Hi again,
Yes, there could be a full-time caseload for a midwife in small town. In
two of the towns in my study there was a person who was generally
acknowledged, trusted and respected as "the midwife". However, there were
times when she was on holidays, away, etc. . Even with planning around her
shifts, birthing women who went into labour suddenly found she was not
available. Women who were very happy to birth locally found themselves
without these midwives when they needed them. There needs to be backup.
It's true though, as you say, the more you spread the workload, the thinner
the experience becomes, leading to deskilling. This is a problem for
nurse-midwives.
I don't know the answer. If anyone has one, please let me know as I'll
build it into my PhD recommendations.
I'm really enjoying being able to discuss this
Cheers
Felicity
Kathleen responded:
At 12:28 PM 8/4/99 +1000, you wrote:
>Dear Felicity,
>>
>I recognise that caseload midwifery will not solve all problems as you have
>so cogently pointed out. Where there are only 12-20 birth per year it is
>difficult to see how a safe service can be operated when a number of
>nurse-midwives have to cover all shifts.
>
>The point of my posting was to say that it is important to sometimes change
>the way we look at things (eg staffing in midwifery units of rural
>hospitals). For the medium sized hospitals 45 births per year would be
>full-time work for one midwife; ninety would be full-time work for two.
>This is a useful idea, don't you think?
>
>This idea does not negate that there are some hospitals which will always
>need multi-skilled health care professionals and many midwives who want to
>be nurses also.
>
>Warm regards,
>
>Kathleen
>
>-----Original Message-----
>From: Felicity Croker [mailto:[EMAIL PROTECTED]]
>Sent: Tuesday, August 03, 1999 1:55
>To: Kathleen Fahy
>Subject: RE: Rural Mid
>
>
>Hi Kathleen & all in this rural mid discussion
>
>I realise that I cannot speak for rural practitioners in towns in SE Qld,
>Vic, SA etc. but I have a pretty good idea about what is happening in N
>and NW Qld.
>
>It really does depend on the size of the hospital and the size of the
>catchment area it serves. 120 births/yr would be unbelievable for many of
>the rural/remote hospitals in north west & far north QLD.
>
>Talking to midwives in the area I am researching supports both
>perspectives. There is a strong need for midwives who are up-to-date,
>experienced and able to handle emergencies in isolated areas with limited
>facilities and often a young doctor who lacks obstetric
>experience/confidence.
>However, maintaining skills is very difficult when the number of women
>birthing in your health district is 12 - 35 year. (Others are sent way
>because of risk factors, or choose to birth in a larger centre). This
>caseload would mean travelling vast distances, without back up.
>
>Often the mid role overlaps with gynae & child health, as well as general
>nursing. There is a place out there for midwives with general nursing
>skills (and mental health & AE ... hard to be the up to date generalist in
>all areas).
>When the midwife is seen to be outdated in her ideas & practise, women tend
>not to trust her and chose to go elsewhere to birth, compounding the
>problem.
>
>Also, there is an aging rural population. The trend is towards young
>couples and families to leave the bush and go where education and work
>opportunities are better. If we are to educate midiwves for the future
>this could see them without (rural) clients. With the birthrate now below
>replacement level, we need midwives who can not only competently meet the
>needs of women but who also have a viable client base.
>
>Many students coming into Mid courses are older/mature women with families
>and commitments. They did general nursing years ago and life experience has
>led them to Mid. They tend not be mobile or have limited mobility. There is
>no childcare in these small rural towns. Even birthing mums find it hard to
>know who will look after their children while they are away for diagnostic
>procedures or birth. Certainly no where a solitatry midwife could leave her
>children in a hurry if she had to head off into the sunset for a period of
>time.
>
>Direct Entry Mid would be a great way to recruit young women who would be
>able to be mobile and practise across a range of settings. It would be a
>most exciting advance for Australian mid, but I think rural practice
>requires special consideration.
>
>Cheers
>Felicity (-:
>
>
>Kathleen wrote:
>At 11:23 AM 8/3/99 +1000, you wrote:
>>I hear you concern about rural women and agree that more rural women should
>>have the option to birth in their home town but I don't think that this
>>means that midwives who are not nurses cannot work in rural hospitals.
>>
>>Eg If 120 women birth per year in a rural hospital it may take 12
>>nurse-midwives to cover all shifts + holidays but if caseload midwifery was
>>used then 3 full time midwives could provide all the care for the same
>>number of women.
>>
>>Dr. Kathleen Fahy
>>Associate Professor
>>Midwifery Co-ordinator
>>University Southern Queensland
>>07 46312377
>>[EMAIL PROTECTED]
>>
>>
>>-----Original Message-----
>>From: Judy Chapman [mailto:[EMAIL PROTECTED]]
>>Sent: Tuesday, August 03, 1999 11:02
>>To: [EMAIL PROTECTED]
>>Subject: Re: Direct entry
>>
>>
>>I agree with Elaine wholeheartedly. I have no desire to do general nursing
>>and restrict my jobsearching to hospitals big enough to employ full time
>>midwives.
>>One of the problems not mentioned also is the lack of doctors who can/will
>>do obstetrics. Many women are forced to leave their families for long
>>periods and travel far because there are no facilities for C/S and of
>>course, there is no way you can have a baby if there are not the facilities
>
>>to do an emergency C/S for whatever reason.
>>The number of social inductions that are done in my centre for the sole
>>reason of letting a woman have her baby and get home to her family is
>>shocking. I don't blame the OB, his heart goes out to them in their
>>loneliness and he aquieses to their request. It is a system which places so
>
>>much emphasis on the need to do an operative delivery which is at fault.
>>Judy
>>
>>
>>From: "Dietsch Family" <[EMAIL PROTECTED]>
>>Reply-To: <[EMAIL PROTECTED]>
>>To: "midwifery@ace" <[EMAIL PROTECTED]>
>>Subject: Direct entry
>>Date: Wed, 28 Jul 1999 20:24:13 +1000
>>
>>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.
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>>
>>
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>______________________________________________________________
>"Never doubt that a small group of thoughtful, committed citizens can
>change the world. Indeed it is the only thing that ever has"
> Margaret Mead
>
>
> _--_|\,-- From Townsville ** Felicity Croker
> / \ in sunny ** Psychology & Sociology &
> \_.--._/ North Queensland ** Centre for Women's Studies
> v ** James Cook University
> ** TOWNSVILLE, QUEENSLAND 4811
> AUSTRALIA
>
> PH: (07) 4781 4909
> INTERNATIONAL: 61747814909
> FAX: 61 7 4781 5117
>
>
>
______________________________________________________________
"Never doubt that a small group of thoughtful, committed citizens can
change the world. Indeed it is the only thing that ever has"
Margaret Mead
_--_|\,-- From Townsville ** Felicity Croker
/ \ in sunny ** Psychology & Sociology &
\_.--._/ North Queensland ** Centre for Women's Studies
v ** James Cook University
** TOWNSVILLE, QUEENSLAND 4811
AUSTRALIA
PH: (07) 4781 4909
INTERNATIONAL: 61747814909
FAX: 61 7 4781 5117
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This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
