Tuesday, May 20, 2014

supervision, part 2

Beautiful Brisbane, the city of my birth

continuing from yesterday's post, ...

[I have posted these comments on a social media site that might not be accessed by many of my readers, so have copied and expanded it here.]

A blog post by UK midwife-author-teacher Sarah Wickham, questioning the Australian regulation of midwives, provides comment on the UK model of supervision of midwives.

I share Sarah Wickham's concern, when midwives are subjected to "vexatious reporting and persecution in a number of ways, simply for supporting women’s choices."

Without pointing the finger at any person, and I wasn't at the recent homebirth conference in Brisbane, I think it's likely that Sarah has heard only a fraction of the story.  In my opinion there have been too many cases recently, some on public record, in which midwives have hidden behind a notion of the woman's choice, when in fact there was no discussion of escalation of care and appropriate intervention.  Midwifery partnership can only be achieved when the conversation between the midwife and the woman is ongoing, and informed *decisions* are made rather than choices.

An effective program of professional supervision of midwives could, theoretically at least, support the midwife in real time whose client is making an informed decision that does not follow usual professional advice.  This would apply whether the midwife was in private practice or employed in a hospital or other birthing facility.   The UK model of supervision of midwives is for all midwives.

A midwife can't afford to be a true believer, or to 'trust birth' in any idealistic way, even though we act to promote, protect and support normal birth and the physiological adaptation of the newborn to life out of the womb.

The setting/place of birth (home/hospital) has become an obstacle in this country to good midwifery practice, because privately practising midwives are restricted to homebirth.  The exclusion of PP midwives from mainstream hospital is not in the interests of wellbeing and safety of mother and baby, and probably contributes in complex (and unaccountable) ways to some adverse outcomes. The midwife's duty of care includes what we do in emergencies, and accessing medical (ie hospital) help in a timely manner. 
The introduction of the wonderful www, and social media, and digital communication ... has had a profound impact on some women's access to information about birth, and their choices. Anyone who remembers 20 years ago, when homes didn't have internet access, and mobile phones were great big clunky devices, will know what I mean. Now women tell me they have 'researched' their choices, as though it's done and dusted. The rise and rise of freebirthing is very much an internet phenomenon.

Please keep the conversation happening.

1 comment:

Anonymous said...

My understanding of Sara's post was that she was commenting on the 'duty of care' issue... or lack of in Australia. Supervisors of midwives are just one piece of the UK system which maintains women's right to bodily autonomy. The SoM ensures that the midwife has provided adequate information/recommendations and has documented this. The SoM is there to support the midwife as she continues to support a woman who declines the recommended pathways. The midwife has no choice... she has to continue care because she has a 'duty of care'. Without a duty of care the supervision of midwives has an entirely different context. If the SoM's role is to support/protect the midwife (not the woman) she will be recommending withdrawal of care.

When I first arrived in Australia I was also shocked by the lack of a 'duty of care' - it was an integral part of midwifery in the UK. Sometimes it takes an outsider to see a situation for clearly.

I was at the Homebirth Conference and the presentation in question was on an investigation into 'vexatious reporting of IMs to AHPRA' - an ACM funded project. Nothing to do with the various Coronial inquiries. Are there plans for the ACM to publish the findings of this investigation?