Just for 2 seconds can we focus on the big breakthrough in womens maternity care

Firstly, I am by no means discounting the importance of the whole current homebirth issue, but for two seconds can I just say a big yahoo for the following breakthrough. This is especially good for those of us who previously didn't have access to continuity of care in the current hospital system and especially those of us considered "high risk" because we were even less likely to have access to this kind of model of care.....

As you may already have heard, Federal Health Minster Nicola Roxon has introduced three bills to Parliament to implement the Government's maternity reform agenda. These are the biggest changes we?ve seen in maternity care in Australia?s history and are a huge breakthrough for women. It means that from November 2010, women will be able to hire a midwife in private practice, receive their antenatal care from that midwife in a community setting or at home, birth with that midwife in a hospital and receive six weeks postnatal care from that midwife. Women will be able to claim Medicare rebates for this care. It may mean that many women who haven?t previously been able to access continuity of care with a known midwife, including women living rurally and women wanting to have a VBAC in hospital, will be able to do so. :clap:

Mara thats fantastic! Where did you get the quote from? Sounds like a media release. I would love to get the reference and send it to my sister.

thanks,

Rachel

yet a women and midwife will still be under hospital policy. so women who choose hb because of the fight for vbac is to hard in hospital is still disadvantaged.

i have a feeling you dont GET why we are fighting for the right to hb..as well as fighting for mwives wh o dont want to be tied to a hospital

How is it a break through when you are taking a chioce away from women?

DOUDOU,
I do understand the HB issue here. It's a very important one and one that I hope is resolved, either by the Govt. allowing midwives to attend homebirth without PI cover, or by helping to make PI cover for independant midwives available. It is certainly the sour grape of the whole maternity reform. And your points are very valid

BUTTT. . .
I am not focusing on just the birth aspect here. What about antenatal and postnatal care???? These are such important factors of having a baby too.
What I am focusing on here is nothing to do with homebirth, and nothing to do with just birth.

It's about women who want a hospital birth but who also want continuity of care. Especially continuity of care through the ante-natal and post-natal period.

Many of us Do not currently have this option in the public system. Especially not women in remote locations or women who are classed as high risk as we are currently not eligible to be looked after by most MGP's or birthcentres etc.

Rommy's mummy, I got that quote from an email I received from BirthtalkTM to which I subscribe. (and who BTW are also concerned by the homebirth issue)You can also find some info on the maternity coalition website (an organisation to which I also support and have a paid subscription)

I agree that is a great step forward for maternity care - woohoo!!! It has certainly been a very big gap in the public systema nd it great to see it being addressed.

I don't think it distracts from the homebirth issue. It is still important for us to stand up for the choice to homebirth but it is also great to celebrate an advancement for woman who want a hospital birth and with a greater amount of support in their birth might lead to a better birthing experience for more woman in hospital!

I think we should allow Mara to be happy about this. So whilst the HB issue is a big one, lets not go off topic with this thread.

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I don't think it distracts from the homebirth issue. It is still important for us to stand up for the choice to homebirth but it is also great to celebrate an advancement for woman who want a hospital birth and with a greater amount of support in their birth might lead to a better birthing experience for more woman in hospital!

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:yeahthat: I completely agree Saram. It doesn't distract from the homebirth issue and that was not my intention. But in reality it IS going to give so many women the potential for a better hospital birth experience all round Not to mention a better ante-natal and post-natal experience for many women too.

i hope you are right but knowing that these midwives will still work with in the policies of the hospital i hope they can still form th relationship required.. all fitted in 10minute appointments

Here Here!!! Big round of applause. Whilst in hospital having my 3rd baby I was fortunate enough to talk with some Mids that were trained in NZ. Their standard of care seems to be much higher than here and their model seems to be based on excellent continuity of care both pre and postnatally (sp). I hope Australia is moving towards this type of model.

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Here Here!!! Big round of applause. Whilst in hospital having my 3rd baby I was fortunate enough to talk with some Mids that were trained in NZ. Their standard of care seems to be much higher than here and their model seems to be based on excellent continuity of care both pre and postnatally (sp). I hope Australia is moving towards this type of model.

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Too right Bekz, NZ's maternity system is what Australia should be aspiring to. Don't 'spose one of the midwives you were talking to was a Diane (logan hosp midwife and Midwifery lecturer at griffith Uni) ;)

That sounds like a very positive advance - great news for those who wouldn't have wanted the home birth option but really would like the one on one care of a middy.

It is good. It's bittersweet because of the homebirth stuff, but hey, I'd prefer bittersweet over bitterbitter any day. :D

And it's a great result for people who might not be able to homebirth because of factors like finances or risk - for someone who can't afford a homebirth *sob* or has a history of haemorrhages, having a midwife I trust and who knows my birth wishes because of continuity of care, is a good thing.

