RE: Senate Inquiry Age
Felicity, I think it's a great idea to have the Senate Submissions available but remember that the Senate Committee must give permission for them to be published first. To do so without permission is contempt of Parliament. Cheers, David Felicity Croker [EMAIL PROTECTED] 8/09/1999 Joy, Your response to the news item should hopefully clarify 'midwifery care'. All the best with the Senate Inquiry. Do you think it would be a useful resource to have the senate submissions on the OzMid or ACMI websites? They are well researched and could provide a useful resource to midwives and consumer groups seeking evidence based information. Cheers Felicity At 06:04 PM 09/07/1999 +1000, you wrote: Dear Sally and all I can't answer either of these questions. The Age medical reporter Victoria Button got a piece about the Inquiry into page 3 of today's paper (Tues). She gave particular focus to Jane Fisher's claims that caesareans are linked to an increased incidence in certain psychological disorders, and that subsequent pregnancies may reactivate the condition. The article reported that: "The Australian College of Midwives called for a funding reform to allow midwifery at all births." I have written to Victoria Button with the following comment: This is not incorrect - but it is probably confusing to many readers. I will attempt to briefly explain why. All (or almost all) women giving birth in Australia probably do have midwifery care. The problem is that the woman (consumer) is not able, under current funding arrangements, to choose a midwife. Very few women are attended by a known midwife. The concept of partnership between each woman and her known midwife is central to the woman centred philosophy of midwifery. Birth is not an illness. A midwife is not a nurse. Funding for both public and private midwifery care is available only through hospitals - which are controlled by doctors who do not understand midwifery care. Public funding for all births includes a 'medical' component, but the midwifery care is treated as part of the service. Antenatal care is frequently provided in the community by doctors, and the funding is through Federal government Medicare. Most of these doctors do not have anything to do with the birth. Those who are involved in the birth do so through the private hospital system, and rely on midwives to attend their clients through labour, and call them in time to catch the baby. Of course, if there are complications, that specialist is called to provide expert care. However there is evidence that the involvement of specialists as primary carers may indeed be a factor in increasing the likelihood of medical intervention. This is one of the main issues that the Senate committee is attempting to address. Ten years ago New Zealand changed from a system of hospital based maternity funding, similar to ours, to a system over which the woman has choice and control. The woman may choose a lead maternity carer, either a GP doctor, a specialist obstetrician, or a midwife, and this is covered by government funding. The committee was particularly interested in the changes in maternity care in New Zealand. A recent report quoted in our submission, Maternity Care Provider and Outcomes, NZCOM 1998, in which the perinatal mortality rate (number of babies who die) for births under a midwife lead maternity carer was 3.6/1000, compared with 11.5/1000 for GP/midwife shared, and 14.9/1000 for OG/Midwife shared, was given a lot of attention. This evidence suggests that it is extremely safe to choose midwifery care. The only midwives in our country who work with a similar degree of independence to our colleagues in NZ are homebirth midwives, and perhaps a few in birth centres. Women are eager to maintain control over their bodies and lives, especially at a time of personal intimacy such as the birth of a baby. You did not stay for the presentation by Maternity Coalition, but I would encourage you to read their submission. I wish you every success in your efforts as a medical reporter, that you will be objective, and present a true picture of the issues you address. Yours sincerely Joy Johnston : -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Sally Tracy Sent: Tuesday, 7 September 1999 9:55 To: [EMAIL PROTECTED] Subject: Re: Senate Inquiry dear Joy many thanks for this briefing. I am going to represent AMAP on the 14th Sept in Sydney. I need some feedback on two points. a.. Does anybody have the latest reference for the spending on ultrasound technology as part of the maternity budget? I have several references but I want to be absolutely sure...they all look so unbelievably high! a.. what constitutes 'early discharge' in the majority of practices? I have conflicting definitions to hand. And when is a woman eligible for visits by a community midwife, after discharge from hospital? Many thanks in anticipation sally -- This
Re: Senate Inquiry VERY IMPORTANT
