Friday, July 31, 2009

RALLY Tues 4 August, 10.30am

A protest is planned outside Nicola Roxon's office.

10.30am to 11.30am next Tuesday AUGUST 4.

1 Thomas Holmes St
Maribyrnong 3032

LEAVE YOUR CALLING CARD WITH THE MINISTER
Every woman, or midwife, or other interested person is asked to make a calling card to leave with Minister Roxon. It is unlikely she is going to come out, that's OK you all need to leave a 'calling card'. [see attached examples]







With a short caption re who they are etc and a photo. For women that have stark differences in birth outcomes they could include pics of these. Midwives could highlight who they are, Mother, Grandmother, Midwife for X years etc.

This rally is being organised by Homebirth Australia, Maternity Coalition, Midwives in Private Practice, and other maternity interest groups.

Thursday, July 30, 2009

Rogue midwives

I have to tell you, dear reader, that midwives like me have now been called 'rogue midwives'. Our governments, both state and federal, are attempting to make private midwifery practice for homebirth unlawful. As one of the midwives who faces this fate, I must assume that I am being considered a rogue midwife.

How does one answer such a charge?

My husband received an email yesterday from a friend who lives in an Asian country, and whose only contact with childbirth is that which is common to all who have been born. With reference to my blog of 26-Jul, , he wrote that: "I remember very well that Joy told us in 2002 in Melbourne that private midwives cannot easily use anymore the official health insurance channel.

"Now it is being outlawed. We deeply regret this process as midwifery is a nice and biblical profession. [See previous post]

"I especially came across the sentence:
“An outsider looking at the list could conclude that midwives are not all that important in maternity services.”
...
"What is the situation of private midwifery in other countries, e.g. certain European countries?"



The message that those who want midwives to accept the outrageous new restrictions to autonomy in midwifery practice are giving us is that midwives in Netherlands, New Zealand, Canada, UK, Denmark, Switzerland ... are also being prevented from working without indemnity insurance, and that acceptable levels of indemnity insurance are not able to be purchased for private practice. Independent midwives in the UK face similar restrictions.

However, midwives in most of these countries are able, under government schemes, to access suitable indemnity insurance. The proposed actions of the Australian government in making independent midwifery practice unlawful is unprecedented across the developed world. It is good to see a politician, Jamie Briggs who is willing to speak out, 'defending the right of mums to have a safe home birth'.

I am aware that people from many countries are reading this blog. If there are other sites that I don't know about, please leave a comment, with the links.


**********
On a lighter note, here's what the 'Village Midwife' does on Thursday mornings, births permitting. With a group of friends, I can hit the ball as hard as I please, occasionally hitting it well, and enjoying the fresh air and beautiful garden setting of a suburban home.




Sunday, July 26, 2009

Who will be advising the Minister?

The Maternity Services Advisory Group is a new advisory committee of the federal health department, in preparation for implementation of the government's current group of maternity reforms.

These reforms include professional indemnity insurance, Medicare and prescribing rights for midwives, as well as the outlawing of private midwifery practice as we, and the rest of the developed world, know it. That is, women employing a midwife as their primary care provider for their complete maternity care, including birth in the place the woman chooses.

The advisory committee of approximately 25 is topheavy (to put it mildly) with medical stakeholders in maternity care.

The list includes two highly respected midwife academics, Sally Tracy and Pat Brody. Barb Vernon, who is executive officer (with a background in politics, not a midwife) of the Australian College of Midwives (ACM), will also sit on the committee. There are three consumer places, two of which are taken by leading Queensland Maternity Coalition activists, Joanne Smethurst and Bruce Teakle. I see NO name on the list of any person who might have substantial recent midwifery practice on their CV. (please correct me if I am missing something here!)

An outsider looking at the list could conclude that midwives are not all that important in maternity services.

Yet the government's proposed reforms are all about midwifery practice.

The picture I get is a big table with some of the big obstetric names: Ted Weaver, Andrew Foote, Andrew Pesce, David Elwood (you can google them if you want to know more about them). There is one female doctor, Marilyn Clarke from Australian Indigenous Doctors Assn. Other medical names are Steve Sant, Steven Katz, Ross Wilson, Dennis Pashen, and a representative of the Medical Deans of Australia and New Zealand. The Nursing College and union are represented, along with several hospital associations.


