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Exactly - well said Justine & congrats on your
wonderful baby news.
Why the midwifery profession proports and has come
to to provide the care usually done by an anaesthetic team (in
OT) is beyond my comprehension really. It is a continuum of the
doctor-handmaiden stuff.....The care of a woman having an epidural in my
(limited) experience is usually attended by only one other health
professional - and that is an anaesthetic team .... or have other
professional arms also agreed to do this as well ?
In a world where some ob's think we might not even
have vaginal births in the next cple of generations ( National media from one of
the Ob's attending the RANZCOG conference in Hobart 2005)...... one has to
wonder what other handmaiden roles the ob's, anaesthetists and obstetricians
will come up with next, that will be pushed onto midwives and perhaps even taken
up !!! This surely has to ring alarm bells when it comes to the legal,
ethical and professional considerations of how and why midwives have adopted the
practices of another health professional's scope of practice.
If an anesthetic is provided, into the spine -
surely the anaesthetist is responsible for the care of that person whilst under
the anaesthetic ? One thing is for sure, we all know who these
trained epidural specialists would try to be blame - if something went
wrong....
On another note, as an advocate for one-to-one
midwifery care with a known midwife, my observation is with the emergence of
some primary models of midwifery care, there is a common theme of
enormous pressure from the medicos to have these models also take
on the(ir) medical ways. I have noticed in some position descriptions
and accreditation competency standards for midwives, that in the name of
'safety' etc we may be inadvertently swaying to the power of our
medical colleagues as we take on the(ir) medical hedgemony of safety,
technology, science etc to justify the existence of primary midwifery models of
care.
I am not essentially opposed to having these skills
however - it is interesting to note that in some primary midwife models (P.D's
and accreditation processes), not only are the essential criteria more strongly
focussed on the 'medical aspects' of maternity care eg: ALSO etc, in contrast
there is generally no essential criteria cited for having attended
appropriate midwifery training to be able to provide primary care for
example : active birth workshops, preceptor training with an IPM or home birth
program such as CMWA etc. Surely this is as if not more important as an
essential criteria for practice ?
I would advocate that we need to provide a balance
here - as it is vital we do not go down the road of taking on the speak and
practice of the medico's lending to some primary practice's developing into a
'hospital in the home' scenario.
If midwives united and said 'no' to being the
obstetric or anaesthetic handmaidens in hospitals - we would have much more
opportunity to learn and practice the art of midwifery - and be truly qualified to provide care as a
primary midwifery.
I know that the women I speak with do not want me
trained in 'taking on' the role and responsibility of the anaesthetic team,
rather they look for a person who has trust in their ability to birth, to
listen, to intuit and to practice with care, competence and safety.
As we are borning the new midwife with 'Bachelor of
Midwifery' programs - perhaps this is the way forward in becoming clear about
removing ourselves from taking on another health profession's responsibility - ie: do not have midwifery students
engage in the provision of epidural care.
The midwifery profession could argue that
the legal, ethical and professional issues of providing care of a woman
'having or got an epidural' does not qualify or fall within our
midwifery scope of practice.
Kind Regards,
Sally-Anne Brown
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