Re: [ozmidwifery] sharing an unusual placenta question - ideas please

[Kirsten Blacker]

my only concern would be if the blood vessel was 
anywhere near the cervix , to avoid ARM at all costs
Kirsten

  - Original Message - 
  From: 
  Julie 
  Clarke 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, July 20, 2003 7:53 PM
  Subject: [ozmidwifery] sharing an unusual 
  placenta question - ideas please
  
  
  Hi 
all
  I have been asked an unusual 
  “placenta” question tonight that I hope you can all help me 
  with…
   
  The woman is expecting her first 
  baby – there are no complications or problems with this pregnancy – there 
  has been no bleeding episodes during the pregnancy so 
  far- however the ultrasound has revealed what appears to be 2 placentas joined 
  by a blood vessel.
  The questions are:  Would we expect there to be a greater 
  risk of 3rd stage complications such as excessive bleeding? Could 
  the blood vessel rupture either during the last few weeks of pregnancy or 
  during the labour, birth or 3rd stage?
  Has anyone ever encountered this 
  type of situation before and if so what was your 
  experience?
   
  Would this be a strong case for 
  having the Syntocinon injection given routinely?
  Is there a greater risk of pph?
   
  Warm hug to 
  all,
  Julie
   
   
   

Re: Re: [ozmidwifery] Lobbying Update and Federal Election Campaign

[Denise Hynd]

Dear Carol
It is great to hear of other places where progress 
is being made toward midwifery led care (EBP for healthy women) Thank you 

 
Would you write a summary for the ACMI Newsletter 
so more Australian midwives can be encouraged by your efforts??
 

Are there others out there with  similar good 
news ??
 
 
Denise Hynd
 
"Never believe that a few caring people can't change the world.  For, 
indeed, they are the only ones who ever have."  Margaret Mead

  - Original Message - 
  From: 
  Carol Van Lochem 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, July 20, 2004 7:08 
PM
  Subject: FW: Re: [ozmidwifery] Lobbying 
  Update and Federal Election Campaign
  
  
  Trish,
  It is fabulous that you have been lobbying our local member, but 
  I feel that it is important that you give him the correct information lest you 
  lose credibility.
  I work at West Gippsland Hospital in Warragul, which is in 
  Christian Zara's electorate and would like to point out the following:
  
"rural birthing using midwife and collaborative models of care (he was 
really stung when I told him the best example of this was NOT in his 
electorate"
  I am a member of a team of 5 midwives who provide 
  collaborative  and case load care to women in this hospital. We recieved 
  State funding for this back in May and are in the early stages, providing 
  collaborative care to women having VBAC, history of difficult births, young 
  mums and Koori women. We are being provided with additional upskilling in the 
  meantime, and will then commence our caseload stream when competent in areas 
  of cannulation, suturing etc. This is the model of care the State Gov. wishes 
  to implement across Vic.
  I have also been the KYM midwife for the past 2 years on the VBAC 
  program, providing 1-2-1 care throught the pregnancy continuum for these 
  women.
  
"When I told him that every hospital in his electorate had 
double the HWO recommended rate for LUSCS and instruments and were off the 
scale for other interventions, he seemed knocked out."
  West Gippsland Hosital figures for 2002 were as follows:
  NVB   63%
  vacuum extraction 10%
  forceps 8%
  Emergency C/S  11%
  Elective C/S   7%
  Intact perineum    66%
  Perineal tears   29%
  Episiotomy    3.7%
  Episiotomy + tear 0.6%
  VBAC attempts   80%
  VBAC acheived    60%
  I think these figures speak for themselves. Some of them are State 
  Benchmarks. Any wonder the poor man "seemed knocked out"
  Yours in midwifery
  Carol Van Lochem
   
  
   
