>> INTRODUCTION

INTRODUCTION

melbmidwifery.com.au

MELBOURNE MIDWIFERY'S

PHILOSOPHY embraces:

the promotion of

homebirth as a safe, healthy option
the right of women to individual choices
developing a partnership between woman and midwife
women's intuitive, innate ability and self confidence
sharing information to enhance individual knowledge
midwife advocacy where and when necessary
compassionate, individualised continuous care including family and/or chosen others
planned hospital backup should transfer be deemed necessary
the art and science of midwifery and breastfeeding
information about the significance of the role of the midwife
dealing with previous unhappy or unexpected experiences

education about

the art, science, skill and intuitiveness of midwifery
pregnancy, labour, birth, postpartum and postnatal
early parenting
the art, skill and science of breastfeeding
the innate wisdom of pregnancy, birth and breastfeeding
the significance of the role of the midwife
neonatal neurological responses
learning to interpret and understand the newborn

BELIEF gives credence to: Return to top

one-to-one continuous care provided by the same midwife enhances a woman's potential to remain in control of any decisions that may affect her pregnancy, labour, birth, post birth, breastfeeding and early parenting experience

the experience of pregnancy, birth and breastfeeding as a healthy, intimate life event for the majority of women

teaching, learning and understanding the innate, neurological ability of the newborn is important to the beginning of healthy parenting

Robyn Thompson

ROBYN E. THOMPSON
RM RN M&CHN LactCons BAppSc

Professional Indemnity Crisis Return to top

Independently practising midwives no longer have Professional Indemnity Insurance. Guild Insurance Limited decided to "withdraw from the Midwifery market" leaving Independent midwives without cover, mine ceased at 4pm on 31st August 2001.

Alternative insurance has not been obtainable since that date. After discussion with family and colleagues I have made a decision to remain loyal to my profession and have chosen to continue my obligation and exercise my democratic right to provide a service for women in the absence of Indemnity Insurance.

To be forced back into Midwifery practice in the hospital system after 20 years of self employment in private practice would be at odds with my midwifery philosophy, values and beliefs. It would be too difficult to contend with a systemised, technocratic, medical approach to providing midwifery care.

Based on the global collapse of the Insurance Industry no one is really sure what direction the future will take.

I am left with no other alternative, I do not own any valuable assets, if found negligent I would stand to loose the value of my share of our family home. Another part of me feels rather pleased not to be controlled by high Insurance premiums this only serves to increase the possibility of litigation which attracts large financial payouts.

I do not want to be pressured to practicing defensive midwifery. My medical colleagues have been forced to practice defensive obstetrics, defensive practice is based on fear. The fear of litigation undoubtedly reinforces defensive practice.

Midwife and medical practitioners never go out with intent of harming a mother or her baby. In order to make things more clear I have to make sure I document with as much detail as possible and give each woman a copy of her record.

Part of each woman's responsibility in the antenatal planning is to arrange for another midwife to be 'on call' to attend her whenever it maybe deemed necessary. I assist her to make a Hospital Booking in case there is a need for back up obstetric/paediatric services at any time during pregnancy, labour or the postnatal period.

I have chosen not to be intimidated by the inequality and discrimination of the power brokers, this would only serve to bow to the pressure of eradicating Independent Midwives and the range of choices they provide for women. Independent midwives are being held to ransom and their careers are being destroyed by insurance bureaucracies that dictate the market.

AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED

MEDIA RELEASE - 13th September 2002

GRAVE CONCERNS EXPRESSED BY MIDWIFERY EDUCATION PROVIDERS

NO PROFESSIONAL INDEMNITY INSURANCE FOR MIDWIVES

Midwifery education is the latest victim in the ongoing saga over professional indemnity insurance in Australia, with the future viability of some courses now under threat. At the same time, midwives are quitting the profession, unable to obtain insurance, and there has been a virtual halt in private midwifery practice nationwide.

The Australian College of Midwives Incorporated (ACMI) says it has explored all opportunities through professional insurance brokers to purchase an affordable policy both within Australia and overseas

“It seems insurance is not on the market for midwives,” said ACMI national Executive Officer, Alana Street.

“Providers of midwifery education now hold grave concerns about the repercussions from the inaccessibility of professional indemnity insurance for midwives.

“Universities face the arduous task of renegotiating insurance which is increasing in cost, decreasing in availability and does not necessarily provide total indemnity.

“Other educational facilities which employ midwives have sought insurance and report difficulties in negotiating with what at times seems an infinite numbers of brokers who act for a minimum number of companies selling insurance,” Ms Street said.

“The resources required to purchase such insurance are enormous. The future of any policy is determined annually, under great scrutiny with a promise to increase the policy cost at the next review of the policy. It means that although insurance may be obtained in the short term, there is no guarantee that it will be ongoing.”

