- It has been a busy week in midwifery as we step into the last days before the 1st July national registration. chaos is all around us and the once united front of midwives now scrabble to meet impossible requirements while the MC claim a victory.
This is a quote from their latest press release.
“Professional indemnity insurance for midwives will start to make it possible for women to choose their own community-based midwife for antenatal, birth and postnatal care, as women in other countries already can,”
I would really LOVE to know how on earth they think this statement could possibly be true.
Here is another great work of fiction contained within a repy from HBA to a recent article.
We have a responsibility to provide them with a registered midwife. Nicola Roxon’s legal background has served her well. She understands Australia’s responsibilities to international conventions such as the Convention of the Elimination Against all forms of Discrimination and case law that has established the rights of adults to determine how or not their body is treated.
SO what is really happening….. The government finally added the small print to the insurance, try and stay with me on this even though it is a little tedious. We have to be in collaboration and this is what collaboration will look like according to the insurance company.
Collaborative Arrangement
A Collaborative Arrangement must provide for:
- consultation between You and an Obstetric Specified Medical Practitioner;
- referral of a patient to a Specified Medical Practitioner; and
- transfer of a patient’s care to an Obstetric Specified Medical Practitioner.
A Collaborative Arrangement means one of the following types of arrangements:
a) a patient is referred in writing to You for Midwifery Services by a Specified Medical Practitioner;
or
b) an arrangement in writing between You and one or more Specified Medical Practitioners which
provides for consultation between you and the Medical Practitioner(s), referral of patients to the
Medical Practitioner(s), transfer of a patient’s care to the Medical Practitioner(s) and which is signed
by you and the Medical Practitioner(s);
or
c) You have met each of the following requirements for each patient:
Stay with me on this everyone.
- You have recorded the name of the Specified Medical Practitioner who is (or will be) collaborating with You in Your written records;
- You have told the patient that You will be collaborating with a Specified Medical Practitioner and recorded this in Your written records;
- You have an acknowledgement by the named Medical Practitioner that they will be collaborating with You in the patient’s care and You have recorded this in Your written records (this acknowledgement may apply to more than one patient);
- You have recorded in Your written records plans for the circumstances in which You will
consult with an Obstetric Specified Medical Practitioner; refer the patient to a Specified Medical
Practitioner; transfer the patient’s care to an Obstetric Specified Medical Practitioner; - - You have recorded any consultation or other communication between You and an ObstetricSpecified Medical Practitioner about the patient’s care in Your written records;
- - You have recorded any referral of the patient by You to a Specified Medical Practitioner in Your written records;
- - You have recorded any transfer by You of the patient’s care to an Obstetric Specified Medical practitioner in Your written records;
- - when You give a copy of the hospital booking letter (however described) for the patient to a named Medical Practitioner, You have recorded the acknowledgement that the named MedicalPractitioner has received a copy of the hospital booking letter in Your written records;
- - when You give a copy of the patient’s maternity care plan prepared by You to a named Medical Practitioner, You have recorded in Your written records the acknowledgement that the named Medical Practitioner has received the copy of the maternity care plan;
- - if You request diagnostic imaging or pathology services for the patient, You have recorded when you give the results of those services to a named Medical Practitioner in Your written records; and
- - You have given a discharge summary (however described) at the end of Your care for a patient to the named Medical Practitioner and the patient’s usual general practitioner and recorded this in Your written records.
Could they mention Medical Practitioner a bit more often?
In words of one syllable: as a midwife you have to have a signed agreement. As a woman you don’t have to agree to see an Ob but your midwife will be discussing you with one and making copious amounts of notes. It also looks like you would need a referral for your care. (I’m hoping I have misunderstood this)
Here is one of the more entertaining get out clauses held within the document.
1.10
Reasonable prospects of success Medical Insurance Australia may, at its absolute discretion, elect not to indemnify You for the whole or part of the Expenses if the Expenses relate to a matter that may give rise to an entitlement to indemnity under Division 1 Section 2 and which Medical Insurance Australia believes You are more likely than not to be unsuccessful in defending.