I am going to stick my neck out here, and comment on the obvious MALENESS of this committee. Every reader can draw her (or his) own conclusions about what that means. Is this the battleground, at which the boundaries of 'women's business', or what is allowed in the quintessential female acts of bearing and nurturing a child, are decided?


A midwife is a guardian of physiologically normal birth, and an expert who works in harmony with the natural processes in pregnancy, birth, postnatal, and breastfeeding-nurture of the infant.

The focus of 'maternity' has shifted, from the primary care which protects, promotes, and supports wellness, with access to specialist levels of care when appropriate, to the highly medicalised world that treats pregnancy as a condition to be managed, treated, and eventually have the growth extracted. The midwife is the forgotten maternity professional, now on the verge of extinction.

Monday, July 20, 2009

Informed Choice: a privilege but NOT a right

There are some phrases that wend their way into the conversations of groups of people, and noone really remembers when that phrase first came up, or what it really means.

'Informed choice' is one of those phrases, and it has come into general acceptance in midwifery along with 'evidence based practice'. It is meant to refer to the consumer's ability to choose from a range of reasonable options. Sounds fair enough!

What information does a young woman who is pregnant for the first time have access to, so that she can make a choice?
The local GP says "Do you want to go private or public?" - Choice #1
"Which hospital do you want to book with?" Choice #2

... and so on. Informed choices, if you look at the information provided, and the choice made. It's unlikely that any evidence will be offered, unless this green newbie to the birthing market talks about homebirth! At this point we can skip information, choice, research and evidence, and go directly to emotional manipulation and downright bullying.

There is only one basic choice in childbearing - either do it yourself, or find someone else who will do it for you. I can not stand under the 'every woman, every choice' banner. I will wave a banner 'every woman: one choice'. And the one professional attendant who has the duty to promote normal birth, and has the skill to harmonise with the natural physiological processes is the midwife.

I live and work amongst women who are enormously privileged in access to information, options, and services. But there are some even within metropolitan Melbourne, and definitely in other parts of this vast land, who are less able to access what most take for granted.

What 'informed choice' is available to the mother who lives on a cattle property 60k out of the nearest town; where the internet connection doesn't always do the job; where midwives are nurses who assist at hospital births; where the hospital is run like a military outpost to train new doctors, and the folk are told they should consider themselves lucky that they even have doctors? Her choice is to get to the local hospital to give birth, and to do as she is told and hope for the best, or to make a booking in the city and get to the city hospital to give birth, and to do as she is told and hope for the best. Even if she is philosophically committed to 'natural' birthing, it's likely that a 'choice' will be presented that subtly but effectively removes that option.

Yet there's one key decision she has to make: either do it yourself, or ask someone else to do it for you.

AND - in case anyone reading this is not sure of the facts, if you ask what would be the safest way; what is the 'evidence based' way? In almost every case, the safest way for mother and baby is that they do it themselves, with a midwife as primary care provider, UNLESS there is a valid reason to interrupt/intervene/interfere with the natural process.

Friday, July 17, 2009

labour IS a right of passage

At a time when every spare moment has been put to preparing submissions and impact statements in an effort to prevent disastrous legislation from being enacted federally, I have noticed a couple of media comments on the statement by Dr Dennis Walsh, a MAN, and a midwife academic, who says that “labour agony is a ‘rite of passage’ and pain relieving epidurals weaken the mother’s bond with babies”.

I agree.

[I have met Denis. He comes from my home town, Brisbane, not that that makes him right. I really don't get the man midwife thing, but a few men have made midwifery their calling, and a few of them seem to be OK.]

A very useful commentary can be found at a feminist philosophers link, posted by SA midwife Lisa Barrett.

ps - there are some in every walk of life who are perfectionists, and when reading a statement by midwives about protecting and promoting the physiological, normal processes in birth, and avoiding the surgical and medical alternatives, become defensive because they know someone (or they themselves) did not achieve what they perceive to be the ultimate, perfect birth. Please remember, noone gets it right all the time. Most of us are good enough most of the time. Ponder this, and apply it to decisions in bearing a child, bringing a precious new life into this world.

