Wednesday, September 29, 2010

AMA Position on collaboration:

Here is the AMA document for collaboration; yes there are parts of it that make me cringe.... however it must be equally difficult for the AMA, not that any midwife wants to hear that; Click on the link to read the document;

Collaborative Arrangements what you need to know? the irony of this document has to make you laugh or cry:

"Working with other health professionals is an everyday feature of clinical practice for a modern medical practitioner. Effective teamwork can improve patient outcomes, create new opportunities for learning,and build a shared understanding of the skills that each person brings to the care of a patient."

If we do not embrace these changes, then pressure will mount on the Government to relax the requirement for collaborative arrangements to be in place. This would risk fragmentation of care to the detriment of patients.

This is the most telling statement of all.... this means the AMA is seriously concerned that if they the doctors do not collaborate then changes will be made......this is in our favour.

As always I am presenting you with the information and you can decide for yourselves; As i have stated before; My vision is that all women will have the choice of continuity of midwifery care with a midwife and the right to claim a Medicare Rebate for fee for services;
Whilst I do not like the wording in this Determination I can see that this is still a historic time for midwives and midwifery....

Friday, September 24, 2010

Why do people read and not leave a comment?

I am expressing a level of frustration; how are people to make decisions when you put out information and you get no responses; what does it take for people to respond? i know you read the blogs, but never a comment; this is so important; does this mean you accept the staus quo, you don't give a toss, you have no opinion, or really doesn't matter what you say nothing will change? I have no idea what to think....because it's one way communication here....

I liken the position of the Australian College of Midwives to the recent federal election: everyone you speak to is voting for the person you want.... or not voting for that person....the numbers are close all the polls predicated 50 - 50 or thereabout.....Now with the Determination; I have to say the polarity is almost the same, although I think that because the majority of midwives are not commenting.... the minority who believe that the determination should be squashed have a louder voice. Therefore this is the common view because the rest aren't speaking..... we have 500 members in WA.... and i have heard from less than a is time to be vocal.....

The facts are that the Determination was passed in July...when it comes up in the Senate next week it is to allow or disallow..... there is no discussion about the determination....the time for talking is over... Any debate that would be had, would then be as to whether, or not, the disallowance motion should be passed.
... the bottom line is if it is not allowed... we then lose everything, because the Government of the day will not reintroduce it. I have to add why would they?

The argument I have been given is that the determination will create a two tier midwifery service.... I believe this happened when we created 'the eligible midwife' not the medicare provider number.... and rebate.... in fact i could argue there has always been a two level midwifery service...those midwives who believe their scope of practice is the experts in normal childbirth.... then to collaborate when things move outside that scope with an Obstetrician.... however there are those midwives who will accept and care for a woman from any risk category because it is the woman's choice..... there we have a dichotomy: my solution is if you had that , trusting, supportive arrangement with your women it wouldn't matter if you had to seek collaborative advice from an Obstetrician..... it is all about the relationship you build with the woman.....

is this a topic to which we will get no agreement or have things just got to a point where the passionate people from both sides are at logger head... and the majority of midwives are just not engaged.....?

Wednesday, September 22, 2010

THE FACTS: The Determination:

1) Will not prevent private midwives being able to practice (they can still access insurance)

2) Will not prevent women being able to make choices –If you are having a homebirth and choose not to access Medicare you do not need a signed agreement with a doctor.

3) Only affects midwives seeking to access Medicare and midwives can choose not to do this.

4) Is not included in the NMBA Quality and Safety Exemption Framework supporting private midwives providing homebirth services

5) Does not re-define the ICM definition of a midwife – it does not define the role or scope of practice of midwives in Australia. It only defines how midwives can access Medicare if they choose to do so. Midwives can still work in public and/or private practice and access insurance and register as a midwife (under our current regulatory requirements that have an accepted definition and scope of practice of the midwife in Australia).

6) Does not mean that midwives must have a signed agreement with a doctor – this is only IF YOU CHOOSE TO ACCESS MEDICARE - Midwives can have
a. an individual signed agreement with a doctor
b. a referral of a woman to you
c. clinical privileging
d. an agreement signed by the medical director of a hospital.

7) Does not mean you need acknowledgment in writing - we have been told by the Minister’s advisors that a midwife writing in her own clinical notes that results etc have been sent to the hospital/doctor where they have a collaborative arrangement meets this requirement.

Urgent information: Determination:

The ACM has sent an urgent e-bulletin out to its members to let them know about the delicate position the College finds it's self in - Whilst the College is not happy with the terms of the Determination we are in real danger of losing everything we have been working for by not accepting this Determination; That is Medicare for Midwives:

The College has consistently requested some changes to the Determination:
".....while we were very committed to seeing the maternity reforms progress there are several concerns regarding the implementation of the Determination. We also noted that very small changes in the wording of the determination would resolve many of these issues. Our suggested word changes are,
• Removing the words ‘named medical practitioner’
• Removing the words ‘acknowledgement by a named medical practitioner’
• Addition of the words ‘a health provider organisation’ to Part 1. Section 4 c (important for rural & remote purposes and also applicable to urban Aboriginal Health Services)."

Also the Minister will continue with the plan for Nurse Practitioners however would let the Midwife Determination go....

"We were also advised that the Minister is very aware of the potential move to disallow the Determination and the government is therefore seeking urgent legal advice about uncoupling the Nurse Practitioner (NP) Determination from the Midwife Determination to enable the NP Determination to progress through parliament. They stated that the Minister has no intention of letting the NP Determination fall through (if the Midwife Determination is challenged) and will work hard to ensure this does not occur. However, the Minister’s advisors also stated that Minister Roxon has ‘lost political capital over this and will not seek to reintroduce the Midwife Determination if it is disallowed’. Sadly maternity care is not high on the agenda in health at the moment despite all our (consumers and midwives) efforts to make it so."

The Minister has clarified these points:
"The Minister’s advisors also stated that in the Determination:
• The requirement for ‘acknowledgement by a medical practitioner’ could be met simply by a midwife recording in the woman’s medical history that information had been sent to a medical practitioner, and
• That the medical director of a hospital could be the ‘named practitioner’ (we have this in writing from Minister Roxon dated 27th November 2009) signing on behalf of the hospital medical staff.
• Clinical Privileging is a Collaborative Arrangement which does not require any further sign off from a ‘named medical practitioner’.

You have to ask yourself whether it would be better to let the determination be disallowed and work really hard to try and get it up in a way that we feel is workable from the beginning?
However, the consequence of this means we risk not getting Medicare for midwives in the next three years or perhaps at all.

This is too big a risk to take! We believe that over the next few years we could see thousands of women benefiting from access to Medicare in a variety of different models. Specifically, we see this will increase access to funded continuity of midwifery care which many women do not currently have.

Please be proactive and leave a comment: what do you think? and please leave you first name when commenting: no anonymous comments will be published

Pauline Costins

Tuesday, September 21, 2010

Reflections from a student midwife:

Student Midwife Reflection six months into her course:

Wow what an experience the past six months has been! I have spent the first half of this year on the maternity ward at Southwest Hospital and work with a fantastic team of midwives. I have loved every day of it and although it has not been easy at times, it has been worth every moment.

I have been extremely lucky in my experiences and have been a part of some awesome births and met some amazing women. I have been a part of three water births, a vaginal twin birth including one breech, hypnobirthing and a baby ‘born in the caul’, just to name a few highlights. My mentor Susan is a great midwife whose knowledge and commitment to women and the midwifery profession astounds me. Although I mostly work with her, I realise it is important to work with other midwives as everyone works differently and has different pieces of knowledge which I know will help me to become the best midwife I can be.

Every Friday we have a Midwives Clinic where women who have shared care with their doctors, come to us for a few visits during their pregnancy. This for me is a real highlight, I enjoy meeting these women antenatally, even if it’s only briefly and building a rapport with them as it is the closest form of continuity of care we have here at the moment.

Everyday is constant learning whether I’m working in labour suites, on the postnatal ward, or in the Midwives Clinic, I usually come home mentally exhausted from everything I have learned that day, I feel like a big sponge absorbing everything! I have become much more confident in CTG analysis and breastfeeding education, although I am not as confident with vaginal examinations as each one is so different, so I am endeavouring to improve on that skill!