Lets hope if there is a problem you are pretty sure of winning or there will be no indemnity.
AND the piece de resistance of the document
3.13
Review of Midwifery Services Medical Insurance Australia may undertake a review of Your Midwifery Services on 21 days’ prior written notice to You, in which event You agree:
I kid you not – they have the right to investigate your midwifery service. It sounds more like the NMBA than they do.
Still reading? So how do the medics see this going?
This is what they think.
TOP-level meetings to draw up consensus referral guidelines between
midwives and obstetricians have broken down, after obstetricians
objected to the involvement of members of a pro-homebirths group.For weeks the NHMRC has been trying to organise a meeting between
the Royal Australian and New Zealand College of Obstetricians and
Gynaecologists and the Australian College of Midwives, to come to an
agreement on referral guidelines.Pressure is mounting to reach an agreement before November, when
midwives will be able to access the MBS, provided they work
“collaboratively” with doctors.But controversy has erupted over the NHMRC’s decision to invite three
community representatives to the meeting, including Ann Catchlove,
president of the Victorian branch of the Maternity Coalition, which
supports homebirths, and another of the group’s former members.RANZCOG has refused to attend the meeting while these
representatives remain invited.Dr Rupert Sherwood, the college’s president-elect, said the choice of
community representatives was biased “to the point of being
ridiculous”, adding the Maternity Coalition were “not really friends of
obstetricians”.If consensus guidelines were not completed before November, Dr
Sherwood said the college would be advising obstetricians not to enter into
collaborative care arrangements unless they were based on the
RANZCOG referral guidelines.A spokeswoman for the NHMRC confirmed it had invited the current
and former members of the Maternity Coalition to take part in the meeting,
saying it was “imperative that women have a say in the way their maternity
professionals communicate in their care”Sarah Colyer
So to all you pregnant women out there, wanting one of the new midwives provided by this reform.
GOOD LUCK
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So I said to Hubby..” Well, looks like we’ll have to go back to India to have our next baby”, and then the reality of that statement kicks in… I have to chose to birth in a third-world country overseas, instead of at home in Australia!! SERIOUSLY FRICKIN WRONG!
Ah, remember the innocent days when we were told that we independent midwives were standing together and had a line in the sand? Seems so long ago….
Lisa, what’s the rest of 3.13 …. in which event You agree: What?
It’s impossible, isn’t it? Feeling really disheartened.
OMFG.
In the words of Ringo Starr, “Everything the government touches turns to crap.” (and I’m a socialist at heart, but seriously? They need to leave birthing women ALONE, among other things)
There seems to be one major thing missing, the most important, the woman and her rights!
What upsets me the most is not that they are all woefully misinformed – it is that before all of this got stirred up and “improved for womens safety and midwives professional sakes”, I could just quietly go about my business and serve women. I have always known the attitudes of medical people toward birth and happily left them to their own delusional little world, why I tried to help women realise their lies from outside of it.
While I knowlingly practiced outside the “guidleines” it was with the full informed consent and sometimes urging of the women. and it was not illegal to do so. Now they have turned anyone who opposes obstetrical control of birth into a law breaker.
what a huge viloation of womens basic human rights and I am sickened by comments that suggest it is good for the majority of women.
Dear Lisa,
Great article!
The other major issue is that there is no right of refusal for women within the policy. If the woman’s outside of the guidelines, the ob, woman and midwife have to agree to the plan of care for the woman. If agreement can’t be made, the midwife is working outside the insurance policy and therefore outside of registration.
This impacts such simple things like refusing VEs, refusing C/S for twins etc. Take the eg of VBAC which as we know = B, therefore consult. If the ob insists on continuous monitoring and the woman continues to refuse … no agreement therefore the midwife must cease care.
This is not collaboration. It is not woman centered care. It is simply placing the obstetrician at the centre.
I’m all for collaboration but it must meet the woman’s needs (not merely the ob’s needs or preferences). Problem is, when the midwife’s an obstetrician’s insurance policies only cover them when there are “reasonable prospects of success” and “You are more likely than not to be unsuccessful in defending”, we can’t do the indefensible.