Dear all Have just returned from the Senate Select Committee hearing. I represented the WA ACMI. There's no doubt the committee has read the submissions and are thinking about issues. Most of my questions came from Sue Knowles and Rosemary Crowley. I found it difficult at times to separate the me hat from the ACMI hat. This was harder when some of the questions were What is your opinion of... and the ACMI doesn't have a stock/united policy. VERY IMPORTANT After the hearing it was suggested to me that we midwives must present to the Senate models which show how Federal money can best be used to fund services - sort of like the ABSP. I just can't do it at the moment. Maybe we need a joint submission. I get the impression that the Committee wants ideas about finding sources of money and then ways of using it. Can this be done by the next hearing? The crux of it is that they want us to do the work! We've done it all before so can we do it again? The rest of this post is about my/ACMI (WA) submission. In my five minute blurb I concentrated on the need for maternity services that reflect womens' expressed needs etc etc. I used a primary health care model to show that not all women have services that are equitable, accessible, appropriate affordable etc etc. I then gave three examples of this ie homebirth, only two birth centres in WA and none in the rural areas, inadequate or even absent services for women in remote and rural areas. Not all the Committee's questions were related to the submission so I had to think a bit. They asked if DEM educ'n would improve relations with the medical profession (my answer No)! I think they were a bit surprised at my somewhat gloomy prognosis about positive relations with our medical colleagues. I started hedging a bit and talked about my 'colleagues'. But, RC said which ones? I answered. There were quite a few questions about accreditation of midwives (visiting privileges) costs of programs ie homebirths and other midwife managed services. Another was why did I think the midwives were so old! I said that I think (but as yet little evidence to support it in mid but if general is anything to go with) that the midwives and nurses leave the profession in droves because of dissatisfaction with their working conditions etc. I used Kalgoorlie (hello Kal) to show that if the work is satisfying and they are able to practice midwifery as they wuz taught they will stay. So it isn't a matter of bringing in 'young students' but of finding ways to make 'em stay! Other comments were about the 'routinisation' of technologies/services, anti-competitive behaviours, lack of appropriate information on which to make informed choices; too much money being spent on something to the detriment of others ie antenatal care etc. I tried to make the point that in some quarters midwife managed care is considered an expensive luxury for an elite group. Midwife led services should be 'instead of' rather than 'as well as' ie it is not an adjunct to obstetric services but a model of care in its own right. I'm not sure if it came out like that but that's what I meant! That'll do for now. It is a bit scary but far from unpleasant. By the way submissions are the property of the Senate and can't be published. We can only comment on what is open to the public. Thanks to those who gave up their time to listen and be supportive afterwards! Carol -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: Checking the Cord... Good or Bad
This is something I've thought about a lot. As a student about 8 of the 24 births I've attended have had cord around the neck. Is that a normal number? The second birth I attended I felt cord and was instructed to clamp and cut it which I did without question as that was what I'd seen done. Then the next time it happened I was with a different midwife who said just wait and see if the baby comes and it did, I was amazed. And then I freaked out a bit as the baby whose cord I had clamped and cut had been a first twin. So I kept thinking what if, what if... Since then the other babies have all had no trouble being born with the cord wrapped around including the ones where I didn't realise it was there. I just find it's a bit of a juggle to unravel them especially if the woman is standing. I have also wondered if feeling for the cord causes labial grazes. Kylie. -Original Message-From: Mel and Michael [EMAIL PROTECTED]To: [EMAIL PROTECTED] [EMAIL PROTECTED]Date: Friday, 3 September 1999 1:02Subject: Checking the Cord... Good or Bad Hello to all you wonderful beings out there on this fantastic spring day. I am just curious as to peoples feelings on checking the cord at birth. Does anyone have any thoughts feelings or know of any evidence about cord checking being associated with the incidence of labial grazes/tears? What are you all doing in your own practice? I used to always check for cord by running my finger along baby's neck but in the last few months I tend to just look for cord as the little ones head restitutes and the shoulders move down. If there is cord I usually slip it over the shoulders rarely with any problems. Since I stopped always checking digitally, I have noticed that women seem to have fewer labial grazes. Most others that I work with always check digitally. Many midwives I have asked about this have said that it is better to check in case the cord is tight and needs to be cut immediately but I have rarely seen a cord so tight that it couldnt be slipped over the shoulders during birth. HMMM!!! Any way, I look forward to hearing what others think before I decide what is best to do. Im off for some serious retail therapy. Happy birthing to you all. Melissa.