  >From: Patricia David <[EMAIL PROTECTED]> 
  >Reply-To: [EMAIL PROTECTED] 
  >To: [EMAIL PROTECTED] 
  >Subject: Re: [ozmidwifery] Lobbying Update and Federal Election 
  Campaign 
  >Date: Wed, 14 Jul 2004 05:07:45 + 
  > 
  >Justine, this is great! I have had success with local Labor 
  Member Christian Zara who put out a letter to all constituents asking us to 
  call him with issues of concern, etc. Well he did open the door! 90 
  minutes after we started our phone call he has invited me to meet with him to 
  discuss such issues of national policy as: rural birthing using midwife and 
  collaborative models of care (he was really stung when I told him the best 
  example of this was NOT in his electorate), professional indemnity (favouring 
  a national govt insurance scheme for all health professionals with a 
  three-tiered review process that is truly multi-disciplinary and 
  non-adversarial), care of all babies and families who sustain birth injury, 
  not just those who successfully sue, increased numbers of staff specialists 
  with incentives for private obs/GPs who can prove true collaborative models in 
  practice, extra funding and assistance for rural midwifery education aimed at 
  clinical experie! nce support both in rural and metro centres (just like the 
  med students get), equity between medical and nursing and midwifery in terms 
  of support in education such as living away from home allowances, travel and 
  meals, nationalisation of health so that we can enforce midwifery 
  representation on M&M committees, as well as have a more direct 
  reimbursement for midwifery services, more accurate measures of costing 
  maternity services and perhaps a commitment to enforce some sort of 
  reimbursement from private doctors who use midwifery services that are 
  publicly paid for but which prop up their incomes! 
  > 
  >Poor guy got an earful, but he spoke beautifully about women 
  giving birth, midwives assisting, babies being born, etc rather than being 
  delivered, midwives doing deliveries... he even knew very well the difference 
  between midwife and nurse! I complimented him on this and he said he was 
  surrounded by empowered women who didn't want intervention. When I told him 
  that every hospital in his electorate had double the HWO recommended rate for 
  LUSCS and instruments and were off the scale for other interventions, he 
  seemed knocked out.

[ozmidwifery] VBAC contact in the ACT

[Judy Giesaitis]

I have a client in 
the ACT who has a h/o  previous uterine surgery and an emergency c/s 
and would like to contact anyone in the ACT who has a similar history.  
Does anyone know of anyone who would be happy to chat to her??  please feel 
free to contact me off list [EMAIL PROTECTED]  
many thanks. 
Take 
care, 
 Judy
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Address:Locked 
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Fax:    
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Email: 
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Re: FW: Re: [ozmidwifery] Lobbying Update and Federal Election Campaign

[Mary Murphy]

Trish writes:
-"I also pointed him to WA and publicly funded homebirths with midwife
entry to hospitals"
Yes we in W.A. have a publicly funded homebirth option (restricted to 150
births/yr) but sadly no midwife entry to hospitals other than as a support
person.  There is an avenue for midwives to work casually at the FBC and
care for private clients there, but once transferred to the labour ward, we
are once again support people.  MM


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Re: FW: Re: [ozmidwifery] Lobbying Update and Federal Election Campaign

[Patricia David]

Dear Carol, apologies for causing offence, at that stage I wasn't aware his electorate 
contained Warragul, (have only voted in one federal election in Vic and didn't quite 
take in all the boundaries) but we did have a discussion about it and your initiatives 
and fabulous figures. I pointed him also to Wonthaggi as an exception and the fact 
that they have halved their CS rates to be around the 7-10% in one year. I also told 
him the bigger the hospital the more likely there was to have intervention, but not 
necessarily because of the increase in risk.

He was very interested and is planning on fact finding around this issue in his 
district. Your unit will be an example, and I expect he will make a visit. The next 
step is to get him interested in federal incentives to have your initiatives 
duplicated across his region. I also pointed him to WA and publicly funded homebirths 
with midwife entry to hospitals (way outside his electorate and a fantastic example of 
collaborative care, I reckon) and their great figures, NZ and Holland.

