Wednesday, December 29, 2010

A year in reflection:

A reminder of the College Vision:
Our vision is to be the leading organisation shaping Australian maternity care for the benefit of women and their families
The Australian College of Midwives (ACM) is the peak professional body for Australian midwives, which strives to maximize the quality of midwifery and maternity care for Australian women and their families through:
• Providing a unified voice for the midwifery profession.
• Supporting midwives to reach their full potential.
• Ensuring all childbearing women have access to continuity of care by a known midwife.
• Setting professional practice and education standards

This has been an amazing year with many highs and lows.... everyone working hard for the College and the greater good ..... above all working to improve the choice for childbearing women and the midwives who work with women.

As I summarise the year from the blog entries I am in two minds as to how well we have done over the year....If I examine the word "well", skilfully, expertly, effectively, efficiently, adequately, admirably, conscientiously and proficiently - then I think as a Branch we have achieved this.... however as I read between the lines there has been some misfortune for me personally: as you can imagine writing a blog for the College I have to be mindful of confidentiality, defamation, ethics, conduct and my own professional standing....there is no such thing as freedom of speech.... however still offering news, honesty, general information etc.... therefore I have to be mindful of what is published.

I have to say that this rule has not been applied to myself and I am in the process of taking legal action against information wrongly published about me threatening my integrity and professional standing... this is a sad reflection of the times and soul destroying. Therefore this is a timely reminder to be mindful of what you publish on the Internet & email...... defamation is the fastest growing litigation....

The blog to date has had over 4500 hits...the blog posts have almost doubled and is up to date with current issues:

January was meeting the then Prime Minister & the Honorable Nicola Roxon, the Big Picture tour of the proposed changes for midwives; Februry.... new midwifery students and Homebirth rallies..... March... GoGirlAustralia... April.... ANMC here to stay as the "appointed accreditation body"... submissions for the "eligible midwife"... May... IMD celebrations...24hr Virtual IMD ..... and the farewell to Jill Banks....June... came the insurance debate, options and collaboration...July was D-Day for National Registration....and Collaborative arrangements... Determination 2010; concern for private practice, fear, stress, tears, it was a nightmare....

August...Australian Election....the nightmare continues; a hung Parliament... Homebirth...Collaborative arrangements...ACM National meeting & Breathing New life Conference Alice Springs....Sept... Determination still dominated the midwifery world... lobbying, emails...meetings with politicians...etc... GoGirlAustralia leaves Fremantle.....

October.. WA joins National Registration... APHRA comes alive for us.... Victorian conference and AGM also AGM for National.... November... History is made... Medicare Provider Numbers for eligible date there are approximately 15 eligible midwives throughout Australia...December... first Midwife to get collaborative agreement.... lets hope this continues....
Trail Blazers, the inaugural Bachelor of Midwifery for WA prepares to enter the workforce as Midwives (who are not nurses), Barb Vernon EO of the ACM resigns and change is in the air..... i have always said as a College we need to be united... "united we stand divided we fall" I am going to pinch a quote from Obama's State Union address " we face big and difficult challenges, we do not give up, we do not quit. We do not allow our fear or division to break our spirit".

Xmas dinner
Thank you to a wonderful executive team we have in WA.... the whole team has worked very hard and continue to work hard for the WA members and women of the State....wishing you all a happy and successful 2011.

My wish for the College & the year ahead:
"Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results."~ Andrew Carnegie

"Coming together is a beginning. Keeping together is progress. Working together is success." Henry Ford

signing of for 2010, see you in the New Year, wishing you all a safe, happy, successful 2011. Pauline Costins

Tuesday, December 28, 2010

Guinea Pigs or Trail Blazers

When I was asked to write something for the ACM blog about the experience of being the first BMid students to get through their training in WA, I realised how difficult it was going to be to sum up the gamut of emotions, the roller coaster ride that my fellow BMidder’s and myself have been on the last 3 years.

We are a diverse bunch of women, some young, some not as young, we have children, husbands, careers, boyfriends, and jobs outside our training to be midwives. Yet I think it is safe to say that for three years we have lived, breathed, eaten, dreamed, hated, loved, and despaired over nothing else but midwifery. Midwifery has been centre stage.

We are the guinea pigs. How often have we heard this girls? The initial reaction to us in some places was palpable. We were told we could not make good midwives (because we are not nurses), that we would not be employed (because we are not nurses), that we would not be able to give certain medications (because we are not nurses). We did wonder at times, if we would be able to do anything at midwives.

Despite these frustration’s, and thanks to the tenacity and support of amazing and wonderful women: Jenny Wood, Lesley Kuliukas, Janice Butt and our tutors, we marched on because we knew deep down inside that it is midwives we want to be, NOT nurses.

As a group we feel very lucky to have experienced many models of care. We were able to see home birth and family birth centre births. We watched women make informed choices about their care and become empowered in women centred models of care. We experienced continuity of care and developed an appreciation of how continuity of care is the gold standard in maternity care.