Wednesday, July 15, 2009

Our natural law rights in childbirth

Australia's independent midwives and mothers are now working against time in a concerted effort to protect normal birth, including homebirth and the mother's right to employ a midwife privately.
(please see previous posts on the draft health practitioner legislation if you want more information)

I have received hundreds of emails and phone calls, some from people who have experience in maternity activism, and others from bewildered people who wonder what they can do to help. One email, which was forwarded from someone I have never met, held the key that helped me develop a new line of defence. The email contained personal advice from a lawyer, who pointed out that the Austrlian constitution has clauses that can be used in defence of women's rights to homebirth as a "natural law right".


The legislation denies a woman’s natural law right to give birth under natural physiological conditions, in the place of her choosing.

The only requirement for physiological birth is that the woman is able to proceed without medical or surgical assistance. Since pregnancy and birth are truly natural states, and are not, per se, reliant on outside management, it is reasonable to protect the woman’s natural law right to maintain personal control over such decisions, including if and when she goes to hospital.

I believe that having a baby at home instead of a hospital is a natural law right , given by GOD rather than by government, and covered under the freedom of religious belief provisions of the Australian constitution. Many religious codes have ancient guidance that can be applied to the birth of a baby. The Christian Scriptures, which are my personal supreme guide to faith and action, teach that children are a blessing from God, to be valued and protected, and give many examples of people who protected and supported the mother and child, even in defiance of government (eg Exodus 1:17). Section 116 of the constitution says that the parliament shall make no laws to restrict your religious belief, practice, and observance.

By denying midwives insurance, and denying midwives the right to practise privately in any geographic location, the government would deny a woman's right in physiological childbirth.


I think we need to stress the difference between physiological and medically managed childbirth. No person can predict a particular outcome in maternity care: the care of the midwife is a partnership with the woman, that develops as time passes and decisions are made. The best/safest/uniquely normal default position, which I call 'Plan A', is to proceed naturally without outside stimulation or pain management, as long as there is no valid reason to interrupt, interfere, intervene, or disturb that physiologically natural process. Even so-called natural therapies, and emotional 'support' can also disturb the natural process. The woman's and baby's body's subtle orchestration of hormones and physical activity cannot be replicated in managed birth. Medically managed birth - whether induction of labour, or pain relief with drugs, or anything else that the birthing woman can't do for herself, should be considered iff (if and only if) the natural process is more likely to harm mother and or child than the medical intervention.

My message today to all who read this blog is that we are fighting for something that is truly worth fighting for! But you probably wouldn't be reading this if you didn't already know that.

Be strong and courageous.
Joy Johnston

Monday, July 13, 2009

Saturday, July 11, 2009

please write your submissions today!

TWO VERY IMPORTANT OPPORTUNITIES EXIST RIGHT NOW.
THE PUBLIC (THAT'S YOU AND ME) ARE INVITED TO COMMENT ON:


*1. Exposure draft of Exposure draft of Health Practitioner Regulation National Law 2009 (Bill B) by 17 July 2009.

"If you wish to provide comments on the exposure draft, please lodge a written submission in electronic form, marked Exposure draft, at nraip@dhs.vic.gov.au by close of business on Friday, 17 July 2009. Please note that your submission will be placed on the website after the closing date for all submissions unless you indicate otherwise." Communique - Ministers release draft legislation for National Registration and Accreditation Scheme.


*2. Senate Inquiry into Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related Bills.
The Committee invites you to provide a written submission which should be lodged by 20 July 2009. A public hearing will then be held later in July. The Committee prefers to receive submissions electronically as an attached document – email: community.affairs.sen@aph.gov.au – otherwise by fax (02 6277 5829).


