Dear Elaine and list,
This issue of midwives needing to be nurses is one that we all have to look
at carefully. It's not only rural and remote - even in some metropolitan
and regional hospitals midwives are often expected to work in general wards
when maternity is quiet, or the other side particularly busy.
As long as mainstream midwifery is linked to hospital shifts, this will
continue to be a problem.
When you link the midwife to the woman, and start asking what is appropriate
maternity care, the issues are seen in a new light. There will always be
jobs in hospitals for some midwives, but I think many could be better
employed as practitioners who provide continuity of carer within small teams
or groups.
A small town that has the potential for 30 - 40 births annually could be
serviced for maternity care by 2 midwives, each taking a caseload of 15 to
20 women, for prenatal, intranatal and postnatal care, and covering each
other for time off. A third midwife, who was perhaps less able to take her
own caseload (most of us have our own children at some stage in our
journey), may cover for annual leave and sickness. These midwives would
attend only 1 or 2 births a month, and if that was not enough work to keep
them busy, they could do nursing shifts at the hospital. Women who develop
complications that require a higher level of care than can be accessed
locally are referred to the larger centre.
One of the problems we are frequently reminded of in smaller communities is
the deskilling of midwives, due to the small number of births. Some small
hospitals find it is impossible to have a midwife employed on every shift.
Does this mean that the hospital can no longer safely provide care for the
women in birth? I hope not.
When there are midwives who are not nurses these issues may become more
clear. I don't think we should wait until that time. Let's bring in
changes to the system so that midwives can practise woman-centred midwifery.
And let's do all we can to keep midwifery alive in each town and district.
Sincerely, Joy Johnston
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]] On Behalf Of Dietsch Family
Sent: Wednesday, 28 July 1999 20:24
To: midwifery@ace
Subject: Direct entry
While I agree that Direct Entry would be a wonderful opportunity for women
choosing to be midwives and for many birthing women. I do have a concern
that I would like to share with the list.
My concern is for women choosing to give birth in small country towns all
over Australia. Rural (let alone remote) Australia is having incredible
difficulty recruiting midwives to practice and as a result maternity
services all over the country are being closed and women are being forced
to larger centres, often many hours away to give birth (A homebirth midwife
is only a fantasy!). Direct entry may help in encouraging more women to
midwifery. But, in these small towns the reality is that midwives also
double/triple as accident and emergnecy nurses, gerontology nurses, etc. As
an idealist, I agree that this is awful and plays a role in discouraging
qualified midwives from practising and the health service should realise
this and do something. As a realist, I must admit (and nearly choke as I
do so) they are - they continue to close down birthing opportunities for
rural women - it makes great sense economically - it is a tragedy for
women, their babies and their families.
My concern is that birthing opportunities for rural women will be even
further reduced if Direct Entry were to be accepted and midwives cannot
also function as nurses in rural hospitals.
Elaine Dietsch
11 Willow St
Leeton NSW 2705
02 69 533 272
[EMAIL PROTECTED]
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