We were privileged to develop relationships with many women, and care for them during their pregnancy, labour, birth and beyond. We have been “with woman” for a diverse group of women: women with mental illness, women who are still teenagers, women from remote Aboriginal communities, refugee and migrant women, single and married women, women addicted to substances, diabetic and healthy, free and incarcerated, public and private. We are coloured by these experiences.

We have had three years to soak up the political environment. I am not sure any of us realised JUST how political midwifery and healthcare could be. We are now well informed of this fact and have consented to being a part of the debate. The same debate as always; how do we work together with other health professionals and how do we respect women’s choices.

There are 17 students in my graduating class, and through our trials and tribulations we have leaned on one another for support and friendship. We are grateful that we have had one another and will continue to support each another as we work as midwives. We are also grateful to the hospitals that have provided clinical placements and the midwives who have had the patience to take us under their wings.

So now that we are heading down the birth canal, there is a lot of stretching, and discomfort, a little bit of fear of what it means to be completely responsible for our actions as registered midwives. We have come a long way, and the learning is only just about to start. Most importantly, we have realised (and we hope everybody else does too) that, we are not guinea pigs, we are trail blazers and we are very proud to be moving the profession of midwifery forward.

Tuesday, December 21, 2010

Don't forget WA Midwives & Nurses need to renew your registration:

WA Registrations are now due: don't forget!

Amid the rush and excitement of Christmas, please do not forget to renew your registration with AHPRA - (on-line registration) due for most 31st December; it will cost you $48.00 to renew until May due to the change over dates of National Registration:

You need to renew both Midwifery and Nursing - or choose one or the other it is your choice as there are now two registers; remember what you are contracted to work before dropping off any of the registers:

The process is easy online or go into the AHPRA office in Hay St Subiaco WA:

Have a safe and Happy Festive Season:

Monday, December 20, 2010

A farewell tribute to Barb Vernon

Midwife means ‘with woman’. This meaning shapes midwifery’s philosophy, work and relationships........recognises every woman’s right to self-determination in attaining choice, control and continuity of care from one or more known caregivers...

The Australian College of Midwives (ACM) is the peak professional body for Australian midwives, which strives to maximize the quality of midwifery and maternity care for Australian women and their families through:
• Providing a unified voice for the midwifery profession.
• Supporting midwives to reach their full potential.
• Ensuring all childbearing women have access to continuity of care by a known midwife.
• Setting professional practice and education standards

I remember meeting Barb Vernon at the WA conference in 2003; this was around the time that Barb started off as the Executive Office for the College. I have always found Barb to be engaging, passionate and her focus was always to take the College to great heights; She has taught me the benefits of being politically savvy and most importantly being a quiet but forceful lobbyer; I regret having less than 10 months as a Board Director to learn from this phenomenal woman. I will not spend my time saying how amazing I thought Barb was, we all know that, and yes we all have our short comings, none of us are perfect, least of all me, however Barbs achievements speaks volumes.....and here creditability is without question.

It is remarkable what Barb has done for women, midwives and midwifery of Australia and where she has taken the College too in the last 7.5 years.... if you mention her name it is synonymous with the ACM: I can’t count the number of times I have heard people say “Barb Vernon, yes a very articulate and intelligent woman” “you’re lucky to have her” and they are correct.

Barb has always put her heart and soul into everything she has done for the College... her major achievements is as follows: (and I have not listed them all).
Medicare funding, provision of PBS and prescribing rights for midwives, national standards for entry to midwifery, establishment of separate, national professional standards for midwifery, separate register for midwives in the new national registration recognising midwifery in its own right, the development of the Midwifery Practice Review, MidPLUS, online CPD and portfolios, the development of an internationally recognised peer review journal for midwives, the list is endless;

For me what Barb has done most is establish mutually respectful and collaborative relationships with key national health organisations, such as, Australian Nursing Federation, the Australian Nursing and Midwifery Council, the Nursing and Midwifery Board of Australia, the National Rural Health Alliance and many others...... She has forged a way forward politically, established good working relationships..... with Health Ministers etc. The college has had phenomenal growth to date; excellent collegial relationships with major stake holders expanded the College activities and services to members for the future and good political ties, the College is at the table for discussions and this is due to Barbs excellent political and lobbying skills.

There does come a time to say goodbye, when you have done all you can and for someone else to come along and take the college the next step, sadly that time has come for us. I bid Barb Vernon a fond good bye and wish her every success in life; and say the ACM & women owe her a multitude of thanks – we went part of the way in thanking her when we celebrated Barb’s achievements at a farewell in Canberra last week.

I am going to leave you with one of my favourite sayings Barb; an Irish Blessing (A Blessing from St. Patrick)
May the road rise to meet you,
May the wind be always at your back,
May the sun shine warm upon your face,
May the rains fall soft upon your fields,
And, until we meet again,
May God hold you in the hollow of His hand.

(Traditional Irish Blessing; origin unknown,
although some attribute it to St. Patrick.)