Ms Street said the critical problem with professional indemnity insurance was having an immediate impact on the right women have to choose their primary carer during pregnancy and childbirth.

“Women’s right of choice is at the very heart of our professional ethos, yet we are now arriving at a situation where the future of the profession is under immediate threat, with no appropriate insurance available for those in practice, and for those giving instruction to the midwives of the future.”

Ms Street said the implications of the non-availability of insurance became evident at the level of midwifery practice initially in June last year, and on education of midwives at the undergraduate and postgraduate level in June this year.

“Students of midwifery are currently being affected by not being insured during some aspects of clinical practice. The inability to fulfil learning and practice requirements of their accredited curricula is of great concern to the universities.

“Student midwives who are not able to achieve the competencies required for beginning practice will not be able to achieve registration or endorsement by the statutory board. This impacts on their ability to become endorsed as a midwife at the regulatory board level. This would only add to a critical workforce shortage in midwifery in this country.

“There is also the likelihood that universities may face litigious actions as a result of not fulfilling a student’s curricula requirements prior to graduation.”

Ms Street said there were other notable implications flowing from the inability to obtain insurance:

Most midwives have ceased practising in private practice since 31st. May 2002.
150 midwives have stopped working as midwives working independently There are obvious repercussions on workforce planning in an already critically short workforce.
The models of care that have in the past been offered by midwives in private practice include planned homebirth, and midwife primary care for planned hospital birth.
These models of care are legitimate options for women to choose, despite being rarely offered by funded healthcare providers.
Anecdotal reports reveal that women seek the services of uninsured midwives or choose not to have a professional caring for them during childbirth.
ACMI have grave concerns for the safety and wellbeing of women and their babies when there is no midwife in attendance.

THE AUSTRALIAN COLLEGE OF MIDWIVES SEEKS AN URGENT RESOLUTION TO THIS GROWING CONCERN IN THE INTEREST OF SAFETY OF OUR COMMUNITY AND MIDWIVES

For further information please contact:

Alana Street, RM FACM
Executive Officer,
Australian College of Midwives Incorporated.
Tel: 03 9804 5071 or 0438 855 529
Email acmi@acmi.org.au

Qualifications Return to top

Post Graduate Courses

May 1991 Child, Family & Community Nursing Re-entry Course Deakin University, Warrnambool Campus
Aug 1988 International Lactation Consultants Association Board of Examiners, Examination (IBCLCE) Qualification - Lactation Consultant
May 1988 Family Planning Course for Registered Nurses, Church Street, Richmond
May 1988 Family Planning Course for Registered Nurses Family Planning Association Victoria. Qualification: Family Planning Certificate
1982-1887 Postgraduate Degree, Bachelor of Applied Science, Advanced Nursing (Administration), Phillip Institute of Technology
1979 Introduction to Management, Mayfield Centre, East Malvern
1978 Infant Welfare Certificate, Tweddle Family Hospital
1977 Ward Management Course (Inservice Programme) Western Hospital
1975 Midwifery Certificate, Western Hospital

PROFESSIONAL PROFILE Return to top

Since 1961 my career path includes qualifications and experience in General Nursing, Midwifery, Maternal & Child Health Nursing, Family Planning and Lactation Consultancy. In 1987 I completed a Postgraduate degree, receiving a Bachelor of Applied Science in Advanced Nursing (Administration). Then in 1991 a Re-Entry Course into Family, Child and Community Health nursing, was completed via Distance Learning, with Deakin University, Warrnambool Campus, Australia. A qualification in Midwifery is via Nursing. Direct Entry Bachelor of Midwifery will be available in some Universities in the near future.

Francavilla happy baby!
During the 10 years from 1975 to 1985 I gained excellent midwifery experience albeit within the medical model of care in major Melbourne teaching hospitals. During this time I held senior administrative positions - Deputy Charge then Midwife (nurse) In Charge of the Labour Ward. Following that I was appointed to Midwife In Charge of Antenatal Outpatient Clinics then Supervisor of a 60 bed Midwifery Department.

Consultant Return to top
My next major project came during 1985 I was invited to be the Consultant to commission the 20 bed Midwifery Unit and Family Birth Centre at Vaucluse Hospital (Melbourne)

My brief was to advise the architect on planning, building, furbishing and commissioning. This included negotiating with the Health Department Victoria on various matters, such as installing the first large spa bath in Melbourne for labouring women. Equipping the unit and completing staff selection culminated the project being completed and commissioned within 18 months, right on schedule.

This midwifery unit was originally designed to provide a practical, warm environment for women with a bathroom in each bedroom. On my initiative and strong persuasion provision was made for an additional Family Birthing Room to give women the choice of a non medical birthing experience. It was also the first private hospital to provide a back-up service for women who chose to birth at home. The turned timber baby cots (now used in the Mercy Hospital Birth Centre) were designed by myself and made by a local manufacturer.

