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MIDWIFERY

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Personalised Midwife Care

This family centred service provides women with personalised continuous care with the same midwife through pregnancy, labour, birth, immediately postpartum during the first breast feed, early subsequent breastfeeding advice and postnatal care

Where?

In the home, in a birth centre or conventional labour ward. Women may prefer to choose shared care with another midwife or medical practitioner. Individual components on any one of the above areas maybe your choice, eg. postnatal care

Personalised care involves sensitive midwifery care, advice and assistance provided by your employed midwife. The time spent at each antenatal and postnatal visit is up to one hour

Responsible Preparation Return to top

Shared Responsibility

The process of preparing for birth, breastfeeding and parenting is a shared responsibility between the woman and her practitioner. Personalised contact with an employed midwife during pregnancy fosters and develops a warm and trusting relationship

Practitioners generally have differing approaches, different education and differing values and beliefs

Throughout my life's journey, experience has taught me that it is important to recognise that no midwife or for that matter any practitioner can never accept total responsibility for the care and decision making for another individual. This also applies to responsibilities involving your own family or those close to you

On that basis I make it clear that I do not accept total responsibility for care and decision making for women who choose to employ my services

As a midwife practitioner I will endeavour to offer the best of my knowledge, professional advice and quality care for any circumstance/s that may arise and will aim to meet individual needs throughout the pregnancy to early parenting continuum

Your Expectations of Me

I will perform to the best of my professional ability but you need to know that due to a temporary loss of professional support services I am no longer covered for malpractice/ indemnity insurance. I cannot accept liability for any untoward outcomes beyond my control. If at any time you are dissatisfied with the care you receive and/or the manner in which you are treated, I urge you in the first instance to speak directly with me. If this approach is still not satisfactory to you I invite you to contact the relevant state or territory Nurses and Midwives Registration Board.

Professional Indemnity

I also inform each woman that I no longer have Professional Indemnity Insurance. Guild Insurance Limited decided to "withdraw from the Midwifery market" leaving Independent midwives without cover. I have made a decision to remain loyal to my profession and choose to continue my obligation to provide a service for women in the absence of Insurance. Being intimidated by the inequality and discrimination of the power brokers is to bow to the pressure of eradicating Independent Midwives and the range of choices they provide for women

Antenatal

Coupled with the belief that each woman has the right to choose where, who and with whom she will birth her baby, is the responsibility of ensuring good antenatal care

This is achieved by regular meetings during pregnancy. This very special personalised contact during pregnancy helps to foster and develop warm and trusting relationships. A confidential detailed personal health record, is taken at the first antenatal visit and must be kept for 25 years legislated under the Trade Practices Act. Most women carry a copy of their own antenatal record

The suggested frequency of antenatal visits is approximately monthly visits up to 28 weeks gestation, fortnightly from 28 to 36 weeks, then weekly until the onset of labour.

Attendance for antenatal care is the woman’s decision and is based on a mutual respect and recognition of individual potential, experience, needs and knowledge

Health & Wellbeing Return to top

Assessing general well being of a mother and her developing baby during pregnancy helps to recognise and minimise pregnancy risks. This generally involves taking blood pressure, pulse and temperature as necessary. Testing urine and pulpating the growth, presentation, position and lie of the baby

Birth Planning Return to top

Involves education, learning and developing a knowledge base that provides you with the confidence to make your own plans for your pregnancy and birth. A Birth Plan is a document that indicates with flexibility your specific needs for your birth experience. Being well informed places you in a better position to give informed consent for yourself and/or your baby. The information a women provide in her Birth Plan assists the midwife and others involved in your care, to support and advocate for you. It is a tool for sharing information and raising questions where more information maybe necessary

Education over the pregnancy may raise certain questions for you and those closest to you. Providing answers and finding more information should be part of the overall birth plan. Some common questions raised are in reference to pain relief during labour, resuscitation for the baby at the time of birth, heavy bleeding or haemorrhage. Other questions relate to the equipment the midwife carries for a homebirth and often the question about how much "mess" is there at a homebirth is asked. All of this and much more is part of Prenatal Care, Preparation and responsible Education

A suggested Birth Plan document is available at your first antenatal visit, alternatively you may prefer to write your own plan. It is suggested that a draft version be prepared by the 30th week of pregnancy, with the final plan completed by approximately the 34th to 36th week. Over the months you will gather a lot of information during prenatal sessions, or by previous experiences as well as many other sources. It is wise to ensure a copy is given to those directly involved in your care

