Tuesday, November 23, 2010

Update on Medicare

Bec and James
For an update on Midwives with Medicare provider numbers, go to the midwivesVictoria blog

Sunday, November 14, 2010

Midwifery - much more than a job

Midwifery is the calling, the profession, the vocation that has claimed my attention and inspired me throughout most of my adult life. During the past two decades I have learnt to apply the basic knowledge and skill that I had when employed in a maternity hospital to the individual women whom I have been privileged to attend.

Midwifery is much more than a job.

When I was employed by the Women's in the 1980s, working a couple of night shifts each week, I used to feel as though I was having one night stands with women, being close to them at such significant moments in their lives, and walking away from them at the end of the shift. This was before I had noticed any professional discussion about caseloads, or continuity of care. I now see this feeling as evidence of my developing *midwife identity*. For twelve years I had a job as a midwife in a public hospital. A job that I could walk away from when the time came, and return home to my young children and my husband.

When the time came for me to move away from that *job* and set up my own *practice*, I experienced a sense of freedom that I had not previously imagined. I went into private practice like a duck to water. I could not have been in a better place, and my emerging identity as a midwife was sealed and flourished. I found that I could write and teach, sharing the knowledge I had acquired from study and from giving birth and nurturing my own children, and the principles upon which that knowledge was based.

I accepted that, in order for a private midwifery practice to be viable in this country, I needed to charge a fee that reflected the commitment I was making. When I was employed in midwifery there was always a pay packet at regular intervals. Now I would not be paid unless women paid me. All I can say is that I have not missed the regular salary one bit. Even as the main breadwinner for our household, the steady stream of clients who employ me to be 'with woman' have provided sufficient income for my needs.

The terrain of private midwifery practice in Australia is changing now. Midwives are now able to demonstrate to the regulatory authority that we are suitably competent in all aspects of basic midwifery, and through that process become eligible for private clients to claim Medicare rebates. The legislation around Medicare, particularly the requirements for collaborative arrangements, has been criticised by me and many others who have read it. The process to provide Medicare rebates is potentially arduous, and there are questions that are still unanswered.  But there is a process, and it is there for midwives to apply.

I know of a small group of midwives who are progressing towards the Medicare eligibility goal - some may already have achieved it.

I have stood back a little, attempting to line up options for collaboration with public hospitals. This is not to focus only on what I need, but to establish pathways for other midwives.

Some of my colleagues have become concerned that midwives who accept Medicare eligibility will be compromising midwifery standards, and women's rights to informed consent or refusal.   I will be watching closely to see that this does not happen.

Monday, November 08, 2010

Global forum: optimising the effecctiveness of Health Workers to achieve MDG's 1 and 5

I would encourage readers to follow, and to consider making a contribution to this global forum.
My responses to the forum questions will be posted at my 'private midwifery' blog, as well as at the forum site

Friday, November 05, 2010

I wonder what this one will teach me?

Mothers wonder ...
Midwives wonder.

I wonder what this one will teach me?

As each decision point is reached and the choice is made, this way or that, the course of events is shaped and cannot be undone. As each baby is born, and the cycle of life moves on, the mother learns something about herself, and something new about life. The midwife, in her interwoven world, also learns something about herself, and reinforces or renews her understanding of the wonder of life.

Dear reader, do you know what I am saying?

Do you understand the flow of life, and the decisions that are made - especially in the context of that basic and primal event of giving birth? Do you recognise a decision as a fork in life's journey. You choose one and you consequently reject the other. You can never come back to this decision, this bifurcation in the path.

The mothers who have had larger numbers of children; five, six, or more, are usually the ones who marvel at the uniqueness of each experience. When these mothers come to see me for a prenatal checkup I love to listen to what they have to say. I don't need to teach them about childbirth. We spend an hour or so in my little office, surrounded by my messy shelves of books and folders, and the cork boards filled with wonderful photos, and some artworks that are particularly dear to me, and my wall calendar with the names of the women to whom I am committed. I usually start with the question, "Did you have anything that you wanted to talk with me about today?" Then we pass the time in an easy, unstructured exchange. At some point I do the basic checks - blood pressure, palpation of the womb and auscultation of the baby's heart sounds. The information is noted down.

But the building of a relationship is what takes most of the hour's visit. There is no box in my paperwork to tick about trust. There is no place to note the unique sharing of lives: a woman and her midwife.

One particular day I was feeling very weary. The pressures of my personal life, and professional stuff including all the campaigning for better maternity services had left me feeling emotionally and physically low. Depressed? Yes, I was. I had become unexpectedly teary when some friends started talking about their plans for holidays. I told my sister about my feelings, and that I had not had a holiday for a long time, and she informed me that was not good work practice. Dear reader, I'm sure she didn't mean to hurt me. We love each other, and talk about things that are important to us.

Anyway, on that particular day, the phone rang. A mother told me she thought her labour was starting. She needed to contact her husband so that he would be at home to look after the children. Soon she rang again. Husband was on the way, and she asked me to come.

As I moved quickly from my introspective mood to a more organised, directed persona, I prayed for strength and wisdom. It's late afternoon. I may be out through the night. I need alertness of mind and strength of body. I may need special courage and wisdom as decision points are reached. I pray for God's special protection and blessing on the mother and child in my care.

On that particular day the labour progressed quickly. A baby was born without complication or incident. The mother sat quietly in an arm chair and focused on her little son as he worked his way to her breast and began to take his first feed. She had a couple of contractions, and I reminded her about the birth of the placenta.

Then the mother lifted the towel from her belly, and said "Joy, there's a lump here still. Could this be another baby?"

Yes, it could ... and it was.

As I put on a sterile glove to check how this baby intended to be born, there was one push, a gush of fluid, and the little sister made her entrance - beautifully.

I will never forget the mother's ecstatic face as she said "I've got TWO babies!"

That night as I returned home I reflected on not just the birth - amazing as it was - but also my physical, emotional, and spiritual journey that day. What did this one teach me? Quite a lot.