Thursday, December 16, 2010

A Directors responsibility under the Corporations Act 2001 (Cth) (the Act)

The Australian College of Midwives is an incorporation therefore falls under the rules and regulations of the Corporations Act (Cth) and the statue of limitation is 6 years, therefore a responsible position.
By law a Board Director is responsible for: The following information comes from Directors Duties under the Corporations Act 2001

Duty to act with care and diligence - s180(1)
A director or other officer must exercise their duties with a degree of care and diligence that a reasonable person would exercise in their position. The standard of care and diligence required as determined by a court would take into consideration the company's circumstances and the director or officers position within the company. The skill required by an executive director is measured objectively in regard to that directors' special calling. So, in considering whether a director is so negligent as to be in breach of the statutory duty, the conduct is measured in two ways: against the (objective) standard of care; and against the standard of skill held by the particular director or officer.

Duty to exercise powers in good faith – s181(1) (Conflict of duties)
A director or other officer of a corporation must exercise their powers and discharge their duties: in good faith in the best interests of the corporation; and for a proper purpose.

Duty not to improperly use position - s182 (Duty not to profit from position)
A director, secretary, other officer or employee of a corporation must not improperly use their position to: gain an advantage for themselves or someone else; or cause detriment to the corporation.

Duty not to fetter discretion's Directors have certain discretion's conferred on them by law and the company's constitution. When exercising such discretion's the directors are subject to two duties, namely: a duty to retain discretion; and duty to give adequate consideration.

Directors must exercise active discretion, they cannot ignore issues or blindly rely on another person. They must give adequate consideration when purporting to exercise a particular discretion.

Material personal interest - director's duty to disclose - Section 191
s191 requires a director who has material personal interest in a matter that relates to the affairs of the company to give the other directors notice of this interest. s191(2) outlines the exceptions to this requirement to provide notice.

The notice must give details of the nature and extent of the interest and the relation of the interest to the affairs of the company and be provided at a directors' meeting as soon as practicable after the director becomes aware of their interest. The details must be recorded in the minutes of the meeting.

Failure to disclose a material personal interest according to s191(4) does not invalidate a resolution by the directors at first instance. It has been held that the threshold for determining whether an interest is material is quite low however this contrasts with Magellan v Mount King Mining NL where the Western Australian Supreme Court stated that the nature of the interest ``should have the capacity to influence the vote of the particular director upon the decision to be made, bearing in mind that the conflict of interest must be of a real or substantial kind''.

Therefore it is considered appropriate to declare even minor conflicts of interest where there is a potential for conflict so as to err on the side of caution.

s192 of the Act provides that a director may give other directors standing notice about an interest. The notice may be given at any time and whether or not the matter relates to the affairs of the Company at the time the notice is given.

This is worth reading and taking note if you are a Board Director........

Wednesday, December 15, 2010

In the best interest

This blog is not meant to reflect any one person or persons: it is pondering on the phrase “In the best interest”: what does this really mean? when it comes to law and ethics there are two very different meanings, traditionally when we refer to children you might consider that parents and doctors talk about “in the best interest” it means what is considered to be best for the child...not what is best for the adult, there are times when both the doctor and the parents do not agree as to what is in the child’s best interest. “Best interests” is the doctrine used by most courts to determine a wide range of issues relating to the well-being of children.

My discussion today is about “in the best interest for the College” – now we are looking at “best interest” from a different perspective: you are looking at a philosophy, an organisation and the people within that organisation: 8 people on a Board an EO, office support staff and the membership & stakeholders: Without the membership nothing else exists:

Defintion of “Best Interest” Authority delegated for taking any action or step the delegatee thinks to be the most advantageous to the organization, under the circumstances. This power is conferred usually where it is impossible to anticipate every eventuality, or where the need for rapid decisions or quick response is critical. It is normally given for a short period, or until the time adequate information is available to formulate specific directions or guidelines.

Just to explain some general governance processes of a board for those who may not be familiar with this process: Usually an organisation will have a Constitution Governance Charter (which sets out the ground rules and job descriptions)and several other polices: The board directors are the strategic thinkers they set future goals and represent the college on the National & political front; The directors are selected by the State Membership, this does not mean that the State Board director is responsible to the state they are the National Board director from each state and territory looking after the best interest of the National College: the board director may choose to report back to the State branch to keep them informed about National issues: Therefore the National College has 8 board directors: from this the office bearers are elected the; College President, Vice President and Treasurer; All the directors are volunteers, this is an unpaid position, done as a professional duty to further the profession.

The executive officer is a salaried position; appointed via advertisement and a panel interview: The EO is responsible for carrying out the strategic plans that the board develops: and managing the office staff to carry out the work required in assisting the membership etc the day to day minutia that is required of an organisation of a 5500 membership; The board directors do not venture into the realm of the EO, that is the day to day running of the college.

