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.

No comments: