Monday, December 01, 2008

IN SAFE HANDS?

With reference to the article “In Safe Hands’ in the Sunday Age.

I think Christine Tippett is actually giving a hint as to how RANZCOG is lobbying the federal government with reference to the Maternity Services Review. It’s OK to extend the ‘allowed’ practice of midwives in hospitals where we can keep an eye on them, BUT we can’t allow those maverick independents any freedom.
It’s the old strategy, divide and conquer. Divide the midwifery profession into the acceptable and the unacceptable …

The Victorian branch of RANZCOG (or was it RACOG then?) did the same thing in 1993 when the new Nurses Act was brought in. An 11th hour fax (everyone didn’t have email then) to the health minister claiming that it would be unsafe to remove the regulations (which required a doctor to supervise a midwife’s practice, amongst other items) resulted in the retention of the regulations until they sunsetted in 1996. Although the regulations have been dead and gone for more than a decade, many midwives in Victorian hospitals are still working under protocols that assume the historical restrictions that existed under the regulations.

I think the midwifery profession as a whole needs to strenuously object to the statement by Dr Tippett that “It’s important that there’s not federal funding for people who are engaged in dangerous practice”, in the context of the claim that some independent midwives attend vbac and twin births at home.

Our laws provide a means of regulating midwifery practice, as well as obstetric, dentistry, or any of the other health professions. Midwifery is not regulated by the obstetric profession. If Dr Tippett has information that leads her to believe a registered midwife has “engaged in dangerous practice”, surely the right thing to do would be to notify the regulatory body of the matter, rather than using the public media to set up a scare campaign against independent midwives. As with any other profession, the regulatory process is a carefully managed and is accountable. It’s not perfect (imho), but it’s what we have, and even midwives have a right to expect fairness in law.

Please tell me if I'm being paranoid here. If not, would everyone who cares about protecting the right of midwives to practise midwifery in any setting, whether they are employed by a health care provider or by the woman, please take this matter seriously. When a person of Dr Tippett's profile is willing to make a statement about midwives engaging in dangerous practice, we must conclude that midwifery is under threat from RANZCOG. And it's not about the twin births or vbacs at home. The issue is who chooses what's best for women?

3 comments:

Sif said...

Tippett's statement seems to suggest that vbac and twin birth at home is inherently dangerous, it is quite a sweeping sentiment.

Which is where "what is best for women" becomes a contentious issue. There is no "best for women" because that assumes that women are an homogeneous group where one size fits every scenario, which flies in the face of evidence based care...

If I'm interpreting this all correctly...

This sentiment strips the individual of any autonomy and centralises all the "power and knowledge" with one small group (in this case hospital based obstetric care provision)...

Sarah Stewart said...

For what it worth's you've got ther support of midwives in New Zealand, except I don't know how many of us know what a fight you've got on your hands. Good luck with it!

Joy Johnston said...

Thanks Sarah.
In many ways Australian midwives and maternity activists look to NZ as a model of what can be achieved. I am inspired by NZ women including Marilyn Waring, Helen Clark, and leaders in the midwifery profession including Joan Donely, Karen Guilliland, Sally Pairman, Maggie Banks and others.

I am quite optimistic about the reform that could come out of the current Maternity Services Review. Even though it has been an uphill battle, we have made some progress in the past 10 years, and many midwives are ready to move into a more woman centred, partnership based midwifery practice.

The NZ model of indemnity insurance for all health professionals, similar to the no-fault TAC insurance in this country, is such a sensible approach. Instead of having a professional indemnity insurance arrangement for each professional, which then requires a person with an adverse outcome to sue their carer, and only get a payout if they win, the NZ government manages a no-fault system in which anyone who experiences an adverse event in health care receives a standardised payment. If there was negligence or malpractice of some kind, this is dealt with by the professional regulatory body, rather than by the law courts and insurers.