Hi all, Midwives and consumers have different agendas. Midwives have to by necessity look after the system they are working in, as well as their own needs, and the needs of the consumers. Consumers are focused on their own needs, the quality of their own care, and the ramifications of this care. As midwives we see the routines that are necessary to impose (in which ever area of practice we work in) and try to minimise the impact that they have on our clients. Some of these routines are necessary (eg. 'I'd like you to meet my backup midwife', 'When we put your epidural in we will do your blood pressure frequently and be with you all the time' etc) but can be thoughtless and disempowering to the extreme (ie no choice in VBAC, VEs, breech birthing etc.). Without the input of the consumers we do not know what they think is reasonable and what isn't. They don't have to make sure the system runs smoothly, they don't have to worry about what their blood will do to others or what the coroner will think. They understand the fundamentals of health care at a very personal level. Yes they do want the system to be there for them when they need it next but their concern is their immediate care and the outcomes of this care. It has been my experience that Governments don't listen to midwives because we have vested interests, and are the minor power brokers in all of this anyway. However they do listen to clients/consumers and although we think that the obstetricians are the power brokers, the consumer has the ultimate power. That is why their input is paramount. Homebirth Australia (consumer only lobby group) saw the importance of this different focus and used it to change many things (including making us homebirth midwives extremely uncomfortable). Their focus was on the quality of care and its ramifications. Are we as midwives yet prepared to have our work and our systems appraised wholisically by the ultimate stakeholder (the consumer)? Are we prepared to listen and change? I say yes. I think midwifery in Australia is ready for this. Regards to all Helen McDonald Tassy. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