Gratitude
My hat off to you ladies and gents on ozmid. What a dedicated, compassionate, hardworking, loving, wise and amazing collective you are. It is a privilege for me to connect with you all and learn so much. Gratefully yours, Marina __ Get Your Private, Free Email at http://www.hotmail.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: incontinence
Dear Carol - my father used to use that very saying, but his words were there are none so blind as those who will not see. Very apt, methinks! Lynne. -Original Message-From: Carol Thorogood [EMAIL PROTECTED]To: Midiwifery mailing list [EMAIL PROTECTED]Date: Wednesday, 8 September 1999 11:42Subject: incontinence Dear all I can't resist giving my bit about Sam's comments. During an interview with a prominent WA ob/gyn I was informed that he did 'social' Caesars because so many of his clients were elderly primips who were concerned that they would have post-menopausal stress-incontinence. He felt that good preventative medicine included Caesars. When I pointed out that there is (I think) no quality research which actually proves that vaginal delivery per se leads to stress incontinence he stumbled around a bit. His next comment was that he was unable to say no to women since it was their choice to have a Caesar! I didn't really see much point in pursuing the issue. What is that saying - there are none so blind as those that cannot see. I couldn't help asking if he thought that routine preventative cholecystectomies were needed to stop a few women developing cholecystitis when they became fair fat and forty! He then became so rushed for time the interview was terminated fairly quickly. Golly, I've just realised what I've done - the cholecystectomy rate is gonna double! Carol
RE: Senate Inquiry Age
Hi Felicity As I understand it the submissions and the hansard recording of the meetings will be put up on the government website - I don't know how ling it takes for this to happen. Joy -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Felicity Croker Sent: Wednesday, 8 September 1999 16:50 To: Johnston; [EMAIL PROTECTED] Subject:RE: Senate Inquiry Age Joy, Your response to the news item should hopefully clarify 'midwifery care'. All the best with the Senate Inquiry. Do you think it would be a useful resource to have the senate submissions on the OzMid or ACMI websites? They are well researched and could provide a useful resource to midwives and consumer groups seeking evidence based information. Cheers Felicity At 06:04 PM 09/07/1999 +1000, you wrote: Dear Sally and all I can't answer either of these questions. The Age medical reporter Victoria Button got a piece about the Inquiry into page 3 of today's paper (Tues). She gave particular focus to Jane Fisher's claims that caesareans are linked to an increased incidence in certain psychological disorders, and that subsequent pregnancies may reactivate the condition. The article reported that: "The Australian College of Midwives called for a funding reform to allow midwifery at all births." I have written to Victoria Button with the following comment: This is not incorrect - but it is probably confusing to many readers. I will attempt to briefly explain why. All (or almost all) women giving birth in Australia probably do have midwifery care. The problem is that the woman (consumer) is not able, under current funding arrangements, to choose a midwife. Very few women are attended by a known midwife. The concept of partnership between each woman and her known midwife is central to the woman centred philosophy of midwifery. Birth is not an illness. A midwife is not a nurse. Funding for both public and private midwifery care is available only through hospitals - which are controlled by doctors who do not understand midwifery care. Public funding for all births includes a 'medical' component, but the midwifery care is treated as part of the service. Antenatal care is frequently provided in the community by doctors, and the funding is through Federal government Medicare. Most of these doctors do not have anything to do with the birth. Those who are involved in the birth do so through the private hospital system, and rely on midwives to attend their clients through labour, and call them in time to catch the baby. Of course, if there are complications, that specialist is called to provide expert care. However there is evidence that the involvement of specialists as primary carers may indeed be a factor in increasing the likelihood of medical intervention. This is one of the main issues that the Senate committee is attempting to address. Ten years ago New Zealand changed from a system of hospital based maternity funding, similar to ours, to a system over which the woman has choice and control. The woman may choose a lead maternity carer, either a GP doctor, a specialist obstetrician, or a midwife, and this is covered by government funding. The committee was particularly