Becoming a mother is a quintisentially profound moment in a woman's life, regardless of her people group, education, wealth, or any other variable. A midwife holds knowledge and skill of working in a way that protects, promotes, and supports wellness in the childbearing process and adjustment to motherhood.
|A greeting card that captures some of the wonder of becoming a mother.|
The regulation of midwifery, and other health professions, is the process by which a society can have confidence in the profession, ensuring high standards of education and practice, and a reliable process of investigation and calling to account any midwife who is involved in care that leads to adverse outcomes, or allegations of professional misconduct.
In its Request for Tender – Privately practicing midwives models of supervision, the NMBA (2013) has stated that supervision is: “a critical mechanism in the training, support and ongoing safe practice of midwifery. It incorporates elements of direction and guidance through a process of professional support and learning which enables a practitioner to develop knowledge and competence, assume responsibility for their own practice and enhance public protection and safety.”
The Australian College of Midwives (ACM) has encouraged members to communicate the following points to the reviewers, either in the consultative process of focus groups, or via the online survey. ACM states that:
- Supervision should be a supportive, mentoring and advisory process, not a management or punitive process;
- There should be one supervision process for all midwives
- If supervision is mandated by the NMBA, the model should be developed, implemented and regulated by midwives, not other professions
- Supervision is not an inter-professional clinical review process
- The importance of current practices in Australia such as the ACM Midwifery Practice Review (MPR) program, should not be overlooked.
- The projects should also be mindful of other review and consultation processes currently happening, and that supervision should not been seen in isolation:
- ACM evaluation of MPR
- NMBA review of the Quality and Safety Framework
- NMBA review of registration standards for both midwives and eligible midwives
- ANMAC’s review of standards for prescribing programs and peer review programs
Many midwives using social media have been quick to express their frustration and dismay at *yet another* level of regulatory control. Questions asked include:
- Why are private practice midwives being subjected to supervision?
- Haven't we jumped through enough hoops with eligibility, insurance, MPR, QSF, and all the codes and guidelines we have to follow?
- The UK Health Ombudsman found their supervision system has problems - "Supervision is a statutory responsibility...the dual role of a Supervisor, providing support but also a regulatory function, allows for an inherent conflict of interest." Why are we introducing supervision if it is not working in the UK?
- Who pays for supervision?
- The UK review also found "There is a weak evidence base in terms of risk for the continuation of an additional tier of regulation for midwives."
- What if the woman doesn't want a supervisor involved in her care?
- Is the supervision remote or ... direct observation?
- How are the supervisors trained? Who trains them?
- Can a non-eligible midwife supervise an eligible midwife?
- What Body does the supervisor report to?
In concluding this log, I would like to put my thoughts on the record.
Anything that comes from the NMBA needs to be of a regulatory nature, and that regulation needs to be transparent about what it is seeking to achieve, and properly managed and funded to maintain the integrity of the process. This sort of regulatory professional supervision could be applied to all midwives who move into private practice, for a period, such as up to five years, with standards against which the midwife and the supervisor are able to assess performance. Midwives who have had some years of experience in midwifery may be able to demonstrate their "knowledge, competence, and responsibility" over a shorter period of time (eg 1 year), while new graduates of a B Mid course, or midwives who are under Board investigation, may remain under supervision for the full five years, or more.
In developing my position on professional supervision, I must assume that any regulatory requirement must be funded, for the preparation and payment of supervisors, and the ongoing development of the program.
I do not agree with a process that attempts to integrate the regulatory surveillance role with a support role. Mentoring and support are valuable elements of professional development, but are different, and should be separate from supervision.
Your comments here, or in the facebook villagemidwife group, are welcome.