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 anticipati
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: 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
RE: Senate Inquiry
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 mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: senate inquiry in Melbourne
Rob,( list) We will be having our session in Brisbane before Melbourne and it struck me that it would be a good idea for us to exchange info so that we each pass the baton, so to speak, rather than repeat info previously provided about homebirth and midwifery models of care, and in that way, the senators can get a more complete picture. The coordinated approach will take...coordination. We'll let you know how we go with our submission. Will you be in Byron next weekend? I'm off to bed - just had a late night over at Kerry McGovern's place before she heads off back to the Solomons tomorrow. Always a laugh! Marina Original Message Follows From: "Tony Payne" [EMAIL PROTECTED] Reply-To: "Tony Payne" [EMAIL PROTECTED] To: "Ozmidwifery" [EMAIL PROTECTED] Subject: senate inquiry in Melbourne Date: Fri, 3 Sep 1999 16:53:19 +1000 All Victorians - the Senate Committee is meeting in melb on Monday 6th, RWH, conference room 9 to 4. Its open to the public, and would be a very good move politically to pack it out.. __ 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: senate inquiry
Sally, How true your insightive comments are. After seeing the pheonix rise in England, all be it slowly, and not without many hiccups, there followed a belief that maticulous hard work of both consumers/ families/clients and midwives could acheive or change anything. The senate enquiry, which I have to admit , I missed the genesis of theis discussion, appears to be a perfect oppurtunity to initiate change and to enlighten and inform. Would it be a good idea for a composite submission of evidence. An individual each being responsible for a facet of the submission? In that way exhaustative research could be performed and all resources could be pooled. Forgive me if someone has already suggested this. --- Sally Tracy [EMAIL PROTECTED] wrote: dear list it is a good time to think about how effective every person can be when united in a single purpose. The document Changing Childbirth in the UK was only effective because a whole lot of energy, consumer ( National Chidbirth Trust UK), midwives and others really pulled their 'fingers out' and submitted responses to the panel set up to make the inquiry. The important thing is to meticulously reference everything..back up all claims with the best evidence you can muster...every bit of energy will help..it is daunting, and it is tiring, but it's worth it. Even if this inquiry ends up with a finding that there is an awful lot of unrest on the ground and no conclusions can be drawnthat's worth it.it's just one of the chances we have to grasp.don't forget the cardinal rule...reference everything -- Sally Witten-Tracy Research Midwife Australian Midwifery Action Project Emu Bottom tel Fax 61 2 47 390667 email [EMAIL PROTECTED] === From Cathy Bock and Nigel Duncan. at BIRTHING HANDS (Homebirth, ante/post natal care and hospital support) [EMAIL PROTECTED] _ Do You Yahoo!? Get your free @yahoo.com address at http://mail.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: Senate Inquiry
kERRY how can we be a aprt of this. Tell us how we can help. I wanna party! your nigel and cathy --- Kerry McGovern [EMAIL PROTECTED] wrote: Hi Di et al And for all the politicans who have attended the Financial Management Reform workshops run recently in Canberra, they will be very keen to know the outcome criteria you use and the outcome criteria women and seeking and the outcome criteria you can promise. Can someone please check who among the Senate Enquiry have attended??? Phone the Clerk of the Parliament's office and ask. If all have attended, then they will want to know how much it will cost to implement this scheme. When you cost this, will you please cost in things like: i) homecare for every woman after giving birth for 6 weeks? ii) cost of maintaining and enhancing the skills of specialists whose services women everywhere have come to expect??? iii) the plan to market to the women that you are deliverying WHAT THEY ARE ASKING FOR iv) and the ultimate benefit in terms of industry, jobs and the environment. Then give them the performance criteria of the new service - and name it well. Maternity Services seems OK to me. But is it possible under the constitution for the federal government to consider deliverying maternity services. I think that's a state's right. So find the appropriate authority under which the commonwealth government can provide a solution. Tied funding isn't on the agenda any longer as Howard has promised state's clear funding with the GST money. Someone will have to find out what arguments will stand water in the new funding environment. Then...name the service the commonwealth has the power and the political will to provide. Give it VERY clear performance criteria. Think carefully about these. There must be one in terms of numbers or quanitity, one in terms of quality or outcomes for the women, one in terms of location and one in terms of cost. Then the service has to have a sexy name so the government can sell a recognisable product into the Australian market...and get the qudos for it. Then there has to be the existing management structure to actually deliver the product - to the specified performance criteria. If we set the performance criteria well (and this list is a good place to start, though many more would need to be involved) [don't kid yourself if you think we can pull this one off alone] then we can set the standard for maternity service delivery (or the service that the commonwealth CAN and WILL ) provide that best takes us along the path to the maternity services we want for ourselves. Then...hell, won't we have a great party!! 