Thursday, October 20, 2011

what will the students think?

A few weeks ago I wrote about the interim Position Statement on Homebirth that appeared , with endorsement, on the website of the statutory body. The Position Statement and associated documents had been prepared by the College of Midwives.

Today I attended a meeting of members of the College, at which I and other members took the opportunity to speak about our concerns around these documents.

After the meeting several colleagues voiced their dismay at what they had witnessed in that meeting. One midwife, with tears in her eyes, told me how distressed she was that midwifery students and newly graduated midwives were present at the meeting, and wondered what will they think of their colleagues.

I am proud to be a member of the College of Midwives. AND I am proud to stand with colleagues from private practice, academia, and employed midwifery practice, to protect the scope of midwifery practice.

I cannot go into detail about the conversations. I have no intention to write anything that identifies others who were present at that meeting. I want to address issues that I spoke about in the presence of several hundred other members. These issues are of huge importance to midwives who practise privately; they are core issues for which midwives are prepared to stand up, and demand that our voices be heard.

It has been pointed out that homebirth represents a tiny percentage - less than 1% - of births in Australia; and that homebirth claims a hugely disproportionate amount of time and energy within the midwifery profession.

A Position Statement on homebirth, endorsed by the government's regulatory authority, becomes a new level of regulation; a new set of rules. Midwives whose professional existence is inextricably linked with the decisions around homebirth have an obvious interest in ensuring that any Position Statement on homebirth accurately represents our position. As members of a professional association we expect, and demand, the right to participate at a realistic level in the development of any Position Statement on the part of midwifery practice for which we are recognised and respected as experts.  Our participation in this important process must be by invitation to organised groups of midwives in private practice, and not merely a general opportunity to comment on a rushed penultimate draft or 'interim' document that has already been sent to the regulatory authority for endorsement. 

The issue that has divided midwives in this debate centres on which women 'can', and which women 'can't', give birth at home. See my previous post 'refining and redefining' for more discussion on risk.

There is no question that homebirth is safe for some women; the disagreement lies in who defines safety; who controls the decision.

I need to conclude this post and go to bed, but a serious point that I need to make is that the focus on *homebirth* is very problematic. Midwifery requires the focus, or centre of care to be the woman, not the planned place of birth. The essence of midwifery is a partnership: a midwife with woman. . The place of birth is of lesser importance. Yet here we are, expending enormous amounts of energy, and struggling with all the resources we possess, to ensure that Australian midwives, and Australian women, are able to continue to make informed decisions about homebirth.

What will the students think?

I hope all midwifery students who are conscious of the debate around protecting women's autonomy in the basic decisions ('Plan A') for birth, and in protecting a midwife's scope of practice, will be proud to be joining such a profession.

Post script:
Please see here to see what midwifery students feel and think about the ACM interim homebirth position statement.


Anonymous said...

What will we think, indeed. Although very disappointed at the stance the ACM has taken, I'm not sure I'm surprised. It seems things must get worse (for women and for midwives) before they can get better. I pray the 'worse' doesn't get much more so. For as both a consumer of private midwifery services (and I hope one day to do so again) and a student midwife (who hopes to be supported in private practice upon completion of my studies) I must maintain a level of stoic optimism. I must admit I sometimes feel a bit like a suffragette must have.

And I agree Joy - we expend considerable energy debating venue, which places the focus somewhere other than where it should be - the woman.

Here's to the voice of the minority, protecting the rights of everyone.

Joy Johnston said...

Stoic optimism is an excellent quality, Anonymous.
The fact that keeps my sense of optimism alive is knowing that a woman has the knowledge of birth and nurture of her child deep in her mind, and no amount of social conditioning or bureaucratic control can take that from her.
I believe that the struggle to protect normal physiological processes in birth will always be with us. Those of us who engage in that struggle need an ideal towards which we are working, while at the same time accepting the reality of the 'system' as it is. There are many 'systems' around the world that are far worse than ours, where women and babies have seriously worse outcomes than we do.

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