Second Midwife Return to top

It is advisable to plan and budget for the services of a second midwife to be available to attend from late first stage labour or when necessary. Over years of experience it has been recognised that there are times when the service of another midwife is an appropriate member of the team and is regarded by the profession as safe practice. If there is an accident or urgent situation that involves your primary midwife, the second is readily available when pre-booked. Some midwives will recommend a second midwife to be present for all births at home, particularly first time (primiparous) labour

The second midwife fee is separate according to the accounting practice of the individual midwife. You may wish to make contact with, attend an antenatal visit or share-care with the second midwife

Hospital Birth/Transfer Return to top

For planned hospital birth or transfer, continuity of care with your midwife means that Visiting Access to that particular hospital is necessary. Some forward thinking hospital systems are paving the way for independent midwives to apply for visiting access. This means, if you choose to birth within the hospital system you can retain the services of your employed midwife to be your primary carer

Your midwife has the availability of accessing medical or other assistance should the need arise. It is perfectly legitimate to have the same midwife provide you with continuous care wherever you choose to birth. If visiting access is not available at the hospital, your employed midwife remains with you to protect you and oversee your care. In these circumstances, your midwife is a strong advocate, advises and helps you make a appropriate personal choices and decisions within the structure of the hospital system, and ensures that you are informed and protected by your rights and responsibilities

Students Return to top

Students completing the Graduate Diploma of Midwifery, request to spend time on placement within independent midwives. This is a responsible way of ensuring that future midwives are exposed to the important role of independent midwifery practice. Your consent is sought to have a student involved. It is a personal choice and perfectly understandably is not to include a student

LABOUR AND BIRTH Return to top

Homebirth Australia is the publisher of "The Pregnant Woman's Homebirth Bill Of Rights & Responsibilities". Author Jan Pilgrim.

The principles in this document are easily translated for application to all pregnant and birthing women. A more fitting Title may be [Bill of] Rights and Responsibilities for Pregnant Women - a guide birthing autonomy.

"The Pregnant Woman's Homebirth Bill of Rights"

There will always be an element of risk in birth whatever the choice of birthplace. … Safety in childbirth is intrinsically related to the mother's emotional, psychological and physical wellbeing during labour. This in turn, is influenced by the choices [that] are made during pregnancy, choices which should enable a woman to give birth at ease with her environment, her attendants and herself.

No professional, however well meaning, will have to live with the consequences of the outcome of labour and birth as long or as intimately as the consumers to whom they offer their services. The choice of birth professional is possibly the most important choice a woman will make during her pregnancy. There is no place for paternalism in the practice of obstetrics although at some stage of labour the decision may be made to place the management in the hands of the professional. … Domiciliary obstetrics is the "art of invisibility" and without complications a woman gives birth herself, supported and aided by her midwife.

This most important choice of birth professional should be made after long and careful evaluation of the practitioners available. It is especially helpful to talk to as many clients as possible and get a clear picture of the mode of practice. Every woman gives birth in her own individual style and will feel easier if her practitioner's style suits her own. Some [most by legislation] homebirth midwives collect statistics of the incidence of complications …such as Caesarean sections, episiotomies and [perineal] tears for on-going review of their own work.

Expertise in decision-making is based on a firm grasp of the possible options, their consequences and their relative risks. It is only possible within the context of a mutually trusting and warm relationship. The complexities of birth and death call for hard logic, love, courage, deep conviction and intuition.

Childbirth …becomes a shared adventure between parents and professionals. The rights and responsibilities of all concerned should be thoroughly discussed and scrupulously observed. In this way, the self-esteem and autonomy of women, whether as birth-giver or midwife will be enhanced whatever the physical outcome of the birth.

The arduous and often unrecognized role of the homebirth midwife has become politicized because of the support midwives give women in their efforts to regain autonomy in birthing. She and her family often suffer considerable personal and economic hardship as she may work outside the mainstream of obstetrics due to lack of peer support. With widespread misconceptions about the safety of homebirth, her professional status is in jeopardy whenever anything goes wrong. However skilled she may be, deregistration and loss of a career is a constant insecurity in the face of social hostility to her chosen mode of practice.