interested in the changes in maternity care in New Zealand. A recent report quoted in our submission, Maternity Care Provider and Outcomes, NZCOM 1998, in which the perinatal mortality rate (number of babies who die) for births under a midwife lead maternity carer was 3.6/1000, compared with 11.5/1000 for GP/midwife shared, and 14.9/1000 for OG/Midwife shared, was given a lot of attention. This evidence suggests that it is extremely safe to choose midwifery care. The only midwives in our country who work with a similar degree of independence to our colleagues in NZ are homebirth midwives, and perhaps a few in birth centres. Women are eager to maintain control over their bodies and lives, especially at a time of personal intimacy such as the birth of a baby. You did not stay for the presentation by Maternity Coalition, but I would encourage you to read their submission. I wish you every success in your efforts as a medical reporter, that you will be objective, and present a true picture of the issues you address. Yours sincerely Joy Johnston : -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Sally Tracy Sent: Tuesday, 7 September 1999 9:55 To: [EMAIL PROTECTED] Subject: Re: Senate Inquiry dear Joy many thanks for this briefing. I am going to represent AMAP on the 14th Sept in Sydney. I need some feedback on two points. a.. Does anybody have the latest reference for the spending on ultrasound technology as part of the maternity budget? I have several references but I want to be absolutely sure...they all look so unbelievably high! a.. what constitutes 'early discharge' in the majority of practices? I have conflicting definitions to hand. And when is a woman
ordering of tests
Dear all I know i have put this request out to you before, but am in need of more specific information, and there may be some of you who have got further down the track than we have. I have put forward (with the help of some colleagues) a protocol for midwives ordering routine tests for the pregnant and birthing women they have all but sole care of. Teh medical men and admin are in agreement that this is a sensible thing to hasten slowly on. We have hit a stumbling block, however with our director of pathology services who says we cant get paid for tests that midwives order. All forms must have a doctor's signature on them. I find this difficult to believe, as many of these doctors only can order tests within the hospital environment anyway, so cannot have full provider numbers necessary for such re-imbursement. As this is covered by the medicare act (in my understanding) and this is a federal rather than state law, and as other hospitals are doing this sort of thing (and thanks to KEMH and Alice Springs for info so far) I know it can be done. It is unlikely these places are doing it for nothing!!! So, my request is for the actual mechanics of the process. I need to know how you are re-imbursed for tests ordered by midwives (and nurses if applicable), what protocols allow this, eg standing orders, using your pathologists provider number just like interns do, etc. It is my understanding that this responsibility can be delegated, it is just a matter of will on the part of those 'at the top'. On another matter, i sat in a meeting hte other day where it was said the hospital needed to put a friendlier face on for women who had chosen homebirth, but who were also booking in to hospital 'jsut in case'. I suggested allowing full visiting rights for their midiwves as the professional responsible. Teh answer was that it was looked at some time ago, but could not occur as other than a support role becuase of medico-legal reasons. Now I know this is probably a furphy. But I would love to have evidence from other centres that this is the case, that midwives can have visiting/admission priveleges without posing a medico-legal risk to hospitals or obstetricians. So, if you are willing to share, I would like copies of policies, pro forma contracts, etc, so I can get moving on this (AGAIN) down here. I think the wind is in the right direction for a change, and I want to ride it. Cheers, Trish -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Website for submissions
Dear Felicity All I would love to see the senate inquiry submissions on a midwifery related website (ACMI sounds good). As a midwife who works at the cold-face ( I've often wondered who developed that term) I would love to have this knowedge at my fingertips so that I could use it to my advantage in any scuffles with administrators and/or medical model advocates. After all the hours put into researching and formulating these documents, they should indeed make a wonderfully rich resource of knowledge and statistics. I do hope this sharing through websites eventuates Jackie Doolan Midwife/Lecturer University of Southern Queensland [EMAIL PROTECTED] mailto:[EMAIL PROTECTED] -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
