Midwives seem to be positioning themselves in two main camps: pragmatism, making the best of the situation, on one hand, and resistance to what is seen as removing the midwife's right to autonomy in practice as well as threatening the woman's right to informed consent. Much of the disagreement centres around legislation requiring a collaborative agreement between a midwife and a named doctor in order for the midwife to be able to access Medicare funding, and visiting access in hospitals for intrapartum care.
The Australian Private Midwives Association (APMA) position statement on Collaborative arrangements [click here] opposes the Determination, contending that:
A recent meeting between the Health Minister Nicola Roxon and four independent candidates who stood in extremely marginal seats in this year's federal election, and maternity activist Justine Caines, has given rise to an interesting report published anonymously at the APMA blog. The writer indicates that"Private practice midwifery will become known as the model whereby midwives are working in private medical practices, with little regard for those self employed midwives who currently provide true midwifery care at this current time."
The Australian College of Midwives (ACM) has promoted the pragmatist position, with statements such as:"It is possible that the Gillard Government is contravening its responsibilities under the Convention of the Elimination of all forms of Discrimination Against Women (CEDAW)."... and"The political cost has been high with Minister Roxon embarrassed by poor advice."
"The College maintains the view that while this Determination is a poor piece of legislation we need to continue working with the Minister’s Office and the Department of Health and Ageing to provide evidence that will support the Minister in making any necessary changes. The College is dedicated to ensuring that midwives and women are not disadvantaged by this legislation." (e-Bulletin 29/10/2010)Leaders in ACM have encouraged members to accept the Determination, indicating a fear that the whole maternity reform process could be derailed if there were to be a motion to disallow the Determination, and that motion were passed. The reforms that enable midwives to claim Medicare funding, and have limited prescribing rights, and the right to order basic tests and investigations are seen as being of great value to the profession as a whole, while the potential disadvantage that comes with a return to medical supervision of a midwife's practice, sold under the guise of team work/collaboration, is seen as an acceptable trade off.
Midwives continue to work through these issues.
I hope to be able to keep readers informed of progress.