During 1987 I drew the original sketch plans, produced a brief and advised the management on specific requirement for the Mercy Hospital Birth Centre. This work was never professionally nor formally recognised. The outcome was positive - a quick lesson in Copyright.

I take pride in mentioning these achievements simply because the jobs were done with great care and enthusiasm. In the midwifery (nursing) profession such achievements often go without appropriate recognition.

Independent Practice Return to top
Independent midwifery practice has been a welcome extension of my career path. Melbourne Midwifery Specialist Services Pty Ltd (MMSS) also trading as Melbourne Pregnancy, Birth and Breastfeeding Consultancy, Birthing Naturally and Breastfeeding Naturally was established in 1987.

Continuity-of-care and carer is the main focus. The range of services provided by myself and selected others spans the continuum from pre-pregnancy, through labour, birth, immediate postpartum, postnatal care, including a large component of lactation consultancy, maternal and child health, early parenting including a continuous education.

Experience in this home based community practice has given me the privilege and opportunity to assist many women with personalised midwifery care in their home, for others in birth centres and some in the conventional hospital labour ward. My role extends to pap smear screening and also relieving work at some Maternal and Child Health Centres.

Providing women with personalised midwifery care, advice and support through pregnancy, birth and breastfeeding is very fulfilling. I try to maintain a balance between my family, practice, education and research.

Counselling is another extension of my role - good listening skills are paramount. Debriefing and reflecting with women on personal events is necessary to resolve important issues that impact on their future. I find myself being a strong advocate for some women. Expert care and advice with breastfeeding is a primary function, an immense amount of debriefing and counselling is necessary for most of these women. Referral is mainly by word of mouth. Hospital visiting is reasonably common for lactation problems.

Education, an important component of the service is provided by one-to-one interaction with women (clients), midwifery student placement, sessional and clinical teaching, seminars/conferences and ongoing education programmes. Three Regional Midwifery Update Programmes in conjunction with Outreach Education Enterprises were completed in the State of Victoria, including many breastfeeding and birthing seminars and conferences.

Personal ongoing education to update my knowledge continues by attending seminars, conferences and various meetings. I believe the major body of knowledge is derived from being with women, their families and their babies in a close, non intrusive relationship.

Health Fund Rebate Return to top
In March 1988 the process of achieving Health Fund Rebate for private midwifery services was commenced. The first submission completed by myself was presented to the General Manager and Claims Manager of the Australian Natives Association (ANA). ANA has since merged with Manchester Unity to form Australian Unity (AU).

For the first time health fund rebate for midwife services was successful and advertised. Rebate has since been gained from a variety of other funds however, Australian Unity continues to be the most responsive and still offers the preferred private rebate for pregnancy, birth and the puerperium. Consultation is currently taking place with Medibank Private.

Mother, Midwife & Grandmother Return to top
My personal and professional role has evolved to mother, midwife and grandmother.

I had the ultimate privilege and wonderful experience of sharing the birth of my first grandson when my son and daughter in law invited me to be their midwife. Joshua was born at home on the 8th floor of a condaminium in Hammamatsu, Japan, March 1993. Homebirth was a rarity for Japanese women.

Eighteen months later in September 1994, I had the additional privilege of being the midwife for the birth of my second grandson Kai, this time at home in Melbourne, Australia.

Together as a family we have shared, in the truest possible sense the experience of continuity-of-care and career with uninterrupted breastfeeding and early parenting. The interchanging roles of mother, midwife and grandmother is a unique, wonderful, continuing experience.

My professional and personal life experiences continue to increase my knowledge base and assist me to gain expertise and maintain a keen interest with strong commitment to ‘a partnership’ of individualised care for women, their babies and families.

Vision Return to top
My vision for the future is:

To maintain my strong family ties. Promote the important role of mothering by being a good mother to my daughter, son and daughter in law and a grandmother who spends valuable time with her rapidly growing grandsons

To remain a strong advocate for women, aim to reduce unnecessary intervention by sharing information, knowledge and experience. Promote homebirth and Independent Midwifery Practice as a safe and preferable option for women

To challenge the routine administration of drugs in labour and injection of the healthy, low risk, newborn with drugs at the time of birth. Continue to question the risks involved when the perfect protective skin of the newborn is perforated with an injection of Vitamin K (1) and Hepatitis B soon after birth. Particularly with the knowledge of hostile, resistant bacteria endemic in hospital environments

To compare the newborn outcome in relation to haemorrhagic disease when Vitamin K is not routine and breastfeeding is uninterrupted. Compare physiological with pathological third stage of labour and highlight the difference in midwifery and medical practice

To be an author and sharing some of my personal and professional experiences for the benefit of midwives, women and students I have progressed to the stage where the future of Melbourne Midwifery leads me to the vision of selecting a team of special midwives who will carry on the business I have established and provide expanded services for women.

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