Patience

The matter that has occupied a great deal of my time and thinking space lately is the new world of maternity reform that centres on being 'eligible' for Medicare. A summary of the 'New Arrangements for Midwives' is at the MIPP blog.

My application for eligibility has been in the hands of the Nursing and Midwifery Board since early December 2010. I have had discussion with the Board's officer who has processed it, and my application was on the Board's agenda for this past Thursday. However, the meeting was adjourned unfinsihed, and my item was not discussed. It will be on the agenda for the reconvened meeting.

A midwife's knitting

I have had knitting or crochet projects on the go, particularly in the cooler months, for as long as I can remember. My projects are not usually complicated. I lose interest in some and pull them apart so that the wool can be used for someting else. I have to be able to put it down and pick it up without losing my place. I'm not a particularly good knitter, not particularly fast.

There are shawls and rugs and hats and slippers and simple toys.

I was a little amused to read in a notice about the Womb-ecology Mid-Pacific conference coming up in Hawaii in 2012 that one of the workshops is ‘silent knitting’

“Of course the “silent knitting” session will be the historical symbol of the paradigm shift we are dreaming of after thousands of years of socialisation of childbirth, at a time when modern physiology is teaching us that one cannot positively help involuntary processes such as the birth process, but that some situations can inhibit them (neocortical activity and adrenaline release). Participants will be in an ideal situation to realise that avoiding the use of language is a way to reduce neocortical activity, and that a repetitive task like knitting is a way to reduce the level of stress hormones: a crucial step towards the rediscovery of authentic midwifery.”

Pain

Beautiful Eve

Am I rushing in where angels fear to tread?

A recent post at the Science and Sensibility blog about Epidural Anaesthesia, written by well known Canadian family physician, Michael Klein MD, will be of interest to anyone who is interested in pain and childbearing. Dr Klein's paper is well referenced, and a reliable review of current medical knowledge about the topic.

The comments by readers reveal to me some of the myths and misunderstandings about pain and childbirth that I encounter from time to time. Comments quickly become defensive, assertive, and even aggressive in defending one camp or the other.

Caring about professional conduct

The topic of this post is one that is unlikely to attract acolades for the writer. It's one of those aspects of professional practice that implies a risk to the recipients of care, and that sometimes difficult judgments need to be made in order to maintain a professional standard.

There are people in every walk of life who develop conditions that may impair their judgment or conduct, people whose thoughts and actions are adversely influenced by alcohol or other substances, and people who fail to meet the community's standard in terms of professional misconduct and abuse of their position of trust. There are also people whose actions as professionals are significantly different from accepted professional standards. While tolerance and acceptance of difference are values many of us hold dear, we must all take seriously our duty of care, and act to protect others at times when we observe conduct that is of concern.

Risk aversion

Midwives who attend women for homebirths have often been portrayed as having an affinity or fondness for risk, accepting and even encouraging situations that would not be considered suitable for midwife-led care in hospital.

Preparing for Medicare

Wonderful artwork by Poppy to brighten the page.

In early December I wrote about the fact that I had submitted my application to be noted as eligible for Medicare (see blog). I have been told that this application is being processed.
In preparation for submitting an application, all midwives are required to participate in a Professional Practice Review approved by the Board (NMBA). The review that I undertook is the Midwives in Private Practice Professional Practice Review ('MIPP PPR' for short) which had previously been submitted to the Board for approval. Having worked on the MIPP PPR since its introduction in 2002, I enjoyed updating it to meet the written requirements of the new Board, and then undertaking a practice review, and presenting my findings to an experienced and respected midwife colleague.

Professional organisations and networks for midwives

Rally outside Julia Gillard's Werribee office 2009

In recent days I have had cause to reflect on the importance of various professional organisations and networks that are available for me as a midwife.  Here are a few:

• Australian College of Midwives - ACM, the peak body representing the midwifery profession in this country.
• Maternity Coalition - MC, advocating for consumers and midwives in maternity care
• Midwives in Private Practice - MiPP, a collective of midwives in Victoria, and a Participating Organisation in Maternity Coalition
• Australian Private Midwives' Association - APMA, representing private midwives nationally

Plans for the new year

As the sun goes down on 1 January 2011 in our part of the world, others have just seen the New Year in.

I have noticed from the statistics function on this blog that a large number of the visitors to this blog are in the United States. G'day, folks! I am delighted to have you visit. I have wonderful memories of five winters in Michigan, and have attached a family pic, with me holding our first baby, that takes us back 37 years.