Trish

Carol Van Lochem <[EMAIL PROTECTED]> wrote:Trish,
> It is fabulous that you have been lobbying our local member, but I feel that it is 
> important that you give him the correct information lest you lose credibility.
> I work at West Gippsland Hospital in Warragul, which is in Christian Zara's 
> electorate and would like to point out the following:
> 
> "rural birthing using midwife and collaborative models of care (he was really stung 
> when I told him the best example of this was NOT in his electorate"
> I am a member of a team of 5 midwives who provide collaborative  and case load 
> care to women in this hospital. We recieved State funding for this back in May and 
> are in the early stages, providing collaborative care to women having VBAC, history 
> of difficult births, young mums and Koori women. We are being provided with 
> additional upskilling in the meantime, and will then commence our caseload stream 
> when competent in areas of cannulation, suturing etc. This is the model of care the 
> State Gov. wishes to implement across Vic.
> I have also been the KYM midwife for the past 2 years on the VBAC program, providing 
> 1-2-1 care throught the pregnancy continuum for these women.
> 
> "When I told him that every hospital in his electorate had double the HWO 
> recommended rate for LUSCS and instruments and were off the scale for other 
> interventions, he seemed knocked out."
> West Gippsland Hosital figures for 2002 were as follows:
> NVB   63%
> vacuum extraction 10%
> forceps 8%
> Emergency C/S  11%
> Elective C/S   7%
> Intact perineum    66%
> Perineal tears   29%
> Episiotomy    3.7%
> Episiotomy + tear 0.6%
> VBAC attempts   80%
> VBAC acheived    60%
> I think these figures speak for themselves. Some of them are State Benchmarks. Any 
> wonder the poor man "seemed knocked out"
> Yours in midwifery
> Carol Van Lochem
>  
> 
-- 
Trish David FACM
Senior Lecturer Midwifery and Nursing
Monash University School of Nursing
Gippsland Campus
Northways Road
Churchill 3842
(03) 5122 6839
0418 994033
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RE: [ozmidwifery] Flinders Medical Centre

[Wendy Taberer]

Hi Denise, thanks for taking the time to
write, will contact you again shortly if I have any further queries.

Thanks again

Wendy Taberer

 









From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On
Behalf Of Denise Hynd
Sent: 19 July 2004 04:58
To: [EMAIL PROTECTED]
Subject: Re: [ozmidwifery]
Flinders Medical Centre



 



Dear Megan





This is very infromative break down of what is available in Adelaide,





Sadly it leaves Perth
in the shadows.





Though we have the Community Midwiferty Program it only
offers 150 places per year.





There are no other 1-2-1 options in WA unless you have 
midwife at home.





There is only 1 birth centre at King Edward which operates
with Teams of 4 midwives per women.





There is a Team Option also at  KEMH through their
clinics!!





Three other hospitals in the metro area have nominal
midwives clinics with GP shared care and little prospect of
continiuty of midwife as the midwives work shifts in either clinics, labour
ward or postnatal though sometimes they maybe partime in either location!!





Denise Hynd





 





"Never believe that a few caring people can't change the
world.  For, indeed, they are the only ones who ever have."  
Margaret Mead







- Original Message - 





From: Megan and Larry






To: [EMAIL PROTECTED] 





Sent: Monday, July 19,
2004 9:54 AM





Subject: RE: [ozmidwifery]
Flinders Medical Centre





 





Hi Wendy,





Have a look at http://www.dh.sa.gov.au/pehs/pregnancyoutcome.htm you
can weed out what kind of things are going on in SA.





