In my last blog entry I referred to the 'framework' under which midwives may be required to work after 1 July next year.
What exactly is meant by this term 'framework'?
I don't know if anyone has carefully defined 'framework' as it applies to contemporary midwifery practice, but from a simple understanding of the term, most people would understand 'framework' to mean the underlying principles that put shape and boundaries to our work, in the same way that the frame of a house defines the shape and boundaries of the house. The framework is not usually visible, but it is none the less essential.
Framework is not new. Midwifery already has a strong framework. For many years midwives in Australia have attempted to allign our framework with the international definition, codes, standards and competencies for midwifery. In many ways this constantly evolving, internationally agreed framework has supported our calls for reform of Australian maternity services, resisting medical dominance supported by anticompetitive government funding arrangements. The International Confederation of Midwives has dilligently collaborated with FIGO (Federation Internationale de Gynecologists et Obstetricians [pardon my anglicised French!]), WHO (World Health Organisation) and other key international bodies in defining and developing a strong midwifery profession.
Independent midwife Lisa Barrett has commented on the expected framework for midwifery in her blog: "In real terms this means restrictions. This is where it gets muddled. Are the restrictions to keep midwives safe or to limit the right of women to chose?"
This statement appears to me to indicate fear that some freedoms that exist at present will be lost. It suggests muddled thinking. Of course there will be restrictions: we already work under restrictions. BUT, the right of a woman to choose is a totally separate issue from the professional boundaries that the midwife works in.
A week ago a client who had booked me for homebirth asked me if I would attend her breech birth at home. Without hesitation I reassured her that it is her choice to give birth spontaneously, working in harmony with her own physical and physiological abilities, in the setting of her choice. And that as her midwife I would be with her. But I also recommended a path of action that included referral to obstetric services for consideration of external cephalic version. I work within a responsible midwifery framework. Had I ignored the need for collaboration when an abnormal presentation is detected I would have been denying this woman the right to an informed decision making process, and restricting her options to the non-intervention model under which a midwife primary carer practises.
Another woman phoned me to tell me she has just discovered that she has twins, and is looking for midwives who will support her choice of homebirth. I encouraged her to make choices that she knows are best for her babies and herself; choices that cannot be made months in advance of the birth. Her right to choose is apart from the midwife's professional framework. If, after having considered carefully all her options, this woman is labouring and intending to give birth at home, I will do all I can to provide whatever professional private midwifery services she wants from me.
The question Lisa asked is "Are the restrictions to keep midwives safe ...?" I don't think so. Any 'restrictions' we experience within a professional midwifery framework are really structure, shape, and boundaries to midwifery practice. Without integrity in the framework the whole structure will collapse. Framework does not keep midwives safe; the safety of midwifery practice is complexly and beautifully dependent on the awesome natural processes that God created, and authentic midwives know how to work in harmony with.
Framework does not conflict with a woman's right to choose between physiological and medical processes.