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Justine,
I
agree with you on what you have put here. I'd love to be able to attend healthy
women which most are but even healthy women can run into difficulties. It is
then a 'good' midwife who would consult and refer with the woman's best
interests in mind.
An
adverse outcome scars all, sometimes that's for life.
Nice
to see someone else up late.
Cheers
Barb
Dear Barb and
all
Somehow Joy has not understood what I meant.
I was talking
about new programs and the fact that midwifery must have its own scope of
practice. Yes women must have access to a full range of choice.
No one EVER suggested taking choice away. Currently less than 1%
of women can access best practice care, that of a known midwife and yet a
woman has no trouble accessing a C/S with no medical indication. So my
comment was about a full continuum of choice. Why should a woman
seeking best practice have her rights denied, while a woman accessing
unnecessary specialist care is well catered for (via the public purse!).
This sad irony is that while healthy women access specialist care
unnecessarily, there is the risk that those in real need can be compromised.
I believe this to be a real issue in regional referral units, esp with
the reduction in practitioners.
The majority of women are not high
risk, but best practice would allow for what you describe, the great support
of midwifery in concert with other care, women in high risk situations would
greatly benefit from the relationship of a known midwife, as would healthy
women.
When I say stand alone. I mean midwives being
responsible for a full scope of practice. ie being able to care for a
healthy woman throughout the episode in any setting. Naturally when
there is indication of complication etc a collaborative approach is
necessary. What we have now is Obstetrics determining the normal.
This is against best practice and is unsafe. As I understand a
midwife is trained to care for a healthy woman throughout the episode in a
variety of settings, but due to medical domination the majority work in a
highly fragmented system.
Hope this makes more sense.
Justine
Ditto, well put
Joy.
We must always remember that all women have the right to
choose. High risk women have much reduced choices but lets ensure that these
women can also be attended to by midwives educated and mindful of the risk
factors. Many women are delaying birth so often have pre-existing medical
needs due to age.
A respectful midwife, who can make a difference, in
collaboration with medical staff that has clearly defined roles and
reporting responsibilities outlined should be able to care for a so called
high risk woman in the safest environment. Or are we saying they should have
obstetric nurses as some often refer to hospital midwives as.
I
have been there for a woman in an ICU in a previous life. She was 35 weeks
ventilated due to severe asthma attack. Although she was not aware of the
birth, sad, at least she had a midwife who was able to tell her of the birth
at a later stage. We luckily had a Polaroid to take photo's as this birth
was totally unexpected!!
Lets not forget some midwives would not be
comfortable to be isolated in a free standing birthing centre, is she a bad
midwife for saying so
Cheers Barb.
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Jen
Semple
Sent: Tuesday, 14 October 2003 4:32 PM
To:
[EMAIL PROTECTED]
Subject: [ozmidwifery] who is
really there for women ? long
From Joy Johnston [EMAIL PROTECTED]
:
I think we all need to see Jan's case as an extreme
case. This is bullying, and unfortunately it will always occur.
Even midwives can be bullies. It’s a human trait to want to
dominate and control. The doctor in this case may have been
dreadfully upset about the loss of a baby the previous day.
Hopefully he was. But his use of the experience to coerce the
labouring woman and her partner into submission appears totally
unfair.
Access to one to one midwifery – even NMAP –
will not change the system overnight. The woman in the story had Jan with
her, and Jan’s a very good midwife. Women in Australia will continue to
seek out the care of specialist obstetricians as long as the system biases
the care in that direction. In NZ you have to pay extra to see an ob
without clinical indication – but there are still women who choose that
option.
Justine’s reference to NZ is an example of
how vastly different the options are in NZ to here. However I have
to disagree with Justine’s conclusion that “we can’t settle for midwifery
programs under the acute setting AT ALL!”
The acute setting has a
monopoly of funding for ALL births in this country, and there is no sign
that that’s about to change. The hospitals can offer homebirth now
if they want to. In the light of all the evidence (and NMAP has put
it out there for all to see) it’s only reasonable that hospitals will see
the homebirth option as attractive for the service as well as the
women.
Maternity Coalition is about mothers and
midwives working together for better maternity care (that’s a long way
from the ideal, but it’s pointing in the right direction). We
support women’s choice and access. Choice of model of care and
provider of that care, and access to midwifery models of care and birth in
the home or hospital. In supporting choice, we also support a
woman’s right to choose the fully medical models of care. Australian
maternity services need total reform, and that’s what we are trying to
bring about. Until that reform has been achieved we really can’t
afford to be idealistic about demanding that all midwifery be offered
outside the acute (hospital) setting, when that’s where the money goes,
that’s where the bulk of the workforce is, and that’s where the woman look
for their care.
Joy Johnston
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