Friday, July 13, 2012

hospitals and independent midwives

When a midwife walks into a hospital with a woman for whom she is providing private midwifery services, that midwife faces a complex and often challenging work environment.

Recently I went to hospital with a woman who I will call Melissa, who was planning VBAC.  Melissa's first child had been delivered by emergency caesarean, after induction of labour at 42 weeks.  This time Melissa was well informed, and intentional about all her decisions.

Melissa had experienced a difficult week 39-40 in her pregnancy.  There were several nights without much sleep, and she had a cold.  A couple of days after her expected due date, Melissa asked me to assess her internally, and consider a 'stretch and sweep' of the membranes at her cervix.  I was pleased to report a well applied head, a very thin cervix, and about 1.5cm dilation.  With very gentle stretching of the cervix, I felt confident that the labour was imminent.

Sure enough, Melissa called me a few hours later, and I went with her as she was admitted to the hospital birth suite.  Melissa laboured strongly, and together we considered any decisions that needed to be made, following 'Plan A'.  I continued 'with woman' through the labour and birth, and afterwards.

There is nothing remarkable about this little account.  However, the matter that has prompted me to write about hospitals and independent midwives is the question of what to call a midwife who goes to hospital with a woman in her care.

I call that midwife a midwife.

Others call that midwife a 'support person', or a 'birth support person', or even 'only support'!

Why?

Because the independent midwife does not have visiting access/ clinical privileges/ credentialling in that hospital.

This is true - Victorian public maternity hospitals have dragged their feet on this matter.  Despite government-supported indemnity insurance for private midwives providing intrapartum care in hospital, there is no likelihood of hospital visiting access in the near future.

So does a midwife cease to be a midwife, just because the hospital refuses to roll out the red carpet?  Of course not!  A midwife is 'with woman': not with a setting for birth.  The midwife's registration is with the regulatory body, which is not under the management of the hospital.  And, let's remember that if a midwife acted in a way that was considered unprofessional, she or he would expect to be reported to the regulatory authority as a midwife, not as a 'support person'.

The ICM definition of the Midwife
declares that the midwife's Scope of Practice is:
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

'Support' is listed in the definition as one of the elements of midwifery.  I do not want to seem to devalue support.  But the point I want to make is that support is a part of the midwife's scope of practice: not an alternative to midwifery practice, and definitely not an alternative to the title 'midwife'.

Thankyou for your comments.

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