Jan
you have put the case well.
To
ripple the waters and move beyond the boundaries of constraint will bring
fruitful change.
Midwives need to be strong, united and show real support for each other
regardless of where they practice (observe the medical profession when they
are faced with a challenge). That is why they have been successful in
obtaining Government support for the Professional Indemnity Crises. To me
this means inequality and maybe we should be pursuing as a strong, united group
the challenge of Professional Indemnity inequality that now
exists.
Robyn
-----Original Message-----On 27/11/02 10:35 PM, "Sally Westbury" <[EMAIL PROTECTED]> wrote:
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Jan Robinson
Sent: Thursday, November 28, 2002 4:11 PM
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery] SalariedVersusContract
I don’t think that we should have to run business to be considered to be a profession.
The really important issues are around the regulation of midwifery. I believe that midwifery should be regulated by professional midwifery organizations. For example. If my husband, the electrician were contracted to the hospital to install electrical equipment, the hospital would not provide him with guidelines because he has guidelines/rules for how he should do it. These are standards provided by his training and licencing bodies, which is from electricians. Similarily we should be able to be contracted to the hospital to provide midwifery services and be expected and trusted to work to a professional standard as guided by our professional body.
If a doctor comes to work in the hospital where are the guidelines for his practice.. don’t we just expect he will work to a certain standard. Come to think about it the doctors usually provide the guidelines for their particular likes and dislikes and the midwives run around providing gloves.. powdered or not powdered according etc ect to the protocols that he provides.
If we are going to change maternity services for women let us also put something in place that establishes us as autonomous practioners.
Dear Sally
You are spot on with your suggestion to put something in place of the services we currently offer.
Of course standards are most important and our College has provided us with a list of competency standards that are hard to beat. But the “something” we really need to put in place of the fragmented care that we currently offer is to commit ourselves to really being more “with woman” as our title suggests.
We need to phase out practices that mean midwives are only partly with women (an hour here or a day or so there) and introduce more continuous care programs.
Surely midwives already employed could contract to their Area Health Authroity to provide continuity of care. We still have enterprise bargaining do we not? There is ample evidence to suggest that this type of care is safe, if not safer, and women receiving continuous care with midwives experience more personal satisfaction. As well, the midwife offering such professional services feels more professional satisfaction. Apart from professional satisfaction midwives midwives experience they are less likely to make mistakes or be involved in misunderstandings during critical times of the pregnancy as the one-to-one communication makes this less likely .
The difference in client satisfaction between continuous and fragmented standards was explained to me recently by a woman who had her first baby in New Zealand and the next one at a large Sydney teaching hospital.
She told me that the NZ midwives made her feel “really special”. They already knew her when she came into their hospital to give birth and they even visited her at home and “put fresh linen on my bed at home and bought me flowers” the next day. She was totally impressed with these kindnesses. There was no comparison between the NZ experience and the Sydney experience where the midwives were nice to her (and she had no complaints at all about them) but she felt she was just another number on their list and she never saw them again when she went home.
One of the hallmarks of any professional is that they have their own clients within their own practice and are able to provide private, personalised care. The service provided by professionals who contract directly with their clients is quite different to that provided by a professional who is employed by someone else, particularly critical care institutions. I challenge all midwives who care for hospital patients to ask them today ... “would you like to have the services of your own midwife throughout your pregnancy if they were available? Would you like to choose where you will give birth to your baby if the choice was available?
While individual midwives can work towards introducing continuous care standards in their practice our College must then promote and protect them. Offering a primary autonomous service is the major feature of any profession and our College should expect no less standard than this of it’s new B.Mid. graduates while encouraging those midwives already practising within the hospital system to be able to seek accreditation through demonstrate the ability to take on their own caseload and continuing to practice in this way. Caseload should in future become the norm and be seen as the major benchmark of clinical midwifery practice.
I hope our College comes up with a program that only accepts midwives responsible for their own caseload as accredited midwife practitioners. Hopefully all caseload midwives will all be issued with their ACMI “Gold Card” to let women and the public know about their philosophy of care.
Regarding salaries vs contracts
The first loyalty of a salaried midwife is to their employer and they must follow the guidelines devised by their employing authority (usually a maternity services committee heavily influenced by doctors.) Salaried midwives find it very difficult to be assertive on behalf of more woman-focused programs within such committees because those who dominate the scene have vested interest in maintaining the medicalised model of care. Even caseload midwives working for hospitals will be less likely to affect personalised care because medical guidelines and protocols usually take precedence. Also the midwife’s first loyalty is to the employer which means that midwife and woman lose some of their autonomy and fail to utilize their combined power.
Midwives who are contracted by community agencies through well-women programs are are lucky enough to be contracted directly with women can use consumer power more effectively to achieve desired outcomes.
They are more likely to be able to articulate exactly what their women want from the maternity services as they are working together in the community. Their contract is usually financed directly through the state department of health.
However midwives are financed, they should continue to promote themselves as autonomous professional health carers, specialists in natural childbirth and well baby care and able to provide individualised care to pregnant women. Salaried or contracted, there is no place to deviate from this philosophy.
So what are we going to put in place of what we currently do?
We can start by listening to women more and standing alongside of them to meet their needs. Once this initial step is taken the road towards true professionalism will become easier.
Jan Robinson
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Jan Robinson Phone/fax: 011+ 61+ 2+ 9546 4350
Independent Midwife Practitioner e-mail: <[EMAIL PROTECTED]>
8 Robin Crescent www: midwiferyeducation.com.au
South Hurstville NSW 2221 National Coordinator, ASIM
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