Re: [ozmidwifery] Waterbirth thread - maternity initiatives!

[Susan Cudlipp]

Good points and I agree with all aforementioned .   I was one of the team for our (now closed) Family Birth Centre, and while it was a fabulous service in many ways, it was also badly thought out, much opposed by the obs (no surprise there) and working conditions were quite difficult for the few of us who did work in it. It was not based on case loading and required a lot of on-call which made having a life outside very hard!  It was also quite an expensive option and not used sufficiently which made it hard for us to argue for its continuation.  Must say that I felt quite 'burned out' after 18months, and I was only working 0.5, but the experience gained was incredible.   We had at that time, a 3-tier system which many women found confusing 1. Obstetric care as either private or public patient in rooms, with no guarantee that "your" obs would be the one on call when your birth happened (unless induced to suit!) but managed under the preferences of "your" doctor for pregnancy care and under the preferences of on-call doctor for labour. (Standing orders and telephone contact - call in prn and for delivery)   2. GP/Midwife public care for low-risk  women, with obstetric back-up when needed - this occasionally was a cause of conflict as you may guess when obs disagreed with management and made life quite difficult at times ( I remember one lovely lady GP being reduced to tears and forced to assist at C/S under most unpleasant bullying tactics)   Ante-natal care by midwives and GP's (2 GP visits as standard, more as indicated, consultation to obs if indicated)  Early discharge or full stay as desired.   3. FBC midwife led care which was essentially very similar to option 2 but with a far more personalised mode of care with a team of 3 midwives, birth in private FBC room and a lot more freedom of choice. With the same back up as above, discharge within 24 hours and EDP by the same midwives.   Now we have only one option, the obstetricians have been taken on staff and have largely given up their private practices, their indemnity is covered by the hospital and they are earning a very large salary for providing 24-hour cover on-site.  The GP's were told they were no longer required  (they are quite justifiably upset by this and are directing their patients to other areas which is having a bad effect upon our booking numbers)  We still have our midwife clinic and perform a great deal of the ante-natal care for the majority of low-risk women, this has also helped improve the assessment skills of our midwives.   Since this change our C/S rate has increased significantly as has our intervention rate. I questioned whether, as a public hospital, we could endorse elective C/S, or 'social' induction  for no medical reason- i.e. maternal request, and was told that we had to support 'informed choice'  (would be funny if it wasn't so sad eh?)   Obs insist on being called for delivery in even spontaneous normal labours (although not all of them feel compelled to attend) which naturally has an impact on the whole situation, and midwife job satisfaction has decreased accordingly.  If we challenge any practice we are 'put back in our box' and getting them to agree to any sensible protocol, even among themselves, is nigh on impossible, as they have all been too used to doing their own thing and are really not into team playing.  Some are obviously more reasonable than others but the balance of power is definitely medical!  Meantime they are on a very cushy number indeed and as the majority are counting down to retirement, are very unlikely to want to change that!   With regards to refresher courses happening - several of my colleagues and I are undertaking the Enhanced Role of the Midwife course which is just getting underway. I think that quite a few of my colleagues would like to work in a midwifery-led model, but I know that just as many would resist it strongly!    Hope this helps add to the general info about what is happening 'out there'   Sue ----- Original Message ----- From: Kim Stead To: ozmidwifery@acegraphics.com.au Sent: Tuesday, March 15, 2005 1:52 PM Subject: [ozmidwifery] Waterbirth thread - maternity initiatives! Hi everyone   I've been following this thread with great interest.  I am a bit confused as to this new initiative and whether it in fact, means anything at all....?   Is tomorrow going to come and go and things continue to stay the same??  Some say that this whole 'initiative' it is just a token gesture to calm the waters and at the end of the day...... the old boys have all the control and are not going to hand this over to midwives?    Like Tina, I have too trained in the BMid model and feel quite equipped to offer care across the whole continuum and work in a caseload model.  The problem is.......  there are very few vacancies for us to work in the model we have been trained for.  I certainly hope this will improve.  The hospital I am at is keen to offer caseload but there are a few hurdles in our way.  I'd be interested to know whether this applies to other hospitals as well......   1.    Lack of committed and skilled staff - or should I say, a huge fear that working caseload is going to impose on our lives too much! 2.    Lack of obstetric/medial support when needed.  There are lots of power struggles going on and obstetricans playing bullies! 3.    How to fund this type of program with no additional funding?      -    I realise there are grants available of which I understand we have been turned down for on our last attempt?  I believe we are also             waiting for the ANF to decide on salary packages for caseload type work.   Another concern that I see is not only the opposition or fear of caseload by many midwives, but also the knowledge gap that exists in the antenatal segment.  I am not sure if preconception and antenatal care and education has been part of traditional midwifery training...  and I realise it is not rocket science but I have also seen many midwives who have become reliant on doctors instead of using their own extensive knowledge and skill base.  Together we have a wealth of knowledge that we need to share with each other.  I am sure you all agree and I hope you can understand where I am coming from.  We know how to fill in pathology forms, how to do a bishop score etc, but we have not been 'alllowed' to perform such tasks.   There are many more I can think of when midwives have been required to call in a doctor to follow protocols!   