Monday, May 19, 2014


This is an amazing old piece of stitching. 
But, I don't think it is meant to represent a ruptured uterus!
Recently, the Nurses and Midwives Board of Australia (NMBA, or Board) has invited midwives to participate in a series of focus groups and consultations that will lead to a process of supervision for privately practising midwives.  I and a number of other midwives and stakeholders have been invited to participate in three expert consultations with the law firm, Pricewaterhouse Coopers (PwC) that has been engaged to oversee the project, and advise on potential models.

This midwife supervision project is all about the statutory duty (of the NMBA) to provide a level of protection for the public through regulation and support of the midwifery profession.  Whether or not they introduce supervision for PPMs, or for all midwives, and what it will look like (how supervision will work) is unknown.  Note that the Board has recently replaced its ‘Safety and quality framework for midwives attending homebirths’ with a SQF for all midwives

If you are a midwife who has worked in the United Kingdom, you will know that all midwives there have a supervisor, who answers to the local regulatory authorities, who in turn answer to the national regulator.  The process is at present being reviewed.  [See Parliamentary and Health Services Ombudsman's Conclusions and Recommendations -added to this post 19/6/14]

The current model of supervision, in the UK context, is a "means of promoting excellence in midwifery care, by supporting midwives to practise with confidence ...", and  a means of protection of "women and babies by actively promoting a safe standard of practice." (NMC 2009.  Modern Supervision in Action: a practical guide for Midwives, p3)

That two-sided goal, to protect mothers and babies, at the same time as supporting midwives, is what statutory regulation seeks to provide.  A process that is focused solely on weeding out those midwives who may have performed poorly in a particular situation is unbalanced and probably unnecessarily punitive.  A process that is focused solely on supporting midwives, and ignores the need for careful correction and improvement, is also unbalanced and may lead to tragic, preventable outcomes for the consumer, and loss of that midwife to the workforce. 

At present in this country any midwife is able to elect to work in a self-employed capacity, or employed privately by a midwifery group practice.  A small number of midwives have chosen one of these pathways, with very little, or no postgraduate experience working in the more structured, and more supervised, environment: mainstream hospital maternity wards.  Within hospital employment models a midwife who has recently graduated will be given support and a process of structured performance reviews over time.  A midwife whose practice does not meet the standard expected within the unit may be asked to agree to a performance contract that includes measurable outcomes.

Midwives who are practising privately form a very small proportion of the profession.  Yet, we are an easy target for bureaucratic control.  In the past few years we have jumped through amazing hoops in order to achieve eligibility for Medicare, and notation on the register as midwife prescribers.  We are instructed and guided by the Board, the insurers, Medicare, and professional bodies, and the list of codes, guidelines and instructions grows constantly.  In my opinion, there is no need for a professional supervision program for all privately practising midwives.  It would be an enormous waste of resources, for very little gain.

I would like to urge the NMBA to establish a targeted professional supervision program, with a strong focus on adult learning through peer discussion and reflection, directed at those midwives who have recently commenced private practice, as well as those who have had complaints or notifications made about their private practice.  The midwife may be required to comply with a program of professional supervision for a period of time, such as 5 years, or a number of episodes of care (eg 50) in which the woman is receiving primary maternity care from that midwife.  The midwife supervisor would need to be a respected and experienced member of the profession, who has demonstrated her/his ability to practise midwifery in the private practice context.  At the end of the supervision period, the supervisor would advise the NMBA of the midwife's successful completion, or recommend an extension.  If at some time the supervisor forms the opinion that the midwife's practice does not meet the Board's standard, there may be restrictions to practice imposed, and the process of notification, investigation, and a hearing would need to be initiated.   The Board has supportive processes like this available for nurses and midwives who seek help in dealing with mental health issues, or alcohol or other substance addiction. 

The opinions shared and explored here are my own.  I would be very happy to discuss this matter further with midwives or others, either through the comment function on this blog, or at my villagemidwife facebook site.


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