Homebirth Australia has produced the Bill in the hope that it will protect and be of help to the parents, babies and midwives who make homebirth possible in this country…

The Pregnant Woman's [Homebirth] Bill of Rights

The pregnant woman has the right

to choose her place of birth

to choose her birth practitioner and to be fully informed of her practitioner's qualifications and experience

to choose who will be [her birth attendants] and the right to refuse entry or to ask anyone to leave her [private] place of birth

of access to literature and information about birth and particularly homebirth

to know her practitioner's methods and techniques of birth

know the approximate costs which will be incurred under her practitioner's care

expect that any information she gives her practitioner will be confidential and not divulged to anyone else without her permission

to comprehensive antenatal care including access to standard tests and procedures related to the wellbeing of mother and child

prior to the administration of any drug, medication, procedure or test to be informed by her practitioner of any direct or indirect effects, risks or hazards to herself or her unborn or newborn baby

to determine for herself whether she will accept the risks inherent in a proposed therapy, drug, test or procedure
to choose how she gives birth and to be treated with dignity and consideration at all times so that she feels free to follow her instinctive reactions during birth
to ancillary medical support when needed

if transferred to hospital, to be treated with respect and courtesy and to be accompanied by her practitioner and [chosen others]

if transferred to hospital, not to be separated from her baby except for valid medical reasons [with informed consent]

to comprehensive postnatal care including support for the establishment of breastfeeding, assessment and care of her newborn baby, and information about relevant screening tests and registration of birth

to be informed if there is any known or indicated aspect of her or her baby's care or condition which may cause her or her baby later problems

of access to her and her baby's records and to receive a copy of her notes when [requested]

in the event of an unexpected outcome to her pregnancy or birth to receive all the additional support and services that she needs

to complain and to receive satisfactory [discussion/s] with her practitioner

As the pregnant woman has rights, so she also has responsibilities

The pregnant woman is responsible for

learning about the physical, and emotional process of labour, birth and postpartum recovery

learning about good antenatal and birth care so that she may choose the best possible arrangements which suit her individuality and circumstances

learning about her practitioner's methods including evaluation of statistics of past cases and talking with other clients

her own emotional and physical wellbeing during pregnancy

attending her antenatal appointments and informing her practitioner if she is unable to attend

her own psychological preparation for homebirth in a society which may be unsupportive and hostile, especially if the pregnancy results in death of a baby
meeting her practitioner's requirements for preparation for homebirth

informing the practitioner of any relevant physical, emotional or psychological [history] which may affect the outcome of her birth. These may include intake of drugs, medications, herbs, allopathic, naturopathic, psychological or alternative therapies and the obstetrical, sexual or psychological history of herself or her relations, friends or partners which are affecting her attitude towards her birth and parenting

making any alternative arrangements for her birth and for booking into a [backup] hospital

making mutually agreed upon birth plans with her practitioner in advance of her labour

choosing a suitable support person or persons for her birth and for ensuring they are emotionally and psychologically prepared for their role at the birth
being assertive enough to dispense with any person who is not supporting her during her labour

ensuring her support people can carry out her preferences if she is unable to express them during labour

the psychological and emotional preparation of siblings for the birth

the choosing and preparation of individual support people for siblings

acquiring information about breastfeeding and care of the newborn

arranging domestic support for herself and her family during the postnatal period

obtaining information regarding the cost of her care and making arrangements for payment

evaluating the quality of care she has received and making any dissatisfactions she may feel known to her practitioner

Homebirth Australia
PO Box 1085, Byron Bay, NSW. 2481. Australia

POSTNATAL Return to top

First 10 Days Return to top

Postnatal visits are generally daily or second daily for the first 5 days, then by mutual arrangement up to the 28 days

BREASTFEEDING Return to top

Lactation Consultancy Return to top

Lactation Consultancy is an area of expertise, specific to helping women learn about the art and science of breastfeeding. Breastfeeding education is offered over the duration of the pregnancy. Education, support and assistance is given to women who have experienced or are currently experiencing breastfeeding problem/s. The service extends to those women who need to debrief a difficult past experience. Lactation consultation provides the mother with individual information, education and problem solving. For a woman who is experiencing breastfeeding problems a consultation involves recording a detailed history, observing a complete breastfeed, followed by a suggested plan designed for individual needs and adapted to the reality of the family situation

Appointment sessions are available for 1 to 2 hours or half day or full day. Assistance can be given with consecutive feeds (lunch and rest facilities are provided). A home visiting service can also be arranged by appointment

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