WTF is the ACM up to???!!
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WTF is the ACM up to???!!
Moving on | Facebook
I read this earlier this morning. So disheartening and disappointing and frustrating and bloody screwed up, aargh!
There are still midwives attending HBAC so don't lose heart. The ACM stance is very wrong and we need to stand up for birth choices, and our midwives.
We have TWO DAYS left to write a letter to the ACM in response to their guidelines.
To the Australian College of Midwives Board of Directors’
By post to PO Box 87, Deakin West ACT 2600.
Or by email to info@midwives.org.au
Everything you need to know is here: Respond to the ACM interim homebirth position statement | National Alliance for Students of Midwifery
Respond to the ACM interim homebirth position statement
RESPONSES must be received before the 23rd Sept (close of business)
SIMPLIFYING THE ISSUES:
What is wrong with the ACM Homebirth Position Statement and Interim Guidelines?
Joy Johnston (A Fellow of the ACM since 1997) states:
The release by the Australian College of Midwives (ACM) of an Interim Homebirth Position Statement and guidance document has prompted discussion and debate amongst those of us who are interested in the boundaries of a midwife’s practice. Of immediate concern is the statement in the guidance that:
“There are some contraindications to a planned homebirth which women should be informed of at booking. These are:
• Multiple pregnancy
• Abnormal presentation (including breech presentation)
• Preterm labour prior to 37 completed weeks of pregnancy
• Post term pregnancy of more than 42 completed weeks
• Scarred uterus”
The word ‘contraindication’ means ‘NO!’… There is little room for movement in the word ‘contraindication’ which in any medical setting means that there is a reason to avoid using a particular treatment…
Village Midwife Blog: Refining and redefining a midwife’s boundaries
The only way in anyone’s book to approach vaginal birth after caesarean (regardless of the planned place of birth) is spontaneous onset of labour, which usually means at home, quietly and privately. The optimal situation as far as I can see is that the woman is able to call her midwife who will work with her in either setting – home and hospital. By ‘black banning’ the scarred uterus from HBAC, it is likely that some women will feel they have no option but to go it alone, or to engage unskilled help, with sometimes tragic and avoidable consequences.“
Midwives Victoria: A scarred uterus
“International Confederation of Midwives (ICM) POSITION STATEMENT ON HOMEBIRTH: The ICM supports the right of women to make an informed decision to give birth at home.
ICM GUIDING STATEMENT TO MEMBER ASSOCIATIONS (The ACM is one): Member Associations based in countries where women do not have access to a full range of options as to where they can safely give birth are encouraged to negotiate with their governments for this to occur.”
Any position statement of the ACM should usually be consistent with, and reflect, the Position Statement of the ICM. Australian Private Midwives Association
Homebirth Australia states:
Many women choose homebirth because they have previously had a traumatic hospital birth. Many have had previous caesareans. Their right to make this safe, legitimate choice must be protected.
Save HBAC in Australia | Home Birth Australia
Lisa Barrett’s blog states:
The college have not affected the women’s right to birth wherever they please but the midwife’s right to attend them. They have listed a number of situations where a midwife should not attend a woman at home, leaving her high and dry and without a care provider. twins, abnormal presentation including breech – Prior to 37 weeks and after 42 weeks, and most interestingly slipped in there is VBAC, however they have dehumanised it by calling it a scarred uterus. Homebirth: Midwife Mutiny in South Australia
The problem here is not whether you (or the ACM) think that homebirth is a good option in situations such as these, but rather that the professional regulations MUST respect a woman’s ability to make her own informed choices, and protect midwives’ ability to legally provide care to them.
Midwife Thinking Response- main concerns with the statements:
* The expectation that the midwife, rather than the woman, determines risk status, and then actively blocks access to birth options based on this assessment.
* The assumption that birth will not be normal because the woman has a uterine scar, is over 42 weeks, has twins, etc. does not reflect a trust in the birth process, and is not evidence based.
* The guidelines contravene the right to self-determination and bodily autonomy.
* True evidence-based practice blends the research evidence, with the expertise of the practitioner and the individual requirements of the ‘patient’ (or woman), rather than universally applying research findings to practice (Sackett et al., 1996).
* Regarding “Consultation is mandatory for the midwife providing care” (Interim Guidance doc. p.2), the midwife should recommend consultation and referral – but to enforce it does not respect the woman’s choice (and breaches confidentiality).
* The ACM guidelines are not aligned with the Code of Ethics for Midwives, Code of Conduct, and Competency Standards (Australian Nursing & Midwifery Council)
The college should support privately practicing midwives who decide NOT to withdraw care and instead support the woman’s decision to homebirth despite any risks involved. The alternative is to leave the woman without a care provider who can identify any deviations from safe process and transfer if necessary. Midwife Thinking | mothers, birth, babies and midwifery
Australian College of Midwives:
“There is no evidence that shows an increase of risk of maternal morbidity or mortality in relation to homebirth” (p.19). ACM Homebirth Literature Review
The interim guidelines contradict the ACM’s own ‘Philosophy of Midwifery’ which says that midwifery:
* recognises every woman’s right to self-determination in attaining choice, control and continuity of care from one or more known caregivers
* recognises every woman’s responsibility to make informed decisions for herself, her baby and her family with assistance, when requested, from health professionals. Frontier Nursing University - Midwifery and Family Nursing Education - Become a Certified Nurse Midwife or Family Nurse Practitioner
RESPONSES must be received before the 23rd Sept (close of business)
Send submissions:
‘To the Australian College of Midwives Board of Directors’
By post to PO Box 87, Deakin West ACT 2600.
