Welcome to the Midwifery Welcome to the Midwifery Profession!Profession!Dr Belinda MaierDr Belinda Maier

Midwifery Advisor 2009 - 2013Midwifery Advisor 2009 - 2013

Nursing and Midwifery Office QueenslandNursing and Midwifery Office Queensland

Clinical Associate Professor, Australian Catholic UniversityClinical Associate Professor, Australian Catholic University

Maier.Belinda@yahoo.com.auMaier.Belinda@yahoo.com.au

• Why midwifery?

• Cute babies?• Cushy job?• Career options?• Climbing mountains?• Feminism?• Being political?

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COALITION, M., (AUSTRALIA), A. & INC, A. S. O. I. M. C. M. W. 2002. National Maternity Action Plan: For the introduction of community midwifery services in urban and rural Australia.

CREEDY, D. 1993. Postnatal depression: improving the experience of country women through professional and community awareness. Australian Journal of Rural Health, 1, 43-9.

EVANS, R., VEITCH, C., HAYS, R., CLARK, M. & LARKINS, S. 2011. Rural maternity care and health policy: Parents' experiences. Australian Journal of Rural Health, 19, 306-311.

FAHEY CM & JS, M. 2005. Australian rural midwives: perspectives on continuing professional development. . Rural and Remote Health 5, 468.

GRZYBOWSKI, S., KORNELSEN, J. & SCHUURMAN, N. 2009. Planning the optimal level of local maternity service for small rural communities: A systems study in British Columbia. Health policy (Amsterdam, Netherlands), 92, 149-157.

HOANG H, L. Q., KILPATRICK S. 2012. Small rural maternity units without caesarean delivery capabilities: is it safe and sustainable in the eyes of health professionals in Tasmania? . Rural and Remote Health, 12, 1941.

IRELAND, J., BRYERS, H., VAN TEIJLINGEN, E., HUNDLEY, V., FARMER, J., HARRIS, F., TUCKER, J., KIGER, A. & CALDOW, J. 2007. Competencies and skills for remote and rural maternity care: a review of the literature. Journal of Advanced Nursing, 58, 105-115.

KILDEA, S. Year. Risk and childbirth in rural and remote Australia. In: Presented at the 7th National Rural Health Conference: The Art and Science of Healthy Community - Sharing country know-how 2003 Hobart, 1-4th March 2003.

KILDEA, S. 2006. Risky business: contested knowledge over safe birthing services for Aboriginal women. Health Sociology Review, 15, 387-396.

KILDEA S, K. S., BARCLAY L, TRACY S. 2010. ‘Closing the Gap’: How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural and Remote Health, 10, (Online) 2010. Available: http://www.rrh.org.au

KORNELSEN, J. & GRZYBOWSKI, S. 2006. The Reality of Resistance: The Experiences of Rural Parturient Women. The Journal of Midwifery & Women � s Health, 51, 260-265.

KORNELSEN, J. G., STEFAN ; IGLESIAS, STUART. 2006. Is rural maternity care sustainable without general practitioner surgeons? Canadian Journal of Rural Medicine, 11, 218-20.

KRUSKE, S. & JONES, R. 2010. Summary Report on Consumer, Carer, and Stakeholder Perspectives on Maternity Care in Regional, Rural and Remote Queensland: .

LUO, Z.-C. & WILKINS, R. 2008. Degree of rural isolation and birth outcomes. Paediatric and Perinatal Epidemiology, 22, 341-349.

ROBERTS, C. L. & ALGERT, C. S. 2000. The urban and rural divide for women giving birth in NSW, 1990–1997. Australian and New Zealand Journal of Public Health, 24, 291-297.

ROSENBLATT, R., REINKEN, J. & SHOEMACK, P. 1985. IS OBSTETRICS SAFE IN SMALL HOSPITALS? The Lancet, 326, 429-432.