New Year 1974, at our home in Biscayne Way, Haslett Michigan

Twelve months ago, I and other Australian midwives were wondering if we would be able to practise legally, after 1 November. We are practising, and intend to continue. I won't say without change - anyone who is so set in their ways that they are not willing to change should not be practising. We must continue to change and grow in our understanding of birthing processes, while we adapt and work within the limitations of our own lives (such as ageing), and the law.

Homebirths 2008 in Victoria

For summary and comment go to the APMA blog.

"a goodly child"

Christmas greetings, as we celebrate the birth of the Child.

As the Christmas season approaches each year, it is usual in our family to not only send our greetings but to briefly summarise the highlights of the previous year.

I have always found this a challenge, wanting to say something worth hearing, without being tedious. The recipients of our letter include our families and close friends, with whom we communicate by phone, email, and in person as often as we can; and other friends, some of whom we have not seen for many years, and with whom we communicate only once a year.

I have been reflecting on the highs (and lows) of this year 2010, and my mind has returned consistently to the two new babies, James and Eve, who were born into our family in May, and who are thriving in mind and body. The wonder and beauty of new life is powerful enough to keep me going for as long as I have energy to think and write.

Like ripples in a pond, my thoughts have then moved to our precious grand-daughter Poppy, and beyond her to our own four children.  I have remembered my own mother, and the generations of mothers before her.

Grand-parents are allowed to dote, quite openly, on their grand-children. Parents are often more cautious. Parents carry the weight of many responsibilities, and often struggle to achieve what they consider basic, such as feeding, clothing, educating, teaching manners, and getting the children to bed on time.


In my musings about our grand-children, and our children, my thoughts moved to the story of a baby, in Exodus 2.
"The woman conceived and bore a son; and when she saw that he was a fine baby, she hid him three months." (verse 2)

Another version says he was "a goodly child". 

The story is well known.  After three months the mother made a little basket of papyrus, and plastered it with bitumen and pitch to make it water-proof, and set in in the shallow reedy part of the Nile river where the princess would come to wash.  She set her daughter Miriam as the onlooker, ready to offer practical assistance of a Hebrew 'wet nurse', the baby's own loving mother, when the princess also saw that he was a fine baby, and decided to keep him.  This decision saved the life of that baby boy.


When the birth of a child is welcomed by a mother who sees that this is "a goodly child", and that mother does all in her power to protect and nurture the child, even in the most adverse circumstances, there is hope for the future.  It was no miracle that the mother of the child saw that he was "a goodly child", and defied the government of the day in the most strategic way in looking after him.  The miracle was that the princess shared in the vision of "a goodly child".  She knew exactly what the mother intended, and she agreed with the mother's plan to save that child's life.

When a child is born there is a flooding of the love hormone, oxytocin, throughout the mother's body, in a way that she can only experience at such a time.  This outpouring continues with each touch, look, and suckle from the infant.  It is right for a mother to look at her child and see "a goodly child".  It is right and normal for a mother to use every strategy at her disposal to ensure the safety and nurture of that child, while maintaining the closeness of the exclusive mothering bond during the infant's first years.

I want to encourage every parent who reads this blog, to take a moment to look at your child, and see that she or he is wonderfully special, a child with great potential.  See that your child is "a goodly child".  Whatever the challenges you face in ensuring the safety and care of that child, so that she or he can grow to unhindered maturity emotionally and physically, keep your vision clear, and remember the mother whose child was wonderfully saved in infancy, and later became a great leader.

I also want to encourage midwives who read my writings to see each child as carrying immense and unmeasurable potential.  We midwives are the guardians of the next generation, protecting the mothers in their ability to not only give birth, but also to see their children for what they are.

May God's blessing be on you as we celebrate the birth of the Christ child.
Joy

Loving

From time to time in this blog I attempt to write a personal letter to my readers. Many readers have never met me in person, and I don't know you. However, our common interest in midwifery and anything that touches on women's reproductive lives gives me the opportunity to use a broad range of topics in writing to you.


The wonder and beauty of human love shared by a woman and her man, are in my mind, founded on the creation story in Genesis 1. God created human kind “in our image, according to our likeness”; “in the image of God he created them, male and female he created them. God blessed them ... God saw everything that he had made, and indeed, it was very good.”