Flinders is a level 3 teaching
hospital which does have a midwifery run birth centre (BC) for low risk
women. They don't have a continuity programme, trying to get one running, so
currently if a woman transfers her care out of the unit she will lose her
midwife and the philosophies of the BC. The midwife running the BC is Julie
Pratt, she has had independant practice in the past and is very
supportive of women centred care. Unfortunately the unit lost VBAC care last
year due to the hospital wanting all VBAC women to be monitered, therfor no
longer low risk, as a result the VBAC outcomes have plummeted. You can
waterbirth in the BC. A range of Obs working at FMC, with various philosophies
which seem to change depending on how strong the woman is, etc. The
web address is http://www.flinders.sa.gov.au/





 





The local area is quite lovely. A few km's
up the hill from FMC is the lovely Adelaide Hills, very open and lots of
natural bush still around with excellent public schools. Head West a few km's
and you have the coastal suburbs, if you love the beach, either way its not too
far. For an area directory go to http://www.adelaide.citysearch.com.au/search?type=map_search and
type in the suburb of Bedford
 Park. 





I have grown up at the coast and recently
moved to the hills so FMC has been my local hospital. I had my first baby there
as a private patient and then my next three at home. We wanted the continuity
and to birth at home.





 





The Women and Childrens Hospital,
has just started a midwifery continuity programme, midwife stays with woman for
entirety of pregnancy. Currently available to 500 women, increasing by another
250 soon and then to 1000 in 2005. 





Also have a community midwifery programme
in our Nthn suburbs, Northern Womens Community Midwifery practice, offering
continuity and option of birth at home.





The Queen Elizabeth
 Hospital, western
suburbs, recently lost all maternity services due to lack of Obstetricians.
TQEH had/has a wonderful midwifery run BC still offering VBAC. Hopefully the
maternity unit will reopen with a stronger midwifery presence, planning is in
the pipeline.





 





We also have very active birth consumer
groups, http://www.maternitycoalition.org.au/memberorgs.html Birth
Matters, CARES SA , Homebirth Network SA and a SA branch of the Maternity
Coalition. We all communicate together very well with a number
of members crossing over to all groups. We have strong links with a few of
our politicians and good communication with a number of our midwives.





 





Anyway, that should get you started, if
you would like to know more contact me on [EMAIL PROTECTED]





 





best wishes





Megan





-Original Message-
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]On
Behalf Of Wendy Taberer
Sent: Monday, 19 July 2004 5:19 AM
To: [EMAIL PROTECTED]
Subject: [ozmidwifery] Flinders
Medical Centre

Hi, I’m looking for information on the Flinders
Medical Centre, Adelaide. 
I have a c.v. on it’s way for consideration.  Live in England
at present with partner and two young children 12 and 9.  Working in a low
risk birthing centre run by about 14 midwives and looking to migrate to Australia. 
Would love to hear more about the hospital and the surrounding areas.

 

Thanks

Wendy Taberer

 

RE: [ozmidwifery] Midwifery led birth centres

[Allison Hilbig]

> Angliss Birth Centre no longer offers VBACs. They do refer women to a
> very supportive doctor for care.

That must have changed in the last few months then - because 
previously that had allowed VBAC and were very proud of that. In 
fact I had an urgent phone call late one night from one of the 
midwives because a woman was labouring in the birth centre and 
her TENS unit stopped working. So I did an urgent dash into work 
(just 5 minutes away) to grab another one for her to use - which she 
probably didn't need but we didn't want anything to possibly upset 
her perceived ability to cope. She was a VBAC and the midwife 
was very pleased to tell me the next day that this woman had 
delivered naturally an hour or two later. 
What a shame they (we) no longer offer that option in the one 
environment that is more likely to produce the required result of a 
natural birth. 