In order for an organisation to function well you have to have a president and an EO that can work together and a board that is united in philosophy – they do not have to necessarily see eye to eye but they have to know how to agree to disagree and come to reasoned decisions, the ability to argue respectfully, have insight to their behaviour and most importantly have integrity. You have to leave your own agenda at the door, because the focus is “in the best interest of the College” that is for all 5500 members not just certain sectors of the membership. Confidentiality is a vital component to any board, mutual respect and good governance. Once on the board it is a National board, no state or territory exists, however this does not stop factions, such as state biases, homebirth etc

If directors come to the table with different agendas and ego’s the ability to have insight is difficult and decisions are clouded by the comment “in the best interest” my question is whose “best interest” are they truly serving? When you have powerful people in the room you are bound to get explosions, what is required is reasoned arguments, powers of persuasion without bullying and mutual respect.... once respect is gone there is a breakdown in communication because there is a tug of war about “the best interest” this is blatantly clear because there is a breakdown of respect and the factions then take over or the personal loyalties to people rather than “the best interest of the College” and then the battle begins.

The other over powering conflict that may influence how boards behave is outside influence – everyone else knows how to run the board – everyone looking into the fish bowl thinks they know best and want their two cents worth – this can be detrimental – again this comes down to a breakdown of trust and the issue of “the best interest” again I ask “whose best interest” or “whose agenda”? Once you as a board member breach confidentiality and let the outside world in...... it opens the board to criticism.... there is a fine line between being transparent and breaching confidences that lead to untenable situations.

If you do not have good governance you will not be able to function as expected and when things go pear shaped you have nothing to fall back on, it is imperative to ensure there are appropriate governance structures in place to protect your board and organisation.

I am truly saddened that great women have been wounded –in my experience 95% of people are good....but sure as hell that 5% can cause havoc, there is always a minority that cause you to have to reconsider your point of view:

I am disappointed that I have not been able to achieve the things I wanted and have a heavy heart however I am confident I have followed my heart and acted “in the best interest of the College”.

Sunday, November 14, 2010


Thanks Carolyn (Thinkbirth)for this link: and yes Carolyn you are correct in saying every item could be a blog on its own......

The World Health Organization (WHO) definition of normal birth is: ‘Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition’.

It is a pity not every State and Territory in Australia adopts this policy TOWARDS NORMAL BIRTH: NSW is leading the way: the policy is aimed to increase normal birth and decrease surgical intervention. Western Australia needs to take a leaf out of the NSW book: I may even suggest it to our Minister of Health and our Chief Nurse and our Midwifery Advisor to see if we could not adopt this proactive lead to ensure that Normal Birth is the focus; even better I might give them Carolyn's 21 strategies to keep birth normal........

10 Steps
1. Have a written normal birth policy/guidelines, along with other
relevant policies, that are routinely communicated to all health care staff

2. Train all health care staff in skills necessary to
implement this policy

3. Provide or facilitate access to midwifery continuity of carer programs in collaboration with GPs and obstetricians for all women with appropriate consultation, referral and transfer guidelines in place

4. Inform all pregnant women about the benefits of normal birth and
factors that promote normal birth

5. Have a written policy on pain relief in labour that includes the use
of water immersion in labour and birth

6. Have a written postdates policy/guideline that is routinely
communicated to all health care staff (All women have an agreed due date of birth
documented in their health record)

7. Provide or facilitate access to vaginal birth after caesarean section
operation (VBAC) that is supported by a written vaginal birth after
caesarean section operation policy/guideline (develop statewide workshop of GPs, midwives and obstetricians to exchange views and skills regarding VBAC)

8. Provide or facilitate access to external cephalic version

9. Provide one to one care in labour for all women experiencing their
first labour or undertaking a vaginal birth after caesarean section
operation, vaginal breech or vaginal twin birth (implement local guidelines/protocols that discourage activities that separate midwives from the woman in labour. This includes the use of centralised monitoring systems as they discourage midwives from being with the woman in the labour room)

10. Provide formal debriefing in the immediate postpartum period for all women requiring primary caesarean section operation or instrumental birth with the opportunity for further discussion and information transfer

What I really like is Carolyn's inspirational and passionate list: this is how it should really plain simple language that everyone understands....

Carolyn's 21 Strategies to help keep birth Normal:

1. Avert the medical 'gaze'

2. Be powerful and able to negotiate as equals to doctors

3. Establish a "round table culture'

4. Dispel 'urban myths' about birth

5. Support women to choose upright positions in labour

6. Educate teenagers

7. Promote the use of positive images of birth

8. Look at system issues: promote and change to woman centred midwifery models

9. Discuss what normal birth means to us and ensure we are talking about the same things

10. Listen to women with respect - what does the woman want?

11. Encourage women in labour to stay home as long as possible

12. Establish and provide support structures to help women stay at home in early labour

13.Establish and provide support structures so women can choose to stay home to give birth if desired