A couple of days ago I was speaking with a mother of four children, all born at home, who lives in a small rural Victorian town. An independent midwife in that town has been attending about 25 homebirths each year, and is loved and respected by her community. Without change to the Health Practitioner legislation and related Bills, these women will not be able to access homebirth from 1 July next year. Even though the Victorian Health Minister has made a public statement about publicly funded homebirth services to be offered in the near future, the only women who will be able to apply for that service will be those within a small radius of the city hospitals from which the model is managed.

This story is repeated time and again across the country. We must prevent the legislation denying midwives the right to practise independently in our communities from progressing any further without crucial changes being made.


We have just a few days in which to prepare our submissions. If my ideas or anything I have written on this blog, or at other sites, is of use in arguing these important points to the Senate or the government, please feel free to borrow liberally.

When you have prepared your submissions, please also send a copy to your State or Territory Health Minister, and your local MPs. Let them know how important the choice of a midwife who can work autonomously in the community, within her scope of practice, is to you.
Joy Johnston

Thursday, July 09, 2009

the personal side of midwifery

I know many of the readers of this blog are interested and very concerned about the matters that I and other Australian midwives have been highlighting in the past months.

On Tuesday I went with several like minded colleagues, including Clare Lane from Midwives Naturally, to the Victorian stakeholders forum on the government's National Registration and Accreditation Scheme for health professionals. A report is being prepared, and I will let you know when it is available. Within the limitations of a large forum's question and answer session, we made every attempt we could to ask the Health Minister to provide a means for the continuing practice of independent midwives.

How did it go? The short answer is that we came away feeling emotionally drained, having banged our heads against a bureaucratic brick wall. The minister clearly stated that the government does not want to support the indemnity insurance for ‘a small pocket of women and midwives’, when there are what he said are ‘better ways to spend the public dollar across the whole health system’ (as he waved his arm across the room at all professionals). I asked what would happen if it was decided that all private GP practices should close, and they be required to work under the supervision of hospitals. (see previous post) The Minister assured the audience that that would not happen. That's a relief, isn't it! After the initial response on questions of homebirth, there was an audible sigh in the room every time another independent midwifery or homebirth question was asked.


Many women choose an independent midwife as their care provider because they value the fact that they have personally chosen that midwife. The same could be said for any other health practitoner - or even the hairdresser or the vet who treats your dog.

Tuesday night was the coldest night for many years in Melbourne. When the phone rang at 2.30 am, and I got into the car to head out, I was shivering a little until the car's heating kicked in. I had a distance to drive - about 35 kilometers. The mother was labouring well, and her baby was born about an hour after I, and the other midwife, Clare, arrived.

The parents of this baby do not appear to be wealthy, yet they chose to engage the private services of two midwives, and pay our fees. Clare and I are not the closest independent midwives to their home, yet they chose to employ us. The main reason the mother gave was that we had attended the birth of their first child several years ago when they lived closer to our homes. Clare and I were more than happy to travel the extra distance and be 'with woman' that night.

This particular mother would probably be eligible for a publicly funded homebirth program, if one existed. Yet should she not retain the right to employ a midwife privately?

The loss of a midwife's right to private practice from 1 July next year will impact on families in subtle and personal ways. Clare and I had both been at the forum the previous day when the Health Minister dismissed our practices as being insignificant, and the women who employ us as being unimportant. We reflected on the deeply personal side of private midwifery practice and homebirth, and will remember this and every birth we attend, as something to treasure.

The personal is political. We cannot allow our elected representatives to ignore our rights to self determination, and evidence supporting the safety of the very model of care that independent midwives offer.

Remember, birth is not an illness.

[for notes on the stakeholders forum, please go to the MiPP blog]

Monday, July 06, 2009

Bill B


Tomorrow (Tues 7 July) I am planning to attend the Victorian stakeholders forum on 'Bill B', the exposure draft of the National Regulation and Accreditation Scheme for health professionals.

I have prepared a couple of documents exploring the clauses in the new legislation, and the impact that this is likely to have on midwives' private practices. Included is a list of questions to ask the representatives from the Department of Human Services at the forum tomorrow. If anyone would like me to send this information to you, please contact me by email joy@aitex.com.au. You will need to introduce yourself if I don't already know you, because I don't want to share my work with people who might abuse it.

