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As always Tina you say it all so well. I think we
should generate a portfolio of caseload working arrangements that have worked or
are working well for midwives on the list so that those who like the theory of
caseload but are apprehensive about the practice in their lives, can see
the reality of the situation.
We can also learn from practices that burn
midwives out and/or are unsatisfactory to women.
Obviously there are probably as many variations of
practice arrangements as there are midwives however, for those just
branching out some well worn paths could be helpful. I think if midwives
realised that (hopefully) caseload could include everything from one birth per
month to five or six births a month depending on the individual midwife / group
of midwives.
marilyn
Sent: Saturday, November 02, 2002 5:37
PM
Subject: Re: [ozmidwifery] Obstetric
Perception - Your thoughts?
In a message dated 1/11/02 10:26:26 AM AUS Eastern Daylight
Time, [EMAIL PROTECTED]
writes:
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
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