Allison Hilbig
Accreditation Coordinator/Deputy Manager of Physiotherapy, 
Angliss Hospital, Upper Ferntree Gully, Victoria

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Re: [ozmidwifery] Re:sharing an unusual placenta question - ideas please

[Susan Cudlipp]

Hi Julie
If it is joined by a blood vessel it is most likely 
to be a large succenturiate lobe. Provided this is well clear of the presenting 
part it should not cause any problems. These are not uncommon.
Sue

  - Original Message - 
  From: 
  Larissa Inns 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, July 20, 2004 7:54 
PM
  Subject: [ozmidwifery] Re:sharing an 
  unusual placenta question - ideas please
  
  HI Julie!
  This sound possibly more like a succenturiate 
  (sp?)lobe than two separate placentas. I'm thinking there is a risk of the 
  vessels breaking and subsequent bleeding and also of retained fragments 
  (cotyledons) as far as I know. I have seen one but it was a c/s so I'm not 
  really 100%. The ultrasound picked it up as the placenta being anterior and 
  then a second ultrasound showed it posterior which created confusion until the 
  placenta came out and we realised that it was anterior and posterior as it was 
  like 2 placentas.
  Will be interested to see what others 
  think.
  Hugs,Larissa
  (2nd yr BMid FUSA)
   
  
- Original Message - 
From: 
Julie 
Clarke 
To: [EMAIL PROTECTED] 

Sent: Sunday, July 20, 2003 9:23 
PM
Subject: [ozmidwifery] sharing an 
unusual placenta question - ideas please


Hi 
all
I have been asked an unusual 
“placenta” question tonight that I hope you can all help me 
with…
 
The woman is expecting her first 
baby – there are no complications or problems with this pregnancy – there 
has been no bleeding episodes during the pregnancy 
so far- however the ultrasound has revealed what appears to be 2 placentas 
joined by a blood vessel.
The questions are:  Would we expect there to be a 
greater risk of 3rd stage complications such as excessive 
bleeding? Could the blood vessel rupture either during the last few weeks of 
pregnancy or during the labour, birth or 3rd 
stage?
Has anyone ever encountered this 
type of situation before and if so what was your 
experience?
 
Would this be a strong case for 
having the Syntocinon injection given 
routinely?
Is there a greater risk of pph?
 
Warm hug to 
all,
Julie
 
 
 

RE: [ozmidwifery] sharing an unusual placenta question - ideas please

[Sally Westbury]

I agree it is probably a large succenturiate
lobe.

 

I have seen only 2 placenta’s
like this. 

 

One was only discovered in retrospect
after a straight forward birthing process.

 

The other had heavy bleeding and it was a
bit confusing because although the midwife easily felt the placenta below the
cervix it was still not being birthed. The woman was also experiencing a lot of
pain (first birth for this mother). The midwife did attempted to assist the birth
of the placenta, believing that it had separated and was being held up at the
cervix, with gentle cord traction, but it did not come easily. Some Syntocinon and
controlled cord traction did help the placenta birth but it was still difficult,
with more cord traction than ‘usual’ (remembering that we are used
to physiological 3rd stage) and severe pain for the birthing woman:
it was very odd. Only on looking at the placenta did we get any explanation of
what was happening. I think that one lobe of the placenta was sitting in the
cervix causing the pain whilst the rest was not separated causing bleeding. 

This is of course the worry that the
placenta is less likely to separate in one nice clean action and so bleeding is
probably something to be alert for and therefore a increased risk of PPH.  

Despite this 2nd experience I would
probably not give routine Syntocinon (I would have it drawn up) but would use
the watch closely and act quickly if my head, heart or gut alerted me.

 



Sally Westbury

Homebirth Midwife

 

"It takes courage to remain a true advocate for women, challenging
authority and sacrificing social and professional acceptance. It takes courage
for a woman to choose a caregiver who will truly advocate for and empower
her."    -Judy Slome Cohain



-Original
Message-
From: owner-[EMAIL PROTECTED] [mailto:owner-[EMAIL PROTECTED]] On Behalf Of Julie
Clarke
Sent: Sunday, 20 July 2003 7:54 PM
To: [EMAIL PROTECTED]
Subject: [ozmidwifery] sharing an
unusual placenta question - ideas please

 

Hi all

I have been asked an unusual
“placenta” question tonight that I hope you can all help me
with…

 

The woman is expecting her first
baby – there are no complications or problems with this pregnancy –
there has been no bleeding episodes during the pregnancy so far- however the
ultrasound has revealed what appears to be 2 placentas joined by a blood
vessel.