What’s the solution?
Hello no, we won’t go.
No way on this earth would I allow my private life to become a football between these various people. No.Way.
It couldn’t get more insulting.
It will be fun to see what the government does when the AMA and RANCID refuse to “collaborate”. “Collaboration” my arse. How fucking ridiculous. Midwife or paper pusher? And what precisely does the Approved Obstetric Oracle have to do in order to collaborate? Can they no longer countenance having to see women in emergency situations because oh noes that norty woman hasn’t had 47 letters sent about her personal information before she turned up?
I note that “hospital booking” has thus become mandated. Fuck that for a joke. Combined with the new national medical records keeping system this bodes very ill for women’s basic human rights in this country. Not that I’m surprised in any way since it was all heading this way _obviously_ from the get go but it is sickeningly awful seeing it in print.
AMA, RANCID, ACM, you have no authority over me. None. You can stick your rules where the sun don’t shine. Any midwives thinking this will be an ace idea to participate, I wouldn’t hire you if your shingle says you’re the Best Midwife in town. You can’t be “with woman” and with this crock of shit so pick a side. And I’m not alone. Women don’t want this shit foisted on them, we’re not eagerly waiting for insurance, we don’t want it because we want the basic human right to give birth as we please. Shocking huh? Yes, we own our bodies, not you.
Here in CA, US I used a midwife. There is no insurance so the midwives make sure you sign a statement that you know they have no insurance, along with all the other stuff you have to sign acknowledging that you have actually read and understand the limitations. It made no difference to me for either of my preg/births. Both were precipitous and drs in the area had me labelled high risk due to advanced age (39 with the first 42 with the second). And of course my second was large – 10 pounds 4 which here means induction or planned c/s. Our options keep getting limited. And god forbid I should choose to have another baby. There is almost no way that I can have a safe birth within the system.
I thank god that there are midwives that have the knowledge and are here to help out. Precipitous labor fears really get dismissed by the medical establishment.
The way I am reading this is that once a woman is confirmed pregnant she becomes a ward of the State, subject to any intervention, and is afforded no right to refuse. Correct? Felons have more rights than pregnant women now. Shocking and sad.
You’re just about right, Janice. We have laws about “concealing a pregnancy” in many states too which means not turning up to cattle call in the local hospital. It’s mostly used to chase down women considered reprobates on welfare but I have sometimes suspected it’s the reason hospital staff will write “No antenatal care” on the records of women who transfer with their hb mw in tow, complete with the records of their antenatal care and birth notes which the staff refuse to accept. At some hospitals a woman who doesn’t attend [insert arbitrary number] antenatal appts is automatically reported to the Dept of Community Services. You’d think we own our own bodies, but nope. And the worst part is NO ONE SEEMS TO HAVE NOTICED but a few homebirthers and we just get ignored by the government and maligned in the press.
I know a woman who put in a complaint which detailed that staff told her her baby would die *not might die* if she didn’t consent to an induction. Supposedly the peer reviewer decided that there was no evidence of coercion. So in our state it’s A-OK to tell grown women lies about the health status of their babies and the medical board does not consider it coercion, nor does the HRC. We’ve really got no where to go but up since we’re already at the bottom of the slippery slope.
Brilliant summary Lisa it is about time that the Government realise that collaboration means nothing remotely close to what they are proposing. This isn’t the mark of collaboration this is the mark of the AMA getting their greedy little hands on a nitch market, next we will have OB’s charging midwives to enter into collaboration agreements with them as afterall time is money!!!
We are WOMEN not cattle to be herded through production lines and accept that our personal information will, without our expressed consent, be shared among medical professionals as though they have the right to treat us as numbers.
I too am all for collaboration but on my terms, if I need to seek the counsel of an OB I will, MY OB not the one who is willing to work with MY MIDWIFE, on seeing that OB I will then make the best decisions I can with the information I have. This isn’t so hard to grasp or is it?
So in the wise words of Janet above…… Hell No we wont go!! They can stick their collaboration up their arse. I won’t be treated as a second close citizen because part of my anatomy is a vagina!