Really looking forward to the day when homebirth is medicare funded or at least subsidised, and registered doulas are funded/subsidised too. Any day now, right?

No her name was Faith but Dianne delivered my first bub

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i hope you are right but knowing that these midwives will still work with in the policies of the hospital i hope they can still form th relationship required.. all fitted in 10minute appointments

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Being that women would actually be hiring them and most likely paying more than the medicare rebate for their services, I would like to think that the midwife would be affording more than 10 minutes of her time per appointment.

And I guess looking at the positive aspect of these private midwives working under/being covered by the hospitals policies at least they will be playing a major role during the birth and also for women who have caesareans the IM they have hired under the new legislation would be able to be with mum in theatre and recovery and thus ensuring bub will be with mum in recovery too. Currently under the hospital system this is not always possible depending on staff numbers.
Also under the "current" system as independant midwives are not covered under hospital PI once a homebirth transfers to hospital the independant midwife can no longer be their clients active midwife as they aren't covered under the hospitals PI cover. This also includes a caesarean birth. The baby could only still be with mum in recovery if there is a hospital employed midwife present. Even if the IM is in recovery with the mother it's not acceptable as the IM is not covered by the hospital IYKWIM.
Just such a shame these private midwives will not be covered for homebirth too :( But I am hopeful this will change and that the buerocrats will eventually see sense.

wow i think thats excellent,
me being a high risk patient im happy with that altho i wouldn't have the $$$ to hire one but good for other ppl :)

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wow i think thats excellent,
me being a high risk patient im happy with that altho i wouldn't have the $$$ to hire one but good for other ppl :)

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You never know Squidipa, with the medicare rebate an IM may not be too far out of your reach.

That's fantastic. One question - can you birth with that midwife in a private hospital or only public? Presume that in a private hospital you still have to have a designated (and paid for) ob - is that right?

And can you have both - so a midwife AND an ob (if you pay for it). Realise that sounds like overkill but I'd actually like both. Midwife to birth with me and ob to do any medical stuff that MAY be required. Would actually like to know both people before going to hospital and getting up the pointy end (so to speak).

im classified as "high risk" yet i dont have the $$... im not also one who has all the tests, constant monitoring & appts etc. i dont see my preg as a illness and yes im lucky not to have had any probs or complications... im just saying that not everyone chooses to have a continous "Care" model. but its great news for those who do want it :D
altho bittersweet if this is going thru same day as law 2 make HB illegal.. *sigh*

I am so pleased to hear this.
I found it very hard not having continuity of care with my last pregnacy. I dont think I saw anyone twice even the same ob! I was dealing with a vbac and continuity would have made a big difference to my stress etc.
having had my first baby in NZ I cannot believe how backwards Australia maternity system seems to be, so yes this is actually a big step forward! Yippee.

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That's fantastic. One question - can you birth with that midwife in a private hospital or only public? Presume that in a private hospital you still have to have a designated (and paid for) ob - is that right?

And can you have both - so a midwife AND an ob (if you pay for it). Realise that sounds like overkill but I'd actually like both. Midwife to birth with me and ob to do any medical stuff that MAY be required. Would actually like to know both people before going to hospital and getting up the pointy end (so to speak).

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Thats a great question Fiona,

I'd say you would definately still have to have your own OB.
Wouldn't it be great if you could have midwifery lead care at a private hospital though.

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I am so pleased to hear this.
I found it very hard not having continuity of care with my last pregnacy. I dont think I saw anyone twice even the same ob! I was dealing with a vbac and continuity would have made a big difference to my stress etc.
having had my first baby in NZ I cannot believe how backwards Australia maternity system seems to be, so yes this is actually a big step forward! Yippee.

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Thats exactly what has held me back from wanting to VBAC in the public system as there are no continuity of care options available in my region (apart from the birth centre which doesn't take on VBAC's). And that's why to me, the new legislation is so great :)

Yep, it shouldn't be toooooo much to ask to have TRUE continuity of care which in my book is having a relationship with everyone who is with you during labour and may deliver your baby. I wasn't very cluey last time so I went to a private obstetrician but now, I'm very, very happy with him and would trust him with my (and DS or DD's) life. But obviously he's not going to be there for the duration of the labour, hence I would also like to get to know a midwife. But I guess the best choice for me is a doula.

This sounds like a great improvement. I have Kyson in a private hospital and while my Ob was fantastic, I never once saw a midwife until I was in labour. It would have been nice to have known the people that were going to be with me while I was birthing my son, rather than a couple of strangers. That's not to say they weren't great, because they were, but it would have been nice to have known them beforehand.

that's great news :) A step forward is better than no steps at all :)

Wow, thanks so much for posting this! I have been trying to find more information about this since I didn't understand the wording of the original media release, but this has confirmed what I had thought.
This is a great advance! I think it will allow more women to see a midwife for a straight forward pregnancy (exactly what they are best equipt for), leaving obs to deal with the more complicated/surgical situations (exactly what they are best equipt for).