The questions are:  Would we expect there to be a greater
risk of 3rd stage complications such as excessive bleeding? Could
the blood vessel rupture either during the last few weeks of pregnancy or
during the labour, birth or 3rd stage?

Has anyone ever encountered this
type of situation before and if so what was your experience?

 

Would this be a strong case for
having the Syntocinon injection given routinely?

Is there a greater risk of pph?

 

Warm hug to all,

Julie

 

 

 

[ozmidwifery] Re:sharing an unusual placenta question - ideas please

[Larissa Inns]

HI Julie!
This sound possibly more like a succenturiate 
(sp?)lobe than two separate placentas. I'm thinking there is a risk of the 
vessels breaking and subsequent bleeding and also of retained fragments 
(cotyledons) as far as I know. I have seen one but it was a c/s so I'm not 
really 100%. The ultrasound picked it up as the placenta being anterior and then 
a second ultrasound showed it posterior which created confusion until the 
placenta came out and we realised that it was anterior and posterior as it was 
like 2 placentas.
Will be interested to see what others 
think.
Hugs,Larissa
(2nd yr BMid FUSA)
 

  - Original Message - 
  From: 
  Julie 
  Clarke 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, July 20, 2003 9:23 PM
  Subject: [ozmidwifery] sharing an unusual 
  placenta question - ideas please
  
  
  Hi 
all
  I have been asked an unusual 
  “placenta” question tonight that I hope you can all help me 
  with…
   
  The woman is expecting her first 
  baby – there are no complications or problems with this pregnancy – there 
  has been no bleeding episodes during the pregnancy so 
  far- however the ultrasound has revealed what appears to be 2 placentas joined 
  by a blood vessel.
  The questions are:  Would we expect there to be a greater 
  risk of 3rd stage complications such as excessive bleeding? Could 
  the blood vessel rupture either during the last few weeks of pregnancy or 
  during the labour, birth or 3rd stage?
  Has anyone ever encountered this 
  type of situation before and if so what was your 
  experience?
   
  Would this be a strong case for 
  having the Syntocinon injection given routinely?
  Is there a greater risk of pph?
   
  Warm hug to 
  all,
  Julie
   
   
   

[ozmidwifery] sharing an unusual placenta question - ideas please

[Julie Clarke]

Hi all

I have been asked an unusual “placenta” question
tonight that I hope you can all help me with…

 

The woman is expecting her first baby – there are no complications
or problems with this pregnancy – there has been no
bleeding episodes during the pregnancy so far- however the ultrasound
has revealed what appears to be 2 placentas joined by a blood vessel.

The questions are: 
Would we expect there to be a greater risk of 3rd stage
complications such as excessive bleeding? Could the blood vessel rupture either
during the last few weeks of pregnancy or during the labour, birth or 3rd
stage?

Has anyone ever encountered this type of situation before
and if so what was your experience?

 

Would this be a strong case for having the Syntocinon injection
given routinely?

Is there a greater risk of pph?

 

Warm hug to all,

Julie

 

 

 

FW: Re: [ozmidwifery] Lobbying Update and Federal Election Campaign

[Carol Van Lochem]

Trish,
It is fabulous that you have been lobbying our local member, but I feel that it is important that you give him the correct information lest you lose credibility.
I work at West Gippsland Hospital in Warragul, which is in Christian Zara's electorate and would like to point out the following:

"rural birthing using midwife and collaborative models of care (he was really stung when I told him the best example of this was NOT in his electorate"
I am a member of a team of 5 midwives who provide collaborative  and case load care to women in this hospital. We recieved State funding for this back in May and are in the early stages, providing collaborative care to women having VBAC, history of difficult births, young mums and Koori women. We are being provided with additional upskilling in the meantime, and will then commence our caseload stream when competent in areas of cannulation, suturing etc. This is the model of care the State Gov. wishes to implement across Vic.
I have also been the KYM midwife for the past 2 years on the VBAC program, providing 1-2-1 care throught the pregnancy continuum for these women.