You may wonder why I have included a picture of a Bilby, a small mouse-like marsupial with big ears?

Midwives share a lot with the Bilby. I'm suggesting that the Bilby be adopted by midwives as our little animal mascot.

The Bilby is at present being brought back from near-extinction. The midwife in private practice is also an endangered species. We need big ears, like the Bilby, to stay alert to any danger. We need to scurry for cover at the slightest sign.

Let's hope we have the resillience and intelligence to overcome the threats to our existence, and continue providing expert one-to-one midwifery care for women in our communities.


In the interests of best practice, and safe choices for all women, I believe:
• Midwives must be able to practise midwifery without government or outside professional interference
• No group of midwives should be subjected to greater levels of regulation than any other group of midwives – independent midwives expect the same degree of regulation as any other midwife
• The midwifery profession expects the same level of regulation as other health professions
• Peer counselling and confidential review of cases should be implemented. Midwives who are acting in a way that may be unprofessional or incompetent or putting their clients at risk should be reported to the regulatory body for investigation – as for any other professional.
• Risk assessment and response to development of complications is a normal aspect of a midwife’s professional capability. Risk assessment is an ongoing process throughout the episode of care. (WHO 1996 Care in normal birth)
• Women who seek the services of independent midwives will sometimes have complex social and obstetric histories, and this makes the dedicated care of a skilled midwife essential. This option is often not available in hospital based models of care, private or public.
• We need urgently to demolish the barriers that exist in maternity care, preventing midwives from attending their clients privately in hospitals.
• The protection of the midwife’s right to attend a woman privately for maternity care in any setting is strongly in the public interest.

Thursday, July 02, 2009

ABC Radio - Life Matters

As if to celebrate the expected demise of private midwifery and homebirth by this time next year, the ABC Radio's Life Matters program has presented an outrageous interview with Dr Hilary Joyce, the new president of the College of Obstetricians and Gynae's.

You can listen to the podcast here.

I have left a comment at the guestbook.

I would like to suggest that midwives working privately should be treated no differently from doctors or other professionals working privately.

Many women who employ a midwife want to know the person who will be with them throughout their active labour, promoting normal birth, and supporting them to make informed decisions. This is best practice in midwifery, yet it's as scarce as hen's teeth in the public system. That's why women employ midwives privately. There is nothing synister about homebirth. Evidence from international and Australian homebirths shows clearly that homebirth is a reasonable choice for well women with a midwife primary carer who is able to refer to obstetric specialists if and when complications arise.

Most midwives in private practice are highly competent midwives, and we have excellent outcomes. I am one. I have practised privately for the past 15+ years, and I stand to lose my livelihood next year because I can't purchase professional indemnity insurance.

The bias of the guest Dr Hilary Joyce in this interview was not explored. The claims linking Australia's maternity obstetrics with obstetric oversight of birth cannot be supported. An outcome for which obstericians are primarily responsible is that more than 30% of Australian babies are born by caesarean surgery.

Obstetricians do not practise midwifery; midwives do not practise obstetrics. The midwife has, by definition, a duty to promote normal birth. The obstetrician is a surgeon, who should be consulted only when illness or complication arise in pregnancy or birth.

Remember, pregnancy and birth are not an illness.

You can read comments, and leave your own at Life Matters Guestbook.

Wednesday, July 01, 2009

1 July 2009



I want to mark this day, 1 July 2009.

In just twelve months from today privately practising midwives who don’t have insurance will be called ‘non-practising midwives’ under the new national Health Practitioner Registration laws. New arrangements will provide indemnity insurance for eligible midwives to practise other parts of midwifery, but NOT homebirth. Homebirth is the livelihood of self employed, privately practising midwives.

The new laws and provisions will potentially open up new freedom for midwives employed by hospitals; an item for celebration. Even homebirth may be provided by the hospitals - the insurance will be provided as part of the employer's vicarious liability arrangements.

It will be confusing and dangerous for consumers, and we need to do all we can to prevent this ill-thought-out health reform from progressing without amendment to enable a midwife to practise midwifery in any setting, which is fundamental to the international definition of the midwife.