"Indeed, it was very good" the way our bodies, male and female, were created. The workings of the male-female creature, made wonderfully in God’s image and likeness, are indeed very good.

It [the way our bodies work together as woman and man] is very good whether we [intellectually] understand the processes or not. It is very good because it has been very good from the start, and we have a deep intuitive knowing that it is very good. 

This separation of intuitive ‘knowing’ from intellectual ‘learning’ fits with my understanding of normal, physiological childbirth and nurture of a baby. (I use the word ‘physiological’, to differentiate from normal meaning ‘usual’, which is often very far from the normal, natural process.)

Intuitive, or maieutic, knowing is influenced by the amazingly sensitive hormonal states within our bodies, and is not dependent on theoretical understanding of what's going on at the time. The intellectual ‘learning’, achieved through more didactic processes involving teachers/writers and students/readers, is a particularly human characteristic. Other creatures who share similar physiology do not seem to share our need, or capacity, to understand why, and how.

Although there are aspects of the whole loving – childbearing – child nurture spectrum that our minds are able to investigate and delve into, I believe that the unique opportunity that the creator has given us is that we can experience something that is VERY good best without seeking to manage, control, or even understand it.

I see this principle being worked out many times when a mother who has given birth to her child is transported into a relationship of deep love for that child.  Science calls it maternal instinct, and tells us that the primal parts of the mother’s brain are able to assert themselves, while the neocortex, or ‘new’ brain, is unstimulated.

That makes sense, and it reminds me that “indeed, it was very good.” The hormonal interactions of the normal loving – childbearing – nurture activities are “very good”. And when, as happens in these activities, there is a climax – a peak of the loving hormones, and we experience an altered state of consciousness with a huge rush of excitement, pain, wonder and amazement that we had not expected and that floods our being: indeed, that’s very good.

I don’t know if there is an ideal way for a couple to enjoy their oneness. I think it’s best not to seek that knowledge from an intellectual perspective. Each couple has the opportunity, in the privacy of their own relationship, to seek deeper and more enjoyable sexual intimacy. There is something reflecting the image and likeness of God in each of us that is, indeed, very good.

Notation on the Register

I have now completed my application for 'notation' on the midwives register, as a midwife eligible for Medicare. My CV has been adapted to comply with the AHPRA standard, and copies of documents need to be certified as correct, also in compliance with the required standard.
This process has been a challenging one for me. A few of my trusted colleagues and friends wonder why I would even try to become 'eligible'. By accepting a terribly flawed process, am I not supporting our society's attempts to medicalise women's lives, and to give a veto power to the medical profession over midwifery and women's choice of physiological birth?
Readers who have followed this process will understand that the decisions midwives must make are complex.

I have come to a pragmatic point of acceptance:
... that the government has enacted a process for certain midwives to be eligible for Medicare.

The person who will benefit from my being eligible for Medicare is the woman, not me. The woman will be able to claim back some of the fee I charge - possibly one third for planned home births, and more if and when I am able to attend a woman privately for hospital birth.
I will seek to do all in my power to prevent this process from taking away a woman's freedom, or working under medical supervision in primary maternity care.

There are several hoops to jump through yet, and it may be a couple of months before I hear back from the Nursing and Midwifery Board of Australia if my application is successful.

Update on Medicare

Bec and James

For an update on Midwives with Medicare provider numbers, go to the midwivesVictoria blog

Midwifery - much more than a job

Midwifery is the calling, the profession, the vocation that has claimed my attention and inspired me throughout most of my adult life. During the past two decades I have learnt to apply the basic knowledge and skill that I had when employed in a maternity hospital to the individual women whom I have been privileged to attend.

Midwifery is much more than a job.

When I was employed by the Women's in the 1980s, working a couple of night shifts each week, I used to feel as though I was having one night stands with women, being close to them at such significant moments in their lives, and walking away from them at the end of the shift. This was before I had noticed any professional discussion about caseloads, or continuity of care. I now see this feeling as evidence of my developing *midwife identity*. For twelve years I had a job as a midwife in a public hospital. A job that I could walk away from when the time came, and return home to my young children and my husband.

When the time came for me to move away from that *job* and set up my own *practice*, I experienced a sense of freedom that I had not previously imagined. I went into private practice like a duck to water. I could not have been in a better place, and my emerging identity as a midwife was sealed and flourished. I found that I could write and teach, sharing the knowledge I had acquired from study and from giving birth and nurturing my own children, and the principles upon which that knowledge was based.