"When I told him that every hospital in his electorate had double the HWO recommended rate for LUSCS and instruments and were off the scale for other interventions, he seemed knocked out."
West Gippsland Hosital figures for 2002 were as follows:
NVB   63%
vacuum extraction 10%
forceps 8%
Emergency C/S  11%
Elective C/S   7%
Intact perineum    66%
Perineal tears   29%
Episiotomy    3.7%
Episiotomy + tear 0.6%
VBAC attempts   80%
VBAC acheived    60%
I think these figures speak for themselves. Some of them are State Benchmarks. Any wonder the poor man "seemed knocked out"
Yours in midwifery
Carol Van Lochem
 

 
>From: Patricia David <[EMAIL PROTECTED]> 
>Reply-To: [EMAIL PROTECTED] 
>To: [EMAIL PROTECTED] 
>Subject: Re: [ozmidwifery] Lobbying Update and Federal Election Campaign 
>Date: Wed, 14 Jul 2004 05:07:45 + 
> 
>Justine, this is great! I have had success with local Labor Member Christian Zara who put out a letter to all constituents asking us to call him with issues of concern, etc. Well he did open the door! 90 minutes after we started our phone call he has invited me to meet with him to discuss such issues of national policy as: rural birthing using midwife and collaborative models of care (he was really stung when I told him the best example of this was NOT in his electorate), professional indemnity (favouring a national govt insurance scheme for all health professionals with a three-tiered review process that is truly multi-disciplinary and non-adversarial), care of all babies and families who sustain birth injury, not just those who successfully sue, increased numbers of staff specialists with incentives for private obs/GPs who can prove true collaborative models in practice, extra funding and assistance for rural midwifery education aimed at clinical experie!
 nce support both in rural and metro centres (just like the med students get), equity between medical and nursing and midwifery in terms of support in education such as living away from home allowances, travel and meals, nationalisation of health so that we can enforce midwifery representation on M&M committees, as well as have a more direct reimbursement for midwifery services, more accurate measures of costing maternity services and perhaps a commitment to enforce some sort of reimbursement from private doctors who use midwifery services that are publicly paid for but which prop up their incomes! 
> 
>Poor guy got an earful, but he spoke beautifully about women giving birth, midwives assisting, babies being born, etc rather than being delivered, midwives doing deliveries... he even knew very well the difference between midwife and nurse! I complimented him on this and he said he was surrounded by empowered women who didn't want intervention. When I told him that every hospital in his electorate had double the HWO recommended rate for LUSCS and instruments and were off the scale for other interventions, he seemed knocked out. 
> 
>So, his office has contacted me twice looking to set up a meeting so he can gather advice on all these issues. If you know your stuff, they will listen. Go for it! Ring them, especially if they open the door for you to do so. Ring their office and make a meeting! Bring paperwork with you, even if it's just a summary of the main points you want to talk about with some suggestions for finding further information. 
> 
>Trish 
> 
>Justine Caines <[EMAIL PROTECTED]> wrote: 
> > 
> > Lobbying Update and Federal Election Campaign 
> > 
> > 
> > Dear All 
> > 
> > Sorry I have not updated you  all sooner.   
> > 
> > Last Tuesday I met with Deputy PM, Leader of the National Party and my local Federal member, John Anderson. 
> > 
> > I was cheeky and did pre-emptive media and before we actually met I had done 6 radio slots and he had done 2!!  This was then followed up with 2 further slots on Thur