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This sounds like a great improvement. I have Kyson in a private hospital and while my Ob was fantastic, I never once saw a midwife until I was in labour. It would have been nice to have known the people that were going to be with me while I was birthing my son, rather than a couple of strangers. That's not to say they weren't great, because they were, but it would have been nice to have known them beforehand.

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krystieLove, I sooo know what you mean. Especially considering the OB only pops in from time to time and then re-appears for the actual birth.

I think it's brilliant that women will be able to access continuity of care with a self-chosen midwife, as per the NZ model. About time! This will be a real blessing for women who choose hospital care. BUT, this needs to include homebirth options as well as birth centre and hospital options. Not at the expense of independent home midwifery. We need an alternative to medically-managed birth, so we can choose which model suits us best.

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I think it's brilliant that women will be able to access continuity of care with a self-chosen midwife, as per the NZ model. About time! This will be a real blessing for women who choose hospital care. BUT, this needs to include homebirth options as well as birth centre and hospital options. Not at the expense of independent home midwifery. We need an alternative to medically-managed birth, so we can choose which model suits us best.

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I agree Julie, I just cannot understand why they cannot include HB services as part of the package. Especially with low risk women.

Yeh, I don't like how they've appeared to give on one hand - but taken with the other.

I fear that even with the new continuity of care arrangements (which I think will be a great improvement - for mothers and midwives), if midwives are still controlled by rigid obstetric policy, they will still not be able to offer the true midwifery model as an alternative to the medical model. They'll end up functioning as obstetric nurses collaborating with a medicalised system. it will be very hard for them to really offer the midwifery model. I think they will not have much autonomy to function as professionals in their own right - just like most birth centre midwives are prevented by obstetric policy from offering women real midwifery care.

I think we need independent midwifery and independent birth centres so women can choose between the midwifey model and the medical model, and so midwives can choose to work within the obstetric framework or practice the midwifery model.

Continuity of care, although an improvement, won't help much if the midwives have their wings clipped by a hierarchy of medical control.

I know I'm saying this badly, but I do know midwives in NZ and UK have much more professional autonomy than here, and that midwives in USA are totally under the control of the medical hierarchy and are reduced to being obstetric nurses.

Prob a bit off topic, but I had this model in the public system with DD. I didn't get to choose my mw, but that didn't matter, as she was lovely and there was a great continuity of care - I had many of my appointments at home, and once my waters broke, she was happy to leave me for 4 days as long as she came over 2x a day, plus i montiored my temp (not that I needed it), I then gave birth to DD in the birth centre and was totally supported in our choices.

So its great that this model is going to be wider available...although, what i can't understand is, that if there is a fantastic option like this already available in the public system, why more women don't choose it. I obviously only know about my experience, but I felt that my mw whilst probably acting in line with policy, she was also acting in line with what we wanted - I know other hospitals will only let you go 24hrs after waters break, or only push for an hour before they intervene - my mw just let me go because whilst dd was taking her time, everything was fine (she finally appeared after 2 1/2 hours of pushing)

it is normal for first time mothers to push for longer than an hour - up to 6 hours even. I though most hospitals allowed at least two hours? One hour for a first time mama is really draconian. She hardly gets a chance. 2 and a half hours sounds about average for a first timer. (Nice work, SammyRo!)

I know a midwife who now works here in Oz, but trained in Europe, and worked there for most of her career. She finds it difficult that she has less autonomy, and authority, in her work here. She has been known to sometimes go her own way, to give mothers a better chance of unhurried vaginal delivery ;). I think she is wonderful to do that, but it is sad that she has to do it underhandedly.

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it is normal for first time mothers to push for longer than an hour - up to 6 hours even. I though most hospitals allowed at least two hours? One hour for a first time mama is really draconian. She hardly gets a chance. 2 and a half hours sounds about average for a first timer. (Nice work, SammyRo!)

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THanks I was pretty chuffed! I'm just sad that this time we have moved and aren't in the catchment for the same hospital.

I've only heard this stuff from mothers groups and stuff, and I remember one mum at a diff hosp who was moved from the birthing centre to the labour ward after an hour. Although I could be mistaken. And another friend who went private who was only given about 4-6 hours once her waters broke before they induced her, and then about the same 4 hours after the induction before they took her off for a c-sect. But that was prob because the ob wanted to go play golf or something ;)


I know the HB thing is still a huge issue, but for me, I am really happy that this type of mw care is being opened up to more people - having built that relationship with our lovely mw meant that we got the birth we wanted. But, as you say, it will probably come down to how much freedom they have to do they're job. And that will probably come down to how much respect they are afforded from the obs. doctors.