I accepted that, in order for a private midwifery practice to be viable in this country, I needed to charge a fee that reflected the commitment I was making. When I was employed in midwifery there was always a pay packet at regular intervals. Now I would not be paid unless women paid me. All I can say is that I have not missed the regular salary one bit. Even as the main breadwinner for our household, the steady stream of clients who employ me to be 'with woman' have provided sufficient income for my needs.

The terrain of private midwifery practice in Australia is changing now. Midwives are now able to demonstrate to the regulatory authority that we are suitably competent in all aspects of basic midwifery, and through that process become eligible for private clients to claim Medicare rebates. The legislation around Medicare, particularly the requirements for collaborative arrangements, has been criticised by me and many others who have read it. The process to provide Medicare rebates is potentially arduous, and there are questions that are still unanswered.  But there is a process, and it is there for midwives to apply.

I know of a small group of midwives who are progressing towards the Medicare eligibility goal - some may already have achieved it.

I have stood back a little, attempting to line up options for collaboration with public hospitals. This is not to focus only on what I need, but to establish pathways for other midwives.

Some of my colleagues have become concerned that midwives who accept Medicare eligibility will be compromising midwifery standards, and women's rights to informed consent or refusal.   I will be watching closely to see that this does not happen.

Global forum: optimising the effecctiveness of Health Workers to achieve MDG's 1 and 5

I would encourage readers to follow, and to consider making a contribution to this global forum.
My responses to the forum questions will be posted at my 'private midwifery' blog, as well as at the forum site

I wonder what this one will teach me?

Mothers wonder ...
Midwives wonder.

I wonder what this one will teach me?

As each decision point is reached and the choice is made, this way or that, the course of events is shaped and cannot be undone. As each baby is born, and the cycle of life moves on, the mother learns something about herself, and something new about life. The midwife, in her interwoven world, also learns something about herself, and reinforces or renews her understanding of the wonder of life.

Dear reader, do you know what I am saying?

Do you understand the flow of life, and the decisions that are made - especially in the context of that basic and primal event of giving birth? Do you recognise a decision as a fork in life's journey. You choose one and you consequently reject the other. You can never come back to this decision, this bifurcation in the path.

The mothers who have had larger numbers of children; five, six, or more, are usually the ones who marvel at the uniqueness of each experience. When these mothers come to see me for a prenatal checkup I love to listen to what they have to say. I don't need to teach them about childbirth. We spend an hour or so in my little office, surrounded by my messy shelves of books and folders, and the cork boards filled with wonderful photos, and some artworks that are particularly dear to me, and my wall calendar with the names of the women to whom I am committed. I usually start with the question, "Did you have anything that you wanted to talk with me about today?" Then we pass the time in an easy, unstructured exchange. At some point I do the basic checks - blood pressure, palpation of the womb and auscultation of the baby's heart sounds. The information is noted down.

But the building of a relationship is what takes most of the hour's visit. There is no box in my paperwork to tick about trust. There is no place to note the unique sharing of lives: a woman and her midwife.


One particular day I was feeling very weary. The pressures of my personal life, and professional stuff including all the campaigning for better maternity services had left me feeling emotionally and physically low. Depressed? Yes, I was. I had become unexpectedly teary when some friends started talking about their plans for holidays. I told my sister about my feelings, and that I had not had a holiday for a long time, and she informed me that was not good work practice. Dear reader, I'm sure she didn't mean to hurt me. We love each other, and talk about things that are important to us.

Anyway, on that particular day, the phone rang. A mother told me she thought her labour was starting. She needed to contact her husband so that he would be at home to look after the children. Soon she rang again. Husband was on the way, and she asked me to come.

As I moved quickly from my introspective mood to a more organised, directed persona, I prayed for strength and wisdom. It's late afternoon. I may be out through the night. I need alertness of mind and strength of body. I may need special courage and wisdom as decision points are reached. I pray for God's special protection and blessing on the mother and child in my care.

On that particular day the labour progressed quickly. A baby was born without complication or incident. The mother sat quietly in an arm chair and focused on her little son as he worked his way to her breast and began to take his first feed. She had a couple of contractions, and I reminded her about the birth of the placenta.

Then the mother lifted the towel from her belly, and said "Joy, there's a lump here still. Could this be another baby?"

Yes, it could ... and it was.

