RE: [ozmidwifery] Epidural top-up Policy

[Mary Murphy]

Title: Re: [ozmidwifery] Epidural top-up Policy

This theme reminds me of a rural hospital about 10 yrs ago where the midwives were trying not to do “routine” VE’s and also in response to a dr who said midwives did not know what they were doing.  Every time a woman needed a VE, the midwives called the doctor to come and do it.  I think the dr gave in first.  If he wanted to know the dilation or it was necessary to know because of timing of analgesia, he had to leave his surgery or bed and do it himself.  I wonder how strongly the anaesthetists would be pushing for their very expensive skills to be used in normal labour if THEY were responsible for maintaining the level of analgesia and safety aspects.  I am still in touch with a young mother of 3 who suffers foot drop/retention-incontinence because of  bladder anaesthesia and severe chronic back pain from an epidural she didn’t want.? I also like the suggestion that Active Birth workshops, including waterbirths, were mandatory, annually, for midwives. Cheers, MM   From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Jenny Cameron Sent: Friday, 20 May 2005 10:33 AM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Epidural top-up Policy   Well said Justine   For the first 3-4 years of my midwifery experience epidurals were not an option for women where I worked. OK they are now but it is not the role of a midwife to top them up. I believe topping up is the job of the anaesthetist, the same as inserting IV's is not a midwifery role ( or a nursing one for that matter). This all about dumping the scut work on to women. Tasks like topping up are the housework of health care; too menial for docs to do, same with IV insertion. Prostaglandin gel insertion is now housework , the newness has faded so now the drudge (midwife) can do that. Am I too cynical...no, a midwife with both feet on the ground. Cheers, see you all in Brisbane.   Jenny Jennifer Cameron FRCNA FACM PO Box 1465 Howard Springs NT 0835   0419 528 717 ----- Original Message ----- From: Justine Caines To: OzMid List Sent: Thursday, May 19, 2005 9:37 PM Subject: Re: [ozmidwifery] Epidural top-up Policy   Dear Lisa and All You seem to have missed my point.  I did not advocate against women choosing an epidural, I said the use of epidurals should not be within a midwifery scope of practice and I stand by that.  I find it insane when a fraction of midwives actually work as midwives and yet we yell and scram to keep supporting all the obstetric who ha.  Don't worry all that stuff is very safe.  I agree every woman needs a midwife, regardless (but topping up the epidural is not being a midwife) As to who should do it, yes let the Drs go for it, it's their domain!  If midwives determined what was and wasn't midwifery then we would have real change in this country NOW. We will never see midwifery practiced fully while there is such support for an obstetric model with all its trappings.  The balance is so severely skewed it is time to get realand establish what is midwifery and the right of healthy women to access it exclusively. With less than .2 of 1% of women being able to be cared for by a known midwife and yet women being able to demand epidurals, social inductions, and elec c/s I  know where the work needs to be done. As a woman I have paid $14,000 for homebirths, with not a cent in return.  Yet I  pay for the 30% rebate for privately insured women to have the works.   Something has to give. I really believe midwifery on the whole to be with well women with only an emotional and supportive role for women accessing medical care and intervention. Just because 80% of women currently receive intervention and many blindly ask for  it doesn’t mean it’s right, or that they are informed.  Most women are told an epidural can’t harm the baby!!   How can we say women really want/need an epidural when 99% of them are forced to share their most intimate moment with a stranger and nearly as many of them can’t even use warm water immersion and they are in a system that sets them up for failure (pelvis too small, big baby, unreal labour time frames etc etc!). What we know is that where midwives form a relationship with women the use of drugs is slashed.  In our local unit Epidurals are hard to obtain and consequently 2 are done each year, what makes these women different to the city women where it is peddled?? Hope this clarifies Justine Internal Virus Database is out-of-date. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.11.5 - Release Date: 4/05/2005