Or by email to info@midwives.org.au
Only submissions with identified senders and a return address will be considered.
There are members of the ACM Board who are keen to hear and represent YOUR voice – so let them hear it!
Remember:
* The ACM will collate the responses according to THEMES, keep it simple.
* The ACM want midwives and consumers to be WITH them, so encourage them to be strong and tell them HOW they CAN GAIN your support.
* The ACM have regulatory power, so it’s no good to us if they feel threatened/ attacked & react defensively.
* Be practical and proactive in your response – what DO you want to see?
Tips for a Powerful Letter:
* Make it short and snappy (try to get it on one page) – it doesn’t need to be fancy.
* ...To the ACM Board of Directors
* Introduce yourself…i.e. I am a midwifery student, a consumer, or a student member
* Say why birth choices and a woman’s access to her chosen care are important to you
* Briefly outline your concerns- what most concerns you about the interim guidelines? (e.g. blanket contraindications)
* Tell the ACM you consider them responsible to show leadership and protect women’s access to qualified care where THEY choose; ask for more consultation & transparency.
* Do it NOW! Leave enough time to send your repsonse via the POST (preferably)
* You must leave a return address for your submission to be considered.
IDEAS:
1. That ACM withdraw the current position statement on homebirth and formally consult widely with homebirth midwives and consumers, their representative groups such as APMA and HBA, before reformulating this statement.
2. That ACM formulate a guideline that unequivocally endorses and describes the process for a woman’s right to informed refusal, and the midwife’s right to legally provide care for her in pregnancy, labour, birth and postpartum, irrespective of the woman’s risk status
3. That ACM stand up for women, rather than sacrifice aspects of midwifery care and women’s birth options in an attempt to cater to the insurance companies. Keep the woman and her ‘responsibility to make informed decisions for herself’ at the centre of midwifery care.
Well, I'm scheduled for a HBAC in January and it's all looking very positive for us so far. My homebirth is even covered under private health insurance. I don't know how things will change in the future, but given that independent midwives already currently have to do a bunch of legal stuff to ensure I'm properly informed as to the risks of both homebirth and the fact that mine is a VBAC (both are covered separately in the paperwork I had to sign), I honestly don't think the sky will fall in and completely deny women their rights in future legislation.
I agree with advocating to improve birth choices and ensure access to homebirth for any woman who wants it in future. Whatever we can do to make that happen is important.
I sent an email on this a little while ago.
My guess is that the ACM are hoping for a more positive outcome re the legality of homebirth in general, therefore their guidelines are complying with what we might say ranzcog wants.
(in the simplest of terms)
The silly thing is that the list of 'contraindications' to homebirth are a many reason women choose homebirth after hospital birth so it sucks. I must get my letter in.
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I think they are trying to appease RANZCOG etc to 'save' some portion of independent midwifery. They may well destroy this mode of care in the process.
Hi Jennifer,:
I am looking into a hbac myself and was wondering if you could help me with some info? If you are in Vic I would love to hear about your exp and get some info on your midwife etc as I have no idea where to begin? Only if you don't mind? Is there anyway you could contact me via this forum or can you send an email?
Good luck with your hbac, I wish you all the best!
Kind regards,
Tarryn
Hi Tarryn
Jennifer got her HBAC. The Maternity Coalition has a list of Midwives in Private Practise, might be a good place to start to look for a midwife. Maternity Coalition-State Branches
Maternity Coalition-State Branches
Also check out the homebirth discussion thread https://www.bellybelly.com.au/forums...on-7-a-173075/
Tarryn, Helen Brown has a bit of a reputation (and personal experience) in HBAC. Could be worth giving her a call :D
Honestly, my HBAC was treated the same as any other HB, except when I booked in my IM at 12 weeks she had to give me a form to sign that said I understood the risk. It wasn't mentioned again. I'm in Sydney, so can't help with an IM in Vic, but check out the list on BB. I found my m/w on here. ;)
TBH, the birth was just an ordinary birth (don't get me wrong, completely amazing experience!!) that didn't require any assistance, intervention, or extra monitoring in anyway. Everything progressed completely normally (albeit a little quicker than I expected once it started happening for real).
It's barely worth mentioning that I've had a c/s before. It was just the most ordinary and uncomplicated of births. I wish everyone could have one just the same!
I don't know if it's worth mentioning, but I also booked into the hospital down the road at about 32 weeks in case I needed to transfer (GP wrote me referral on my m/w's request). I saw a m/w and an ob at the hospital and actually both were very supportive of my HB decision, even though they officially noted that they advised me against it. I liked that the ob said she didn't expect to see me again and wished me all the best.