As I put on a sterile glove to check how this baby intended to be born, there was one push, a gush of fluid, and the little sister made her entrance - beautifully.

I will never forget the mother's ecstatic face as she said "I've got TWO babies!"

That night as I returned home I reflected on not just the birth - amazing as it was - but also my physical, emotional, and spiritual journey that day. What did this one teach me? Quite a lot.

Midwives with Medicare 2

During this past week there has been an increse in activity in preparation for the advent of the medicare-midwife next Monday 1 November.

Midwives seem to be positioning themselves in two main camps: pragmatism, making the best of the situation, on one hand, and resistance to what is seen as removing the midwife's right to autonomy in practice as well as threatening the woman's right to informed consent. Much of the disagreement centres around legislation requiring a collaborative agreement between a midwife and a named doctor in order for the midwife to be able to access Medicare funding, and visiting access in hospitals for intrapartum care.

The Australian Private Midwives Association (APMA) position statement on Collaborative arrangements [click here] opposes the Determination, contending that:

"Private practice midwifery will become known as the model whereby midwives are working in private medical practices, with little regard for those self employed midwives who currently provide true midwifery care at this current time."

A recent meeting between the Health Minister Nicola Roxon and four independent candidates who stood in extremely marginal seats in this year's federal election, and maternity activist Justine Caines, has given rise to an interesting report published anonymously at the APMA blog. The writer indicates that

"It is possible that the Gillard Government is contravening its responsibilities under the Convention of the Elimination of all forms of Discrimination Against Women (CEDAW)."... and

"The political cost has been high with Minister Roxon embarrassed by poor advice."

 The Australian College of Midwives (ACM) has promoted the pragmatist position, with statements such as:

"The College maintains the view that while this Determination is a poor piece of legislation we need to continue working with the Minister’s Office and the Department of Health and Ageing to provide evidence that will support the Minister in making any necessary changes. The College is dedicated to ensuring that midwives and women are not disadvantaged by this legislation." (e-Bulletin 29/10/2010)

 Leaders in ACM have encouraged members to accept the Determination, indicating a fear that the whole maternity reform process could be derailed if there were to be a motion to disallow the Determination, and that motion were passed.  The reforms that enable midwives to claim Medicare funding, and have limited prescribing rights, and the right to order basic tests and investigations are seen as being of great value to the profession as a whole, while the potential disadvantage that comes with a return to medical supervision of a midwife's practice, sold under the guise of team work/collaboration, is seen as an acceptable trade off.

Midwives continue to work through these issues.

I hope to be able to keep readers informed of progress.

Midwives with Medicare

sisters Anna and Jenni, and their beautiful babies

Today I have checked through the application form that midwives are required to complete in order to obtain a Medicare provider number.

I would love to be able to say to my clients that from 1 November they will be able to claim Medicare rebates on my fees. However, as I do not yet have a doctor who will meet the legal requirements of the Midwives Collaborative Arrangements Determination I cannot proceed with any such application.

If you want to check the full detail of the Medicare fee schedule, go to the Federal Register of Legislative Instruments F2010L02640. [I can't find the link, but I have the document saved as a .pdf]

Here are a few examples of the Medicare fee schedule for a participating midwife's services:
Item 82100
Initial antenatal professional attendance by a participating midwife,
lasting at least 40 minutes, including all of the following:
(a) taking a detailed patient history;
(b) performing a comprehensive examination;
(c) performing a risk assessment;
(d) based on the risk assessment — arranging referral or transfer of the patient’s care to an obstetrician;
(e) requesting pathology and diagnostic imaging services, when necessary;
(f) discussing with the patient the collaborative arrangements for her maternity care and recording the arrangements in the midwife’s written records in accordance with section 2E of the Health Insurance Regulations 1975
Payable only once for any pregnancy
$51.35

Item 82120
Management of confinement for up to 12 hours, including delivery (if undertaken), if:
(a) the patient is an admitted patient of a hospital; and
(b) the attendance is by a participating midwife who:
(i) provided the patient’s antenatal care; or
(ii) is a member of a practice that provided the patient’s antenatal care
(Includes all attendances related to the confinement by the participating midwife)
Payable once only for any pregnancy (H)
$724.75

Item 82130
Short postnatal professional attendance by a participating midwife, lasting up to 40 minutes, within 6 weeks after delivery
$51.35


Clearly it would be in the intersts of both the woman and the midwife for this funding to be accessible. Midwives practising in homebirth would at least be able to give their clients the benefit of rebates for prenatal and post natal visits. Once midwives have visiting access at public hospitals (this is still theoretical), women who choose to have their own midwife attend them at a hospital would be able to claim a substantial rebate for the fee.


