[ozmidwifery] public-private birth centres
Thanks guys for your comments so far, the Dr who is making the proposition is definitely one of the lower interventionist ones around these parts and he supports most of the local women who choose to have a homebirth. When I asked him how he thought it might work he didn't really seem to have much of an idea which leaves it pretty open to come up with our unique model. I will be pushing for visiting rights for independent midwives but am sure the insurance (lack there of) will be raised before too long. Lynne as you mention 'caseload' would be my preferred option but at the end of the day if this increases the choice for some women then it will be great because to be honest there is no choice at the moment here in the south west of WA. Unfortunately numbers will be an issue realistically we can probably only aim for around 100 births a year and that means staffing will be an issue because it will not be able to have staff on 24 hour basis. From my experience you need to be booking around 500 and have at least 350 births a year to justify a full complement of staff around 12-13 full time equivalents. Lynne with the private patients are they assigned a midwife and then does the women negotiate with that midwife to have antenatal care as well as their OB and would that woman try to be there for the birth or is dependent on what committment the midwife can make to the woman and in your clinics how do the women pay if they just see a midwife, does the hospital itself bill them and then they get the monies back off their health fund or does the OB have to be involved in the clinics. Yours in midwifery Pete Malavisi -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] public-private birth centres
Hi everyone, we have been approached by a doc here in the south west of WA about establishing a public/private birth centre, I am not aware of one in Australia but I could be wrong, if so could someone let me know how it works and any suggestions or thoughts on how it should work would be greatly appreciated. Yours in midwifery, Pete Malavisi -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Birth Centre submission
We are looking atlodging a submission/business case to establish a birth centre in the south west of WA, this will cater for a rural regional area, if anyone else had already had to do this in their area it would be extremely helpful to get an electronic copy so that we don't have to re invent the wheel. I would appreciate if anyone could contact me on [EMAIL PROTECTED] with any information. Yours in midwifery Pete Malavisi -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Midwifery-led units - warning, a bit of a rave!
I tend to agree with Jenny, Community led birth centre would address the
potential for alienating other family members, particularly fathers who
at times need just as much support and understanding as the mothers, the
other point I like is that it literally throws it back onto the
community to take some responsibility for their own unit. Of course
people will ask but what does it mean? and of course we can reply that
it works on midwifery philosophies rather than medical ones, anyway just
some thoughts.
On Wed, 21 Sep 2005 12:55:06 +0930, Jennifairy
[EMAIL PROTECTED] said:
ok, bear with me while I think out loud in your general
direction
well we have the 'baby friendly hospital initiative', so how
about the 'woman friendly birth centre'? I mean, better
still, 'the community' (representatives of) should really be
heavily involved in this kind of primary care health
structure (physical as well as intellectual), then it could
be 'community-led birth centre'. I think (right now this
minute, subject to change without notice) that as long as we
are identifying the structure (ie the physical space, not
the governing body) with the politics of care provision (ie,
who is the 'primary carer') then we are going to have
confusion. I had a bit of a look at what constitutes
'midwifery-led care' 'continuity of carer' etc, for an
assignment at uni, these terms encompass a whole range of
different models of care - its not as clear cut as it seems!
The definitions would seem to be consistent, but how it
works out in practice 'on the coalface' (now theres a term
that seriously needs an overhaul!) varies enormously.
As I said, Im guessing that what we'd mostly like to see is
the idea of a 'woman-led' birthing culture actually
happening that requires a shift in perception not only
for Mr Mrs Joe Average (boy, Im just piling up the dodgy
metaphors arent I?) but for the PTB's within the 'health
culture' . because that means moving away from the whole
'doctor as God' thing that goes with relinquishing
responsibility = litigation etc, to actually believing that
'ordinary people' can take responsibility for thier
health/care... as long as the 'ordinary people' wont or cant
do that, there will be others who do, where there is
responsibility there is power, where there is power there
are invariably individuals who are drawn to it.
Starhawk in her book Truth or Dare identifies 3 kinds of
power in society - power-over ( backed by force or some
other kind of control, deeply embedded in heirarchical
structures, enables one individual to make decisions that
affect others..); power-within ('empowerment', a sense of
personal control 'mindfullness'..); power-with
(influence, the power not to command, but to suggest be
listened to or not, to work with others for a common
goal..)
Im bringing this up because what I see is a clash of
cultures, where midwives are 'traditionally' allied with
women their self-identified needs (power-with) rather than
that of the institution which is all about heirarchy
control (power-over) because it was spawned from a
militaristic culture
So really we are talking different languages - the language
of 'power-over' is very different to that of
'power-with' to come back circuitously to my point
(its there somewhere!), the terms that keep being used
('midwifery-led care', 'medical-based model', even
'free-standing birthing unit') come from the language of
'power-over' because they all identify who is 'in
control', who is in the 'power-over' position...
um, Ive just looked at the time Ive gotta run, thanx for
bearing with me while I ramble incontinently, I will leave
you with one of my favorite definitions - madness is when
you froth at the mouth; insanity is when you froth at the
brain (sorry, has absolutely no bearing on this
conversation, completely irrelevant, but for some reason I
remembered it now - Im just a sharing kinda gal)
jennifairy
As I watched the 7.30 Report last night, that dreadful
term midwifery led unit kept springing up. I have a
real problem with this term, as you can read on My Diary:
http://www.birthinternational.com/diary/index.html
Can't we do better than this?
Thinking caps on please!
Andrea
-
Andrea Robertson
Birth International * ACE Graphics * Associates in
Childbirth Education
e-mail: [EMAIL PROTECTED]
web: www.birthinternational.com
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Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
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Re: [ozmidwifery] intermittent auscultation
Sally I agree with what both you and Gloria are saying, with a low risk women term and all progressing well in labour where is the evidence to support any auscultation, I also believe that it can he horribly invasive and could easily be construed as intervention. Surely as professionals we can use our skills to make the call on whether auscultation is needed or not. I also believe that there can be a lot of angst built up over listening too often in what in most situations is the normal physiology of 2nd stage. yours in midwifery pete malavisi On Fri, 29 Jul 2005 16:24:32 +0800, Sally Westbury [EMAIL PROTECTED] said: OK. What the Nice Guideline have based the bulk of their guideline on are the following three studies. All of these studies have randomized high and low risk pregnancies. I would like to propose that the auscultation intervals set are reflective of a lack of risk screening. I would like to us think about is whether it is appropriate to try to translate these auscultation interval to a low risk client group?? What do other people thinks?? Efficacy and safety of intrapartum electronic fetal monitoring: an update SB Thacker, DF Stroup, and HB Peterson STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA Vintzileos, A. M. et al. 1993. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics Gynecology 81:899-907. METHODS: The study was conducted simultaneously at two university hospitals in Athens, Greece (Alexandra and Marika Iliadi Hospitals) from October 1, 1990 to June 30, 1991. All patients with singleton living fetuses and gestational ages of 26 weeks or greater were eligible for inclusion. The participants were assigned to continuous EFM or intermittent auscultation based on the flip of a coin. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