14. Examine our own attitudes to 'being with woman' in pain and uncertainty

15. Seek to establish a relationship with each woman

16. Allay fear: let woman know what birth is really about

17. Address anxiety of support people and other health professionals

18. Pay attention to the language we use

19. Have confidence in women's ability to give birth

20. Pay attention to our body language as body language conveys meaning: what are we saying?

21. Set up birth space intentionally - find out what makes each woman feel safe and do that.

Thursday, November 11, 2010

Yeah AHPRA coming to the party; Good News;

After some frustrated phone calls to the College and a few letters to AHPRA it is good to see that AHPRA are listening and things are becoming easier; it pays to voice your opinion and it is even better when the other party comes to the table; well done to the ACM (Barb Vernon EO) for going in to bat for us and well done to AHPRA for considering the issues on the table and resolving them....... here is some of the good news;

I have just had confirmation from AHPRA that: (via the ACM)

1. MPR certificate will from now on be taken as sufficient evidence of
c. Current competence to provide pregnancy, labour, birth and post natal
care to women and their infants;
d. Successful completion of an approved professional practice review
program for midwives working across the continuum of midwifery care;

2. Professional references can now be provided by a midwifery colleague. The requirement for a reference from a ‘member of the multidisciplinary team’ (obstetrician) has been dropped

3. References do not need to address every element of the ANMC competency standards. They are able to be a general third party statement of support for your application from a midwifery colleague or manager

As for my application I am happy to announce that;

AHPRA has also agreed that they would be happy for ACM to reissue MPR certificates to existing applicants with wording that confirms their review was in relation to their competence across the full scope of midwifery practice. I am still waiting on a response to my questions relating the 3 year / 5 year requirement on the application form & the criteria for certifying documents;

Fantastic; now all I have to wait for is that the college will send a certified copy directly to AHPRA on my behalf, (which won't take long) and I will get the amended original for my midplus folder to replace the current one.... then I will get my notation; yeah!

Step one; MPR completed;
Step two: Eligibility completed: next Medicare!

Keep watching this space............

Saturday, November 6, 2010

Red tape of AHPRA:

Next installment of my application for eligibility; here I was Miss Perfect at following instructions and I haven’t got it right; I had all my documents certified by a lecturer at the university stating "this is a certified copy etc"to be informed that this was not correct: for your information these are the certified people for AHPRA;

Who can certify documents?In Australia, the following people are authorized to certify documents:

Justice of the Peace, Bail Justice, Registrar or Deputy Registrar
Commissioner for Declarations, Commissioner for Oaths, Commissioner for Affidavits
Accountant (member of the ICA, ASA, NIA OR CPA)
Registered members of the teaching profession (not university)
Member of the police force
Sheriff or Deputy Sherriff
Public Notary
Permanent staff member of AHPRA

Alas this means I have to do it all over again; photocopy and resend. Second problem, the letter from my past employer was not sufficient, it was not enough to say that I had been employed across the spectrum of midwifery and that I was deemed competent by the institution, the manager has to address the ANMC competencies as well, this is a step too far… I have completed the Midwifery Practice Review which addresses each competency……I am a patient woman and I understand that you need to ensure that midwives are competent…. But this really is going overboard.

What I thought was going to be a relatively smooth process is turning into a mind field of red tape and bureaucratic nonsense; there is something to be said about waiting until the first batch have gone through to iron out all the problems, however one would not consider that there would be so many issues and the goal posts moving.
Watch this space: Pauline

Monday, November 1, 2010

How to apply for eligibility:

Today I sent in my application for an eligible midwife; like anything new the process is TIME consuming and there will be teething problems: I am hoping that I have completed everything as required; You do not need insurance to apply for eligibility; I have to say that I have had to send my application to Sydney as WA is not ready for this process: Here is my step by step process:

Step 1; Go to the AHPRA website and download on the first page fourth heading ‘Registration’ on drop down menu second one down click ‘Registration Process’; left hand side blue box; fifth one down; click common registration forms; Standard Format for Curriculum Vitae:print and save this form.

Step 2; While on the AHPRA website go to the Nursing and Midwifery site and download the Registration Standards for the Eligible Midwife third from the bottom; then on the left hand side fifth from the bottom click on forms; a third of the way down the page look for the heading Notations; click on Application for addition of notation as an eligible Midwife; print and save this form.

Step 3: Now you need to read and complete the forms; to make sure you meet these requirements before you apply; I have heard that there has been a problem with Independent Midwives who do not have Midwifery Managers.... so watch this space.... I would think that maybe one way around that might be that they could sign a statutory deceleration..... as this is legally binding.... but that will be for the Board to decide....lets hope they will work it out soon...

a. Current general registration as a midwife in Australia with no restrictions
on practice; You need to add your registration number with AHPRA:

b. Midwifery experience that constitutes the equivalent of 3 years full time
post initial registration as a midwife; Here you need a letter from your current Midwifery Manager outlining that you have worked across the continuum of midwifery care, antenatal, intrapartum and postnatal this letter is dated and signed;
You also need a statement of service; this is obtained from your HR department; I rang Health Corporate Network and gave them the years I work at the government institution and they sent me a very detailed statement of service;

c. Current competence to provide pregnancy, labour, birth and post natal
care to women and their infants; this can be proven by completing the Midwifery Practice Review (ACM) or some other accredited program(I don't know of any other one apart from the ACM one.