As I have considered how I could possibly comply with these requirements, without giving up my integrity as a midwife, the only pathway I can see is if I can obtain a collaborative arrangement with a public hospital. In effect, that's the way I have collaborated with the medical profession for many years. My clients have homebirth backup bookings at (usually) the Women's, Monash Clayton, or Box Hill. If medical referral is needed at any time through the episode of care, the medical team on duty at the time accepts the referral.

I will keep readers informed as we progress down this pathway.
A quick calculation of the fees payable by Medicare for:

• an uncomplicated hospital birth (1 midwife) $1504.65
• antenatal and postnatal care for planned home birth $779.90

[These amounts are calculated assuming that the mother has 3 long and 2 short prenatal checks; and two long and 3 short postnatal checks.  Other once only consultations as described in the legislation.] 

Reflecting on progress in midwifery

Hello Grandpa!

When I studied midwifery (in the early 1970s) we learnt about the hormones in the menstrual cycle and the physiology of conception. We learnt about FSH and LH and oestrogen and progesterone and testosterone. We knew that oxytocin existed, but it was just the hormone the caused contractions of the uterus. The synthetic copy of oxytocin, Syntocinon, was used liberally as it could be measured and given in a 'scientific' way. I don't know if oxytocin crucial role in milk let down and love making was mentioned. The action of endorphins as natural opiates, and adrenaline and nor-adrenaline were part of that complex mystery waiting to be better understood. I don't remember any mention of bonding or maternal behavioural adjustments.

When Noel (my husband for the past 37 years) studied veterinary medicine in the late 1960s he learnt the same physiology. Vets became fascinated with the world of artificially managed conception, ovum transfer, and surrogacy in the world of producing the fittest and most highly desired offspring.

Noel's Masters and PhD research explored the protective effect of colostrum in the newborn calf. He showed that colostrum protects the calf against diarrhoea (scours) and septicaemia (blood poisoning) in the early days after birth. This result sounded obvious to me, but was important scientific knowledge at the time. My journying with him through academic processes, including the literature review and carrying out the research, informed me a great deal and opened my mind to critical thinking.

... move through time to today.

Noel and I are now doting grandparents. We have seen huge changes in our own understanding of the physiology of all things to do with childbearing, reproduction, and a human mother's ability to love and care for her child.

Acquiring knowledge of natural physiological processes in childbearing and nurture of the infant has been a fascinating journey that has, for me, absorbed my mind over most of the past three or four decades. It's an incomplete process.

As long as I am able to call myself a midwife I will have a duty of care to promote normal birth. I hope that midwives around the world will also claim that purpose.

Looking at the big picture

A lovely young woman in my care came for a prenatal checkup, beaming. After the usual hello she told me of her sister's birth a few days ago. Her sister gave birth to her first baby at a big public hospital, without any assistance, without any drugs! The wonder of physiological birth - the miracle of birth - has left its mark on this woman's mind. I was pleased to hear the story. Normal birth is worth protecting.

We know that birth is not an illness, yet a normal birth is often something that is a surprise rather than the expected pathway.

Medical dominance in birth has, for many people, extinguished this amazing knowledge. Midwives and doctors often see birth as a minefield, expecting disaster at any moment. Then they proceed to interfere, interrupt, intervene ... and hey presto ... they were right!

Years ago we midwives who were budding activists for promoting normal birth used the Fortelesa Declaration (WHO 1985) to get the message out that ‘Birth is not an illness’.

In the early 1990s we used the Innocenti Declaration (UNICEF and WHO) on the rights of the newborn to put pressure on maternity services in relation to breastfeeding and bonding.

In the mid-90s we promoted the ICM Definition of the Midwife, which is now incorporated into national codes of midwifery practice and educational standards.

We still have a long way to go. We need to constantly go back to this ‘big picture’ stuff, and hold it up as our standard.


The current state of play in the government's efforts at legislative reform (see another blog) is simply unacceptable to midwives under international and national midwifery standards.

Midwives have to just say NO! It’s not good enough to say we will take baby steps to Medicare funding. Compromise that is wrong is simply wrong, and will be regretted in the long run.