Is it the unknown or lack of confidence/skills in this area that is contributing to the fear factor?  If so, what are we doing about it?  If and when these types of models of care are initiated, how will we staff them with the current state of our workforce and lack of midwives?  I believe each and everyone one of us has it in us to work to our full potential  and it should be our right to move in and out of different models to suit our individual situations but I believe we are on the back-foot preparing and supporting each other to do this.   I don't believe in my area that we would have adequate numbers to undertake Caseload in this area effectively and efficiently.  It would be shame to start and burn out because it were not set up properly.  I can imagine who would be laughing too and saying "I told you so!"  How do the rest of you feel in the areas you live in?  Is this a rural thing or does it apply to the metropolitan areas also?  I'm in rural Victoria.   I have heard through the grapevine that there is money available for refreshing/reskilling of midwives....whatever you would like to call it, but how and when is this going to take place?  Do any of you know of any refresher type programs that are currently availbable?  Shouldn't this already be happening in preparation for our day in the sun?   I also think the idea of independent midwives mentoring grad midwives is terrific in theory, but again..... finding midwives who are still managing to work in these models is another difficulty in itself.  I worked with a beautiful midwife yesterday (relatively new) who said she had never seen physiological 3rd stage.  I wonder if she has ever truely seen a normal birth?  How can we expect midwives to facilitate normal births when they have  not had the opportunities to witness them?   We need more MIPPS to help keep this balance with student midwives.  We all know we need more support to encourage and support independent midwifery!!!    I hope that this post is not offensiive to anyone as that is not my intention at all.  I'm only new myself so full of passion and ideas but lacking in the experience department.  I see that we can all offer each other so much and I really feel passionate that we need to begin working together and supporting one another in the drive for better employment options.      I'd like to see this happen before I die as well!  Someone please tell me that this is going to happen.......?  I'm only in my 30's!   Your in midwifery and forever learning so forgiveness please for my foot in mouth disease!!   Kiwi Kim         -------Original Message-------   From: ozmidwifery@acegraphics.com.au Date: 03/15/05 14:12:14 To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] waterbirth   Hello Tina   Bear in mind that our midwifery workforce is ageing, avg age is 48. I am 51 and if I was young and at the beginning of my mid career I would be into caseloading big time. I have just started a new job (in a mid hospital)  and it is hard making even that change to another hospital. Finding out where everything is etc. It is never easy & I have worked in many different institutions and it gets harder each time.  Also in this and most hospitals midwives are expected to look after general patients.I think this would be enough to swing midwives towards caseloading. I accept that most Australian midwives do not realise that caseloading is easier to manage than set shifts. I heard Caroline Flint talk on this issue and she clarified it well. I would like to do it in principle, but at the moment I want some time free for me after 35 years of busy caring.   I believe things are changing but it is slow and we need to keep up our education of the public. In particular I think we (midwives) should be in the primary schools and kinders introducing the role of the midwife and talking about how to have a healthy society through healthy childbearing and parenting. Tina, hang in there, it is happening, albeit slowly. You will probably be writing all this up as part of the history of Australian midwifery one day....a Masters project perhaps?!! Cheers   Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835   0419 528 717 Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835   0419 528 717 ----- Original Message ----- From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, March 14, 2005 1:12 PM Subject: Re: [ozmidwifery] waterbirth In a message dated 3/14/2005 1:52:01 PM AUS Eastern Standard Time, [EMAIL PROTECTED] writes: It concerns me that Australian midwives are so slow to see the advantages in forming partnerships with women, listen to them and work with them to provide the types of birth services women want. It is difficult in many areas to convince midwives to even contemplate taking on their own caseload. Perhaps time will alleviate my concerns.  I hope I see all Australian midwives working 'with women' before I die. Jan Hello Jan and everyone. Jan I couldn't agree more!! As a recently graduated midwife, educated via a Bachelor of Midwifery (predicated on continuity and woman-centred care) I am now working fulltime shift-work across my scope of practice (rotating thu pregnancy, birth and after birth care) and I can't believe that midwives feel that full-time shift work is a wonderful way work!! Having just completed my midwifery studies with full time uni and a caseload of between 10-15 women a year across the 3 years of the B Mid...I was NO WHERE nearly as tired I am now with doing the full-time shift work.....it sucks big time!!! Where I work is a large regional midwifery unit in Victoria, and the move is towards implementing one-to-one midwifery care for women, with a known midwife throughout their pregnancy, birthing and early parenting journey - caseload. However, this move is being met with strenuous opposition from many of the midwives who WILL NOT even contemplate that perhaps there is another way to be 'with woman' than the current fear based, institution focused, inflexible rostered based system of maternity care. So like Jennifairy, I too am also working with a MIPP to keep my skills up of supporting women in their on own power to birth at home on a partime basis where I am sharing a small caseload of women with another midwifery colleague, while continuing to work to educate midwives on  the benefits of one-one midwifery care with known women....whilst continuing to practice the bulk of my midwifery in what now seems like on planet Mars!! Yours in reforming midwifery Tina Pettigrew.   No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.7.2 - Release Date: 11/03/05

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