Dear Clare, Sue and Andrea I am also concerned considering the state-wide implications of the establishment of a hospital managed (therefore obstetrically controlled) home birth service.
Firstly I applaud the efforts of Pat Brodie and Nicky Leap for moving to the establishment of a HB service. I do however think a community to hospital interface (when necessary) rather than the proposed hospital in the home approach would be a much better option. A few questions that pop up are: How will this impact on less progressive Area Health Services (particularly rural ones) where women have NO other choice but full obstetric management of their care? How can a hospital run HB service complement NMAP, considering it is community midwifery, particularly outside of hosptial control with an emphasis on the woman/midwife relationship. Where is the evidence for the safety of an obstetric managed HB service? Effective care cite obstetrics as unsafe for normal pregnancies let alone the HB. The only evidence a hospital run program can gather is the effectiveness of that model, it cannot credibly make a case for any other model. Realistically this model will be the minority model because so few other areas have obstetric support (I would see Hunter as the only one with Northern Syd now with Sally's efforts in Ryde). Just look at the disaster in the Illawarra (a total NO to community midwifery for Shellharbour and more misery for a whole lot of women subject to obstetric control). I would think some modifications are needed to enable this to be duplicated across the state, eg a community board of management with a consumer emphasis and voting rights to balance the acute setting control. The women in South East Area Health Service are fortunate to have the greatest compliment of choice publicly available. Lets spare a thought for the poor women in Orange, Dubbo, or even Campbelltown or Shellharbour. In the short term the only way we can promote a state-wide HB and community midwifery option is via individual contracted midwives. We need to continue the pressure to gain status for former IPM's (and anyone else willing to contract) so they are insured and funded for public work. This may not ensure a service at Brewarrina but will enable a much further field than the fortunates in Sth East Sydney. Justine Caines > I am getting really confused about what is happening in South East Health. > On the one hand I spoke to someone at Randwick who said that there was no > movement in introducing homebirth and there didn't look like there would be > any in the near future. Then I hear that some politician is dragging > his/her feet (can't remember who it was) about funding, then I am asked (but > not yet directly) to be a consumer rep on the comittee who will be > introducing homebirth at St Georges, and then your email seems to imply that > a lot of decisions have been made. > > This is really frustrating, after all we can only be talking about a small > number of women at the start who will be choosing homebirth, especially if > the educators at the hospital are under pressure to tell a certain story. I > run a homebirth support group and have tried to get this information so that > there can be some linkage between the community and the hospital, but I feel > increasingly frustrated that I haven't got a clue what is happening!!!! I > am concerned that the program is being set up to fail and then that will be > the reason they cite for not introducing the program elsewhere in the state. > Any more information out there? > > Claire Saxby > > >> From: Andrea Robertson <[EMAIL PROTECTED]> >> Reply-To: [EMAIL PROTECTED] >> To: [EMAIL PROTECTED] >> Subject: Re: [ozmidwifery] New models of midwifery care >> Date: Fri, 28 Nov 2003 09:50:58 +1100 >> >> Hi Sue, >> >> I have checked this out - at the RHW in Randwick, there are 8 midwives on >> the Birth Centre team with experience of homebirths and it will be these >> midwives who are offering the homebirth option. A similar situation is in >> place at St George. THere will also be four very experienced home birth >> midwives available asmentors for the new graduates who want to work in this >> way - they will be supported through at least their first five home births. >> >> I am not sure of these programs are picking up ex-independent midwives >> although it would seem to be a great opportunity for those who want to >> continue to work in this way but with better back-up resources and more >> midwife-friendly hours (which may be important for some with family >> obligations). I understand that there has been quite an influx of midwives >> from the UK and NZ who have home birth experience, which is very useful as >> we move towards establishing home birth services here. >> >> We are really hoping that these new services get going quickly - the NSW >> Department of Health will be watching to see how popular they are and how >> they function as a basis for looking at other ways of funding homebirths, >> perhaps directly, or through Commmunity Health. If these home birth >> programs in the South Eastern Sydney Area Health Service fail or don't get >> started, then there will be less reason for the NSW Dept of Health to >> support any other proposed models of midwifery care. >> >> We are all very hopeful that we can at last get home birth available as a >> regular option for women choosing the public health system in NSW. Its a >> start, and will provide important evidence for initiating other services as >> well. >> >> I know that St George are canvassing the help of independent midwives in >> their catchment area and hoping they will also offer practical assistance >> and support to get the program running. Once it is in place we can then >> move on to other possibilities.... >> >> Cheers >> >> Andrea >> >> >> >> >> At 08:54 AM 28/11/2003, Sue Cookson wrote: >>> Hi Andrea, >>> I have just read your entries regarding the new style of midwifery care to >>> be offered in parts of Sydney. Well done to everyone who has participated >>> in >>> the work of implementing this change. >>> >>> I do wonder however about the skill levels of the midwives involved, >>> particularly where homebirths are offered, and in light of your comments >>> re >>> the numbers of midwives willling to attend your workshops. Do you know if >>> these programs are 'catching' ex-independent midwives who ceased work due >>> to >>> the PI fallout, or are we seeing a new wave of midwives willing to step >>> out >>> of the narrow parameters of their training? >>> >>> Are there any other areas in NSW where midwife centred care is being >>> implemented?? >>> >>> Sue >>> >>> >>>> ----- >>>> Andrea Robertson >>>> Birth International * ACE Graphics * Associates in Childbirth Education >>>> >>>> e-mail: [EMAIL PROTECTED] >>>> web: www.birthinternational.com >>>> >>>> >>>> -- >>>> This mailing list is sponsored by ACE Graphics. >>>> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. >>> >>> -- >>> This mailing list is sponsored by ACE Graphics. >>> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. >> >> >> ----- >> Andrea Robertson >> Birth International * ACE Graphics * Associates in Childbirth Education >> >> e-mail: [EMAIL PROTECTED] >> web: www.birthinternational.com >> >> >> -- >> This mailing list is sponsored by ACE Graphics. >> Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > _________________________________________________________________ > Stay in touch with absent friends - get MSN Messenger > http://www.msn.co.uk/messenger > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. 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