STRONG, K., TRICKETT, P., TITULAER, I. & BHATIA, K. 1998. Health in rural and remote Australia: The first report of the Australian Institute of Health and Welfare on rural health Australian Institute of Health and Welfare, Canberra

TUCKER, J., HUNDLEY, V., KIGER, A., BRYERS, H., CALDOW, J., FARMER, J., HARRIS, F., IRELAND, J. & VAN TEIJLINGEN, E. 2005. Sustainable maternity services in remote and rural Scotland? A qualitative survey of staff views on required skills, competencies and training. Quality and Safety in Health Care, 14, 34-40.

VAN TEIJLINGEN, E. R. & PITCHFORTH, E. 2010. Rural maternity care: Can we learn from Wal-Mart? Health & Place, 16, 359-364.

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Midwife• A midwife is a person who, having been regularly admitted to a midwifery

educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.

• The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

• The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.

• A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

• Adopted by the International Confederation of Midwives Council meeting, 19th July, 2005, Brisbane, Australia Supersedes the ICM “Definition of the Midwife” 1972 and its amendments of 1990

Eligible MidwifeEligible Midwife• What is an ‘eligible’ midwife?• An eligible midwife is a midwife who meets further professional criteria that enables them to work

in private practice and may obtain a provider number. By having a provider number their private clients may access Medical Benefits Scheme and Pharmaceutical Benefits Scheme.

• This is legislated under section 38 (2) of the National Law.• How do I gain registration as an ‘eligible’ midwife?• The standards are documented on the Nursing & Midwifery Board of Australia website, available

at:• www.nursingmidiwferyboard.gov.au.• Summary of Requirements for Eligibility:• A current general registration as a midwife in Australia with no restrictions on practice• Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as

a midwife• Current competencies to provide pregnancy,labour, birth and post natal care to women and their

infants• Successful completion of an approved professional practice review program for midwives working

across the continuum of midwifery care• 20 additional hours per year of continuing professional development relating to the continuum of

midwifery care• Formal undertaking to complete, within 18 months of recognition as an eligible midwife, or the

successful completion of recognised prescribing course.

• So is a midwife a midwife or is there better midwives than others?

Employment as a midwifeEmployment as a midwife

• Public

• Private

• Self employed

• Hybrids of all of the above

National Maternity Services PlanNational Maternity Services Plan

•Five year vision• Maternity care will be woman-centred, reflecting the

needs of each woman within a safe and sustainable quality system. All Australian women will have access to high-quality, evidence-based, culturally competent maternity care in a range of settings close to where they live. Provision of such maternity care will contribute to closing the gap between the health outcomes of Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Appropriately trained and qualified maternity health professionals will be available to provide continuous maternity care to all women.

National ReformNational Reform

• Scope of practice

• Professional identify

• Private practice

• Access for your clients to have MBS/PBS rebates

• Models of care – High risk, low risk, all risk

• Woman centered

futurefuture

• Greater access to visiting rights, indemnity insurance, credentialing…

• Negotiated contracts….• More public models…• More rural and remote models that utilise

midwives to full scope of practice….• Rural/remote midwives with maternal child

health, sexual health and immunisation qualifications….

"The personal is political" "The personal is political"

• Are we living in an enlightened and equal society?

• Risk has become the norm even normal is only normal because there is as yet an absence of risk!!!!!

• Women are both personally responsible and separated from the personal in the immediate space of being at risk. This exposes a discourse of medicine based on the separation of mind and body, the mechanistic framing of the maternal body. It is also the fragmenting and isolation of women’s bodies into functional and dysfunctional parts, cervix, placenta and uterus for example. This pathologic body is identified in specific ways, (always at risk), therefore screened, managed and treated. This is a powerful way to maintain the discourse of medicine and excluding other discursive constructions.

• Why is it ok to assume medicine or midwifery can determine what is good or bad for women?

• When did it become ok to take women out of their personal context and frame everything for them in a medical context

Fundamentally why is it even ok for Fundamentally why is it even ok for anyone to decide anything for anyone to decide anything for

women?women?

• Water birth

• Pain relief

• Homebirth

• Cesarean section

• Sex???????

• My reasons for being a midwife are all of the above including my girls and everyone's girls!!!!

• • The challenge now is to practice The challenge now is to practice politics as the art of making what politics as the art of making what

appears to be impossible, possible.appears to be impossible, possible.Hilary RodhamHilary Rodham