I work in a caseload model of care which means on call plus all the
things you mentioned, and personally I love it (most of the time) but
when we are looking for other midwives to replace us for long service
leave or whatever, we cant get midwives interested and we often have
comments like "I dont know how you do it!" or" I have a life outside
work" (so do I is my reply I fit work in around my life not the other
way around) but its a long standing culture we need to work at changing
my hope lies in the new direct entry midwives who believe what I do is
the norm !So though I wish it wasn't the case I think your friend is right.
Hi Dawn and all....
saw your posting Dawn and as a first year B Mid student (nearlly 2nd year oh my goddess :-)))) I felt compelled to reply....Yes, for me personally, independent practice, continuity and woman centred care is what I am to do. I keep saying the 'powers that be' have two years to sort out all this insurance crap...Midwifery by its very nature, doesn't sit comfortably within a nine to five working day.....sadly the system imposes that on us and women.....I agree with you....its the nursing/midwifery culture that we have to change...
Here in Victoria a year or so ago...the Government did a review of the 'Maternity Services Enhancement Plans'.....this report confirms many of Debby's friends sentiments...Part of its findings were that that the biggest 'barriers' to developing and implementing midwifery-led models of care were midwives themselves...
In the context of developing and extending on current models of team midwifery Eg like that at Southern Health, the report states...."Some of these achievements are not yet systematic but they are nevertheless, significant developments because they demonstrate ways forward as maternity services work towards goals about the continuity of care for all woman. The potential for expansion of these models is noted, as are the barriers to expansion. Barriers include a shortage of midwives who both embrace team midwifery models of care and are available to work on the rosters required for team work, as well as resistence from midwives themselves, to change their practice from obstetric maternity practices to new models of care."
The B Mid is aimed as you have suggested Dawn....to educate midwives that continuity of care IS the 'norm'....it aims to address this very issue described by this report...that until we have a workforce of highly motived, confident and competent midwives willing to work across the continnuum of pregnancy and birth....not just with 'expertise' in one area of midwifery....will we have the ability to change maternity services on a larger scale....
Lastly...Joys comments sit very comforably with me.....I have midwifery friends in NZ....who work a fulltime caseload (4-5 women a month for 10 months/year) with young familes...They argue the reverse is true.....that they couldn't work designated shifts...of bewteen 8-10-12hours....this inflexibility they argue dosn't sit comforably with family life. They structure their work around their family and the women they work with. Small group practices seem to work well so they have support for one another and back each other up when needed.....They have worked as both employed and self employed midwives....so they can speak from experience in this regard....and they all say that working with caseload of known women is far better to proving fragmented, inflexible system focused care from both the woman's and the midiwfe's perspective!!..They argue that if they are happier in their work, as some midiwves have said here already...it makes for a happier family life.
Yours in reforming midwifery,
Tina Pettigrew.
B Mid Student
Victoria University
