Mandy sent me this reply but couldn't send to the list so I'm forwarding it
on.
I find the differences between South Africa and Australia very interesting.
Thank you for taking the time to answer so fully. I'll take up some of your
points more fully in the response I am making to Joy Johnson's posting re
this topic.
Kathleen Fahy
-----Original Message-----
From: Mandy O'Reilly [mailto:[EMAIL PROTECTED]]
Sent: Friday, August 27, 1999 12:13
To: Kathleen Fahy
Subject: Why can't we practise as midwives in hospitals?
Dear Kathleen
Just to introduce myself, I currently read the list but for some or
other technical reason am unable to post to the list. I am a midwife who
has adopted Australia as home, even though I am currently living in
Jakarta, Indonesia.
I studied general nursing and then midwifery in South Africa which was
my birth country. I practised in Canberra for 2 years before moving up
here due to my husbands work.
What was very interesting for me was the difference in terminology (and
I suppose perspective) regarding both nursing and especially midwifery
in Australia versus South Africa.
In South Africa one has the Nursing Act which is government legislature
that deals with the profession of nursing. Formulated by the profession,
it stipulates a scope of practice. The terminology of the act is very
broad and discusses the role of the nurse as being independent as well
as interdependent of doctors and other heath workers. The central theme
of the act is accountability and responsibility. In real terms this
means that the nurse is responsible for any acts or omissions and has no
legal place to hide if she does not maintain her skills or follows an
incorrect doctors order. Competence is inherent in the requirement of
accountability. The act clearly states that the nurse may do any
procedure within her (very broad) scope of practice. According to the
act a nurse may, in an emergency and the absence of medical back-up,
carry out any procedure or administer any drugs they feel necessary to
save the life of the patient. The proviso is that they accept
responsibility for their actions.
The act discusses, actions, omissions and negligence. There are well
defined disciplinary procedures in place. These include, temporary
suspension, losing registration and the requirement that any matter with
civil or criminal liability be reported to the judicial system.
Hospital policy is merely a guideline, it protects the hospital form
vicarious liability. Accountability is the determining factor that
nurses use to guide their practice.
(and needles to say evidence based practice)
South African was the first country in the world to register midwives
(yes they were home birth midwives and this did not restrict there
practice.) I believe that was in about 1890. Until the mid 1940's
nurses, midwives, dentists and doctor were all on the same register.
They now have receprocity on the various boards. This does not give them
the right to veto but appears to make communications smoother.
The midwifery act is basically the same as the nursing act (midwives are
registered separately) but it very clearly defines the role of the
midwife as being responsible for normal pregnancy, birth and labour etc.
(Interestingly is requires that midwives promote breast feeding) The
act allows for midwives to prescribe and administer certain drugs (peth,
synto etc.) in her independent role. Once again the act is very
encompassing and gives the midwife a fair amount of autonomy.
While I am sure there aspects of the act that are debatable. The broad
terms really allow midwives to practice in a manner that is women
centred.
Midwives have admission rights, they bring in their balls, have the
light low or what ever else they feel is optimum for their women. Health
Insurance companies pay.
This has been an evolving process and obviously there is still a lot of
growing to do.
After this background and in response to your question regarding
Australia what I think is:
Midwives are too bound by hospital policy in oz. The hospital governs
their practice because they do not have legal autonomy. I have seen this
credentialing thing being totally mis-used to restrict practice, in
what the hospital believes is its own vicarious interest. Often the folk
doing the credentialling are not that experienced. In one particular
instance I had I was told by the educator, who had never sutured an epis
or tear herself that I had to be credentialled to do this. This was part
of my basic ed 20 years ago and part of the defined scope of practice of
a midwife as I know it. Please don't take this as a gripe about me, it
is an example of hospital policy in this particular unit at that time.
I tried to introduce the use of a ball (love them) before they were
known in oz and was told it was not going to be passed by the safety
com. They actually thought I was crazy. They are now using balls.
Another example of this is a post on the list where someone was talking
about hospital policy that had been formulated regarding the use of
balls. Not to be used when a women has had analgesia. My interpretation
of what should be ( if we as midwives are to gain the rights we need
to help women birth optimally)
is that hospital policy highlights the possible problems in this
situation and cautions- but holds the midwife accountable for her
practice.
I think the Victorian act is a good start but believe that midwives
around the world need to have their role legally accepted formalized in
order for us to make great strides. Inherent in this proposal is that
legislation must ensure the ability of the midwife to grow and not
restrict her scope of practice unintentionally.
Regards
Mandy O'Reilly
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