d. Successful completion of an approved professional practice review
program for midwives working across the continuum of midwifery care; as above

e. 20 additional hours per year of continuing professional development
relating to the continuum of midwifery care; if you have MidPLUS this will be easy you will just print out your summary; If you do not have MidPLUS you will have to produce evidence of attaining these points; copy your certificates and get them certified copies; I did not send any originals of certificates they were all certified copies.

f. Formal undertaking to complete within 18 months of recognition as a
eligible midwife; or the successful completion of: I wrote a letter using this wording saying that i will formerly undertake the course when it is ready.

i. An accredited and approved program of study determined by the
Board to develop midwives’ knowledge and skills in prescribing, or
ii. A program that is substantially equivalent to such an approved
program of study. As above.

Step 4: Follow the Standard format for CV; as it is slightly different to your current one; I just cut and pasted from my regular CV. One thing that is very different is the request for clinical / procedural skills - with this one I made up a table that gave the dates of my general clinical competences such as Obstetric emergencies; suturing, IV cannulation, neonatal resuscitation etc; and added certified copies of the certificates; You must make a declaration that your CV is true and correct and sign it. The CV has to be an original not a copy;

Step 5; add payment for your application; $90.00

Step 6: you also need someone to witness your signature when you have completed the application form

Step 7; Make sure you go through the checklist it is helpful to ensure you have completed everything; although the checklist does not ask for a letter from the manager and this is a requirement; Not sure why when you provide a statement of service;

Step 8; Take a copy of what you have prepared, I find this always good practice; double check it again and then post it to the AHPRA office in your capital city; if in WA post to Sydney NSW for the interim until the office is more settled in WA, as we only came on board middle of October.

I found this process tedious especially having to photocopy and get 16 copies certified of my qualifications and certificates; the CV was not problematic but had to be changed from my usual format; the letter from the employer was not difficult nor was obtaining the statement of service you just need to allow for the time to prepare for this application; I am hoping now that I have all this information that hospitals who require credentially will not want any more than this and when you have prepared it once it is then done.... life should be easy now....NEXT STEP MEDICARE PROVIDER NUMBER:

Lets hope I have not forgotten anything and have completed the application as required... will let you know how I get on......go on be daring take the step and apply for eligibility;

For more information visit the AHPRA website;

Monday, October 25, 2010

APHRA is up and for running WA

National Registration is finally here.... I have heard about it for over 20 years and finally the time has come; CHECK YOUR REGISTRATION:

Australian Health Practitioner Regulation Agency for WA is up and running, have some fun and check out your name, check out your doctors name see if they are registered and if there are any restrictions placed on them. Click on this link APHRA then scroll down a third of the screen, go to the second blue box, heading HEALTH PRACTITIONERS then click How can I check my registration status? Follow the instructions and all you have to do is put in your full name, health profession and state, you don’t need the registration number.... and then see what happens.

I am undecided whether I think this is a good idea or not, yes I think it is beneficial that you can check so easily that someone is registered, but having my disciplinary history for the world to see, that I consider an invasion of my privacy. I will however remain open about the concept and see how it all pans out. In terms of people state hopping when they are investigated yes a fantastic idea, but for those who genuinely make a mistake your record is there for everyone to see.

You can also visit the Decisions and check on all Health Practitioners and decisions made in relationship to complaints.......this is transparency for you; These are outcomes of court hearings, tribunal hearings and hearings conducted by regulation agencies that were completed or started before 1 July 2010, relating to complaints and notifications made about health practitioners or students.

Let me know what your thoughts are? And be sure that you don’t find your name in that may work as a deterrent.

Click here to read more for WA....Practitioners from WA who have not renewed by 30 September: also read frequently asked questions information. The APHRA site is packed with information, spend some time looking at the site, it is worth your time;

Sunday, October 17, 2010


WA Branch ACM presents the 2010 Annual Conference and AGM
@ City West Function Centre,
45 Plaistowe Mews, City West, West Perth

Friday 12 November; 08:30 - 16:30

Come and be inspired and energised about new initiatives in the world of midwifery, pregnancy care and childbirth education for women and their partners. Hear updates from the College at the AGM and finish the day relaxing with friends and colleagues at the sundowner drinks and nibbles.

Pregnancy screening - What’s the latest?
Gestational Diabetes - future changes being proposed - Dianne Bond
Which women are Vit D deficient? - Sadie Geraghty
Cannabis - should we be screening? - Renate McLaurin
Implementing screening for haemoglobinopathies - Dr Janet Hornbuckle
Childbirth Education - making a difference - Deb Slater & Lesley Kuliukas
Mandatory reporting of child sexual abuse - Statewide Protection of Children Coordination Unit
EPDS - using it with men? - Pam Whittacker
Beer & Bubs - Cath Cook
Yummy Mummy - remedial massage and pampering - Amy Mitchell Annual General Meeting

REGISTRATION 08.30 - 09.00
Registration includes refreshments & lunch Sundowner drinks and nibbles 16.30 – 17.30Free parking all day

(02) 6230 7333 1300 360 480 (free call)
Pay on line.....

