of midwifery to qualify and they have kindly laid out the areas (which coincidentaly make up a good hospital practice). Clinical assessment, monitoring, strategies for diagnostics and of course the consultation and referral. There is more but you get the picture.
5. Collaboration.
   • The stepping stone to which they thought the would totally stamp us out.
   • A collaborative agreement (which we all know is almost impossible).
   • So the standard is, The midwife will comply with the requirements.
   • The evidence will be a stat Dec signed by the midwife and held at the board.

   This my dear colleagues and friends is a “signed collaborative agreement”. The one they promised we wouldn’t have, the wording of which we have all begged to be changed. We have argued and pleaded with our leaders to say NO to it in every way, to stand up for midwives and for women. There it is, reformed but legally binding.

6. The education about pbs mbs.
   • There is a grandfather clause. If we are eligible but don’t have the education, we can be seen as eligible as long as we undertake further education within 18months. However, this isn’t really a grandfather clause, we are not going to be recognised for our expertise. If after a given time we haven’t jumped through the hoops we will be banished forever.

On a positive note, We don’t have to be eligible to get on the register, just follow the frame work and get our own insurance.

Quality and Safety Framework.

At the beginning of the document it says we have to comply with the whole framework but these are the minimum requirements. (Like every other government document the blurb is massive and depressing)

1. Current practicing certificate.
   • Having a documented plan for meeting the professional standards, competencies and continuing professional development requirements including resus and multidisciplinary maternity care programmes.
     • I hope this doesn’t mean working in the hospital, as a multidisciplinary care programme is just that. also the word doesn’t instill confidence Multidisciplinary sounds like torture to me.!!
2. Having a documented plan and strategies to engage in collaborative care with relevant maternity care professionals when required for situations articulated in the ACM consultation and referral guidelines.
   • This seems to be a strategy for a signed agreement to me. Throughout both documents the ACM referral guidelines are pushed as if they are not negotiable.
3. Maintaining clinical notes for reflective practice and share with other health professionals.
   • WTF. A woman can’t even get her own hospital notes without going through freedom of information act, yet they want to have access to the woman’s note with no question. THAT IS DISGUSTING.
4. Maintaining a record of advice about referral or transfer recommendations made by the midwife in the course of commencing or providing care.

The last few points are getting midwives to do mid practice review and having to join into a peer review and hospital review at the drop of a hat.

There is also a point about supervisor of midwives. I won’t go into detail until the actual paper comes out as I’m sure it’s not doable and would be pretty positive that even the upper midwifery groups would want it removed. If it’s not removed it’s a point of high discussion next week.

So to round up. The reading of the whole document suggests that midwives have to cover their arses and have no choice but to follow the referral guidelines. If they don’t, because a woman wants total confidentiality, then look out.

I can understand midwives wanting to see the positives in here and hope that when these documents finally get to us we can make them work somehow.

I think they are wrong. I think this is not workable for women in any way and not workable for midwives. All along we should have said NO it’s not right, we don’t need more monitoring. Women should be able to chose anyone or no one as she believes is best for her. We will fight to the end for the rights of women.

If was was suggested the government inadvertently forgot homebirth. WHY ON EARTH would they do this to us?

Who will be able to support women in their choice to homebirth with a registered midwife if she has a VBAC after 2 sections, it’s her 5th baby, it’s breech and she doesn’t want to go to the hospital because they will immediately section her? The answer? NOBODY.

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Related posts:

1. Quality and Safety Framework
2. Draft guide to eligibility
3. Collaboration and the midwife
4. Collaboration or exclusion
5. The Final Cut