The hardest part of becoming a midwife for me is the constant battle for ‘normal birth’. I see midwives everyday advocating for their women to allow for the birth that they want and some doctors just need to interfere. It seems that some of them feel the need to ‘rescue’ these women from that ‘horrible thing’ called labour, they don’t seem to realise that it is the most natural part of life. I’ve seen women coping beautifully with a labour that is progressing and a baby not distressed at all and a doctor walk in and insist on interfering in one way or another, which alters the woman’s ability to trust her body and it appears to be only for the reason of doctor convenience. It is frustrating and on going. The doctors are there for those women, who need assistance in the birth of their baby and in obstetric emergencies, and that’s when midwives then step aside and work with the doctors for the safest option of birth, whether it be an operative vaginal birth or caesarean section. It can be draining being an advocate for these women to get a ‘normal birth’, but worth every bit of it when you get a happy and healthy woman with a happy and healthy baby.

The most important lesson that I have learnt is to always listen to the woman. If she states she feels an urge to push, yet was only 2cm dilated half an hour ago, BELIEVE HER!!

So another six months to go until I am a fully fledged midwife, it is scary, yet exciting. I can’t wait to see what to future holds and look forward to the rest of the year!

Written by Aleisha (Student Midwife)

Tuesday, September 7, 2010

Midwives wonderful women......dinner with Marg Phelan

Marg Phelan a midwife originally from Victoria, now living in NT (president of the Australian College of Midwives in 2003) is cycling around Australia to raise awareness for midwives, normal birth, women's childbirth choices and breastfeeding. Marg and her superb team travel on average 100k per day, what a feat.... tonight they were enjoying a glass of red, and the company of the ACM WA Executive, student midwives and colleagues.....

I have just come home having a wonderful dinner with a phenomenal group of women; being a midwife is such a privilege and opens the door to meeting a multitude of people from all walks of life.

The team

I was enjoying chatting to Marg's team, Sue a renal nurse specialist from the NT who is the driver of the bus, Lois a scientist from Victoria who advocates that cycling keeps you young, Rhea also from Victoria an infection control nurse, says she sleeps really well after cycling and its the best way to see the country and Rob who is a midwife also from Victoria who has just joined the group to do the driving from Perth to Victoria says no way am I cycling happy to drive the bus, so that Sue can do some cycling with Marg. Marg does all the cycling and the others take turns or cycle with Marg...I have to say it puts me to shame knowing that the average age of the group is 60 years young.... my legs just ache at the thought of 100k's a day.... oops ladies after our chat about going to bed early the computer went on when I came was calling me......just had to write about you all before Alzheimer's set in....what an inspiration all these women are, such dedication and passion..... how would I describe them.... fantastic, wonderful, remarkable and unique.

A couple of our Bachelor of Midwifery students Beth and Lisa who organised the Mum's bub's and midwives at Point Walter also joined us for dinner....they had the opportunity to chat to the team, it's about the new and the experienced sharing the common goal of midwifery and how to keep moving the profession forward and upwards into the future.....

These sorts of evenings allow us to network, share stories, enjoy a glass of red... and just chat.....

Have a safe journey and we will be watching you.....go girl australia... anyone wanting to help Marg Phelan please visit her website or email her on

Ciao Pauline

Friday, September 3, 2010





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Welcome to Marg Phelan.........Go Girl Australia

Go Girl Australia - Marg Phelan, cycled into Fremantle around 12noon today, it was a beautiful sunny day and there were wonderful people to meet her.....I was so excited... in my time I have waited for lots of different occasions and I must say I was thrilled to meet this exceptional woman.... I would put Marg Phelan in my 10 best people I have met in my lifetime....she is an extraordinary woman, such passion, drive, commitment for her fellow human being.....a truly inspirational woman.

Marg will be here from the 3rd - 9th Sept before heading south to Mandurah.

You still have a chance to meet Marg Phelan on Monday at Point Walter 12 - 2pm...come and share some time to meet and greet this amazing woman; -
Sponsor Marg with donations of cash, fuel vouchers, cycling gear, bike parts, accommodation, food;
Advertise Go Girl Australia through your business or community group
if you wish to donate to the cause please bring some cash with you or go online to Go Girl Australia and sponsor;

This is Marg Phelan just arrived at Woodman Point after cycling from Darwin. Go Go Girl!