ACM CPD points apply *Program subject to change

Cheers Pauline

Wednesday, October 13, 2010

Check out the Determination for Medicare Provider Numbers

Please have a look at the Health Insurance (Midwife and Nurse Practitioner)Determination 2010Health Insurance Act 1973
I, NICOLA ROXON, Minister for Health and Ageing, make this Determination under
section 3C of the Health Insurance Act 1973.
Dated 4 October 2010

This determination comes into force 1 November; Midwifery services and fees range from $31.10 - $724.00 and providing a service fee for 6 weeks postnatal period...

We have to remember that this does not cover homebirth and we need to continue to put pressure on the government to pass this midwifery services fee onto women who choose to have a homebirth.....

Cycling around Australia...Where is Marg Phelan up to

Here is an Update from Marg.... see where she is now;they have done really well, what an achievement to cycle across the Nullabor, I remember many years ago driving across and thinking my God miles and miles of complete nothingness...but spectacular at the same time.. I couldn't imagine cycling across.....what a phenomenal group of women... here is part of Marg's email letting us know where she is.....

Hi all
We are half way across the Nullabor. We are at Eucla for 2 nights and move on tomorrow. We have been out of phone and internet cover for the past week so unable to contact anyone.
Hope all is good for you and everything is going as planned.
Cycling going well in spite of head winds, cool temperatures and some rain. Robyn is doing a great job with Muriel (name of the van) and the roadies duties
We have 6 more days of no coverage till we get to Ceduna.

Check out our website as Su has put more photos on and some more on the blog.

Love and hugs to you all
Gogirls xxx

Marg Phelan, Midwife
Cycling for midwives, women
Normal birth & breastfeeding

Wednesday, October 6, 2010

Order your ACM WA Merchandise now:

The WA ACM Branch has an exciting range of merchandise for you to purchase for friends, family and special occasions; sun hats, fleece, shirts, thumb drives, sun-visor and more...take a look...
Click on the picture to access a larger view; once opened in picasa click on picture again, this will enlarge the view: place your order by emailing us at; together with your payment details;
Thank you

Tuesday, October 5, 2010

Curtin Graduation: Nursing and Midwifery: 2010

That time of year again, celebrating the graduation of a new batch of Nurses and Midwives.... a few more people with PhD's and others with Masters,Graduate Diploma's, Graduate Certificates etc; great achievements, congratulations to all. I particularly enjoy the pomp and ceremony of graduation... the excitement of the graduates, their proud parents, partners, family... it is just wonderful... As a lecturer I feel a sense of achievement and warmth....anticipating a fantastic career for these budding graduates...taking both professions forward...our future leaders; It was good to see a baby in the its mother received her award....

These are some of the nursing class of 2010, I had the pleasure of teaching these nursing students.....and am looking forward to watching their careers grow and they becoming our future leaders;

The student response was presented by Corrina Farr, Postgraduate Diploma (Midwifery)who also won the Australian College of Midwives Membership Award:
The Western Australian Nurse Memorial Charitable Trust Award was won by Debra Pallier:
In total there were 12 presentations for prizes and awards.... many excited and happy recipients.

It was good to see Jenny graduate.... her PhD was 10yrs in the making....when I listened to her one minute speech, I was happy that I have decided to do something other than my PhD; her advice to the audience was "if you are going to embark on your PhD, please make sure you are young enough to enjoy the benefits of completing it. I left my run to late, if I was to advise you about anything that would be it...start it when you are younger".

Good luck to all the graduates may your career be fulfilling and may you always remember to treat your clients with the same respect and care that you would expect for yourself.

Wednesday, September 29, 2010

AMA Position on collaboration:

Here is the AMA document for collaboration; yes there are parts of it that make me cringe.... however it must be equally difficult for the AMA, not that any midwife wants to hear that; Click on the link to read the document;

Collaborative Arrangements what you need to know? the irony of this document has to make you laugh or cry:

"Working with other health professionals is an everyday feature of clinical practice for a modern medical practitioner. Effective teamwork can improve patient outcomes, create new opportunities for learning,and build a shared understanding of the skills that each person brings to the care of a patient."

If we do not embrace these changes, then pressure will mount on the Government to relax the requirement for collaborative arrangements to be in place. This would risk fragmentation of care to the detriment of patients.

This is the most telling statement of all.... this means the AMA is seriously concerned that if they the doctors do not collaborate then changes will be made......this is in our favour.

As always I am presenting you with the information and you can decide for yourselves; As i have stated before; My vision is that all women will have the choice of continuity of midwifery care with a midwife and the right to claim a Medicare Rebate for fee for services;
Whilst I do not like the wording in this Determination I can see that this is still a historic time for midwives and midwifery....

