Fw: [ozmidwifery] Request for information on current models of midwifery led care

[Graham and Helen]

Dear Anne   Thanks a lot for the taking the time to answer my questions.  Would love a copy of your stats.  Are there any plans to increase the staff to cater for the obviously high demand?    One of the reasons I wanted to know if a doctor has to "admit" a labouring woman is because I feel when they do, they inevitably do a VE on admission which I feel is totally unnecessary 99% of the time and seems to set the woman up for the old "failure to progress" line and then on to a caesar.  This is where the doctors go wrong if you ask me.  There are so many other ways to see if a woman is progressing in labour but once you have that cervical dilatation timeline it seems to influence all decisions from then on.  So if the midwife is the primary care attendant I suspect admission VEs aren't done routinely in labour....correct me if I'm wrong....   Anyway, that's my vent for the day.   Helen Cahill ----- Original Message ----- From: Anne Clarke To: [EMAIL PROTECTED] Sent: Wednesday, August 04, 2004 3:45 PM Subject: Re: [ozmidwifery] Request for information on current models of midwifery led care Dear Helen,   I work at the Birth Centre, RWH Brisbane and we are the primary carers, however, we also see ourselves as a team and refer when appropriate, but this does not mean we give up caring for our client.   The comments that are put forward are quite inflammatory and they can be sued if they are not careful.   However, the best ammunition is our statistics and cost effectiveness and consumer satisfaction.  They can never argue about that!   You are quite right comparing the Obs and GP senario, again they cannot argue with that.   1.  Medical indemnity status of midwives working in New Zealand - my understanding of it is that they work under the control of the health department and   Yes   2.  If anyone gets sued it is the hospital/health service.  Is this correct?   Yes.  However, if you have acted negligently they will sue you too.   3.  If the hospital is successfully sued, where does the money come from if a huge payout is granted.  My understanding is that taxpayers all contribute somehow to a government fund for such purposes.    Yes   4.  Do all the women see a doctor at the beginning of pregnancy to be screened as low or high risk or does the midwife screen them and refer them on if needed.   At the Birth Centre, women go on a ballot drawn about 7mths before their due date e.g. we will be doing the ballot for April 2004 next month.  Meanwhile the women book into the hospital and see the consultant/registrar to be 'passed' by them.  I tell the women not to leave the room until the doctor has written somewhere in their notes that they are OK to come to the Birth Centre unless there is a specific medical reason for not coming.  They do not have to wait for an USS (as some of our mother's decline any USS's).   The women in the ballot are sent a letter either offering a place (on proviso they are passed by the doc) if they were unsuccessful in the ballot they are still to be passed by the doc to come to the Birth Centre as some women may miscarry or change their mind (this is not often) and an opening may occur and then those on the waiting list from the ballot can be offered a place a little later down the track.    Meanwhile the women who do not have a place can either share care with their GP or they can be cared for by the Phoenix project.  The Phoenix is a team of 4-6 Midwives who can look after low and high risk in the ANC and one of them is on call per shift to look after her in labour ward.  Many women who do not come to the Brith Centre for a myriad of reasons like the option of the Phoenix.   5.  Do all women see a doctor in labour on admission or do the midwives totally provide the support/care with medicos only being called if there is a problem.   We only include the medicos if there is a problem - but we still look after the woman.   We order any tests (blood, MSU, USS etc) as needed.   6.  What are the comparisons between perinatal mortality and caesarian rates between countries with midwifery led care and Australia - I've heard they are lower but don't have any research to back my claims.    Our stats are outstanding.  If you want a copy of the stats I do not have them on email but can snail mail them to you if you like.  Email me back with your address if you want these stats.   It also costs approximately $1,800 per woman for her care with us.  It costs twice as much through the 'regular' system for a healthy singleton pregnancy.  Again you cannot argue with this.   Regards, Anne Clarke