Re: [ozmidwifery] SalariedVersusContract

[Marilyn Kleidon]

I totally concur with Tina. Although not as a B.Mid (though a member of the collective since I was a student when the collective began) but as a recent direct entry midwifery graduate/graduate midwife. I share her vision of providing/offering midwifery care (in the continuity of care model) to women in the care setting of the woman's choice: out of hospital or in hospital birth. Similarly lack of PI insurance is my issue.   I don't think midwives have to be independent practitioners in the sense of running their own business to be considered professionals. I don't think any other profession makes that distinction and I truly believe that we, midwives, should avoid making it. Saying that I do believe that when we practice outside of the sanctity of a woman's home we come under different constraints due to the place of practice. If midwives are not involved in the practice guidelines, procedures, and protocols of agencies (whatever they may be: hospitals etc..) that provide maternity care and hence either contract with or employ care providers then we should be. I do believe that the only way the majority of women will gain access to midwifery care as envisioned by the NMAP is through the public sector. It truly is only a select few who even know of independent midwives let alone the other issues.    I do think positions should be created for the new midwifery graduates getting them involved in caseload midwifery from the start. They should not have to orientate themselves to ward work unless they choose that as their orientation of practice. In this context Canada has a very good system of setting up caseload practices (including low volume and high volume practices) and incorporating new graduates with mentor midwives, I don't know but would bet that New Zealand does too. I guess I am saying we don't have to reinvent the wheel on this one. I want to be clear, I think it is essential that hospitals maintain core staffs of ward midwives. However, I don't believe it serves any purpose to insist that new graduates begin their careers this way. If a midwife wants to change her orientation then perhaps a retraining could be offered?? However, this is the current system unless you go off and start your own practice.   Regarding women's choice: in my midwifery program informed choice was a cornerstone, we wrote papers on it, we wrote our own, we role played it, we critiqued our mentor midwives and they critiqued us. We were all so aware how vulnerable and open to influence pregnant women are and what a powerful role we have as their midwives. However, it is a contentious issue, and it is an easy trap to give the information that reflects your choice (the midwives') or the institution which employs you (hospital). In this context(as well as others) I think peer review is an essential part of professional midwifery practice. I again agree with Tina's observations of variations in practice.   Regarding handmaiden status: we have to remodel this for each other. Role models, role models, role models. I personally don't think it is a gender issue. If we weren't a female dominated profession we'd call it "sucking up to the boss". Another name is syncophant. But we need role models. Ok I think I've said enough for the evening. I do think it is an authority issue.   That's all for now.   marilyn   ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, November 26, 2002 6:11 PM Subject: Re: [ozmidwifery] SalariedVersusContract In a message dated 27/11/02 12:29:44 PM AUS Eastern Daylight Time, [EMAIL PROTECTED] writes: Anyway what I am getting at is there has been no political will to look at midwives differently, in terms of equity, midwifery as a profession deserving support and new solutions for recurrent problems (the cost of escalating intervention etc). At least not in Australia and I think part of the reason is the hand maiden status and mind set of midwives and women! What do others think?? Especially the Bmids?? Denise Hi Denise...thanks for the invitation to respond here...as a BMidder....the vision I have for my practice is the ability to offer my service to women, wherever the woman chooses to birth her babe...the issues with PII have certainly squashed the independent   aspiration for now...though this is my long term aim...but inorder to provide continuity of carer....I'll take salaried/contract work as a midwife to give women choices in their birthing....I think if midwives are smart/politically savvy and don't take the medico approach of making decisions on behalf of women...then you can easily work/negate your way around many a hospital or agency policy/protocol....the final decisions in care and planning for birth rest with the woman...so she can decide what is best for her if she is given information in which to make her decisions...and be supported in whatever decisions she makes...I think where midwives get into strife is where they start living/acting out their own pol! ! itical agendas thru women who end up being the pawns in the whole political process. Not an ideal situation...and the midwife who sees that she has 'gone out on a limb' for a woman who is less than embracing of what the midwife 'whats' for her...in the end comes out the loser...discontent, disillusioned, frustrated and bitter with the birth world. ....Recently in working with a follow thru woman, I attended her pregnancy care visits to the hospital....her model of care was midwife-led care in a birthing unit.....but I was amazed at how subordinate and not so midwife-led it was. Some of the midwives were in their care of the woman far happier to defer or abdicate decisions to the doctors inorder to 'keep the peace' and were very accepting of medical dominant policy/protocol....While some of the midwives seem to embrace the whole responsibility/accountability thing....many do not...and would rather be seen in the handmaiden role in preference to accepting full responsibility for their midwife role. I suppose what I'm getting at here is if midwives don't see themselves differently to nurses...if midwives don't take themselves seriously as autonomous practitioners...if midwives don't have the trust and faith in their midwifery knowledge and skills to embrace responsibility and accountability...then how can we ask that anyo! ! ne else does....be it the government...the medical profession...the public..??? yours in reforming midwifery Tina Pettigrew Bachelor of Midwifery Student Victoria University