Friday, September 24, 2010

Why do people read and not leave a comment?

I am expressing a level of frustration; how are people to make decisions when you put out information and you get no responses; what does it take for people to respond? i know you read the blogs, but never a comment; this is so important; does this mean you accept the staus quo, you don't give a toss, you have no opinion, or really doesn't matter what you say nothing will change? I have no idea what to think....because it's one way communication here....

I liken the position of the Australian College of Midwives to the recent federal election: everyone you speak to is voting for the person you want.... or not voting for that person....the numbers are close all the polls predicated 50 - 50 or thereabout.....Now with the Determination; I have to say the polarity is almost the same, although I think that because the majority of midwives are not commenting.... the minority who believe that the determination should be squashed have a louder voice. Therefore this is the common view because the rest aren't speaking..... we have 500 members in WA.... and i have heard from less than a is time to be vocal.....

The facts are that the Determination was passed in July...when it comes up in the Senate next week it is to allow or disallow..... there is no discussion about the determination....the time for talking is over... Any debate that would be had, would then be as to whether, or not, the disallowance motion should be passed.
... the bottom line is if it is not allowed... we then lose everything, because the Government of the day will not reintroduce it. I have to add why would they?

The argument I have been given is that the determination will create a two tier midwifery service.... I believe this happened when we created 'the eligible midwife' not the medicare provider number.... and rebate.... in fact i could argue there has always been a two level midwifery service...those midwives who believe their scope of practice is the experts in normal childbirth.... then to collaborate when things move outside that scope with an Obstetrician.... however there are those midwives who will accept and care for a woman from any risk category because it is the woman's choice..... there we have a dichotomy: my solution is if you had that , trusting, supportive arrangement with your women it wouldn't matter if you had to seek collaborative advice from an Obstetrician..... it is all about the relationship you build with the woman.....

is this a topic to which we will get no agreement or have things just got to a point where the passionate people from both sides are at logger head... and the majority of midwives are just not engaged.....?

Wednesday, September 22, 2010

THE FACTS: The Determination:

1) Will not prevent private midwives being able to practice (they can still access insurance)

2) Will not prevent women being able to make choices –If you are having a homebirth and choose not to access Medicare you do not need a signed agreement with a doctor.

3) Only affects midwives seeking to access Medicare and midwives can choose not to do this.

4) Is not included in the NMBA Quality and Safety Exemption Framework supporting private midwives providing homebirth services

5) Does not re-define the ICM definition of a midwife – it does not define the role or scope of practice of midwives in Australia. It only defines how midwives can access Medicare if they choose to do so. Midwives can still work in public and/or private practice and access insurance and register as a midwife (under our current regulatory requirements that have an accepted definition and scope of practice of the midwife in Australia).

6) Does not mean that midwives must have a signed agreement with a doctor – this is only IF YOU CHOOSE TO ACCESS MEDICARE - Midwives can have
a. an individual signed agreement with a doctor
b. a referral of a woman to you
c. clinical privileging
d. an agreement signed by the medical director of a hospital.

7) Does not mean you need acknowledgment in writing - we have been told by the Minister’s advisors that a midwife writing in her own clinical notes that results etc have been sent to the hospital/doctor where they have a collaborative arrangement meets this requirement.

Urgent information: Determination:

The ACM has sent an urgent e-bulletin out to its members to let them know about the delicate position the College finds it's self in - Whilst the College is not happy with the terms of the Determination we are in real danger of losing everything we have been working for by not accepting this Determination; That is Medicare for Midwives:

The College has consistently requested some changes to the Determination:
".....while we were very committed to seeing the maternity reforms progress there are several concerns regarding the implementation of the Determination. We also noted that very small changes in the wording of the determination would resolve many of these issues. Our suggested word changes are,
• Removing the words ‘named medical practitioner’
• Removing the words ‘acknowledgement by a named medical practitioner’
• Addition of the words ‘a health provider organisation’ to Part 1. Section 4 c (important for rural & remote purposes and also applicable to urban Aboriginal Health Services)."

Also the Minister will continue with the plan for Nurse Practitioners however would let the Midwife Determination go....

"We were also advised that the Minister is very aware of the potential move to disallow the Determination and the government is therefore seeking urgent legal advice about uncoupling the Nurse Practitioner (NP) Determination from the Midwife Determination to enable the NP Determination to progress through parliament. They stated that the Minister has no intention of letting the NP Determination fall through (if the Midwife Determination is challenged) and will work hard to ensure this does not occur. However, the Minister’s advisors also stated that Minister Roxon has ‘lost political capital over this and will not seek to reintroduce the Midwife Determination if it is disallowed’. Sadly maternity care is not high on the agenda in health at the moment despite all our (consumers and midwives) efforts to make it so."

The Minister has clarified these points:
"The Minister’s advisors also stated that in the Determination:
• The requirement for ‘acknowledgement by a medical practitioner’ could be met simply by a midwife recording in the woman’s medical history that information had been sent to a medical practitioner