'night all PS If you think I'm being humourous! I'm Not. I really mean this. It can be done, and midwives havn't got the skills to do it alone. How are we going to respond to this enquiry??? Cheers! Kerry At 07:28 PM 7/5/99 +1000, you wrote: excerptsmallerHello Kathleen I am also of the opinion that we need to use this (senate inquiry) in a positive way and not be bitter and cynical about it. I hope that the committe will be truely overwhelmed with the deluge of information they will recieve and be forced to examine the incredible disparity (bad pun) of birthing services in this country. It will also serve to demonstrate the hard work that is going on all over the country by commited individuals who put women where they belong - at the centre of service provision, recognise birth for what it is - one of womens' most powerful life experiences, acknowlege the important and pivotal role midwives have in woman-centred service provision, and examine the path maternity care is on. /smaller smallerWe need to use this carefully, and make sure that women benefit from the information which hopefully will be used to change things for the better. Hey! The millenium is around the corner - let us go into it with panache! We are midwives - let's do it!! /smaller smallerLynne Staff /smaller /excerpt -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. === From Cathy Bock and Nigel Duncan. at BIRTHING HANDS (Homebirth, ante/post natal care and hospital support) [EMAIL PROTECTED] _ Do You Yahoo!? Get your free @yahoo.com address at http://mail.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: Senate inquiry
When I have written my response I will post it on ozmidwifery. I will do this before sending it to the senate so I can benefit from your critique. If there is a way we can improve or responses by being coordinated then I am happy for that. Dr. Kathleen Fahy Associate Professor Midwifery Co-ordinator University Southern Queensland 07 46312377 [EMAIL PROTECTED] -Original Message- From: Heather Gulliver [mailto:[EMAIL PROTECTED]] Sent: Monday, July 05, 1999 11:50 To: sue Cc: [EMAIL PROTECTED] Subject: Re: Senate inquiry Hi All, Please note my post today re this Senate Inquiry was written a couple of days ago and I couldn't get on line at the time to send it off. Hence it will seem somewhat ignorant now the informative posts have been written. Thanks to those who have followed through and given the info on the areas to be investigated and how (to whom) to make submissions. Is there some way we could co-ordinate our responses??? I'll try and see that the word is passed around to some consumer groups and our local homebirth and ACMI branch is aware. Once again do recognise my prior post was intended for the list some days ago. Cheers, Heather. sue wrote: Senate Community Affairs References Committee INQUIRY INTO CHILDBIRTH PROCEDURES The Senate has referred the following matter to the Senate Community Affairs References Committee for inquiry and report by 30 December 1999. Childbirth procedures, with particular reference to: (a) the range and provision of antenatal care services to ascertain whether interventions can be minimised through the development of best practice in antenatal screening standards; (b) the variation in childbirth practices between different hospitals and different states particularly with respect to the level of interventions such as caesarean birth, episiotomy and epidural anaesthetics; (c) the variation in such procedures between public and private patients; (d) any variations in clinical outcomes associated with the variation in intervention rates, including peri-natal and maternal mortality and morbidity indicators; (e) the best practices for safe and effective births being demonstrated in particular locations and models of care and the desirability of more general application; (f) early discharge programs, to ensure their appropriateness; (g) the adequacy of access, choice, models of care and clinical outcomes for rural and remote Australians, for Aboriginal and Torres Strait Islander women and for women of non-English speaking backgrounds; (h) whether best practice guidelines are desirable, and, if so, how they should be developed and implemented; (i) the adequacy of information provided to expectant mothers and their families in relation to the choices for safe practice available to them; and (j) the impact of the new Medicare rebate provided for complex births, including the use of the term 'qualified and unqualified neonates' for funding purposes, and the impact that this has had on improved patient care and reduction of average gap payments. Written submissions are invited and should be addressed to: The Secretary Senate Community Affairs References Committee Suite S1 59 Parliament House Canberra ACT 2600 Closing date for the receipt of submissions is 6 August 1999. For further details contact the Committee Secretary, Phone: (02) 6277 3515, Fax: (02) 6277 5829. E-mail: [EMAIL PROTECTED] Comments to: [EMAIL PROTECTED] Last reviewed 30 June 1999 © Commonwealth of Australia _ Do You Yahoo!? Get your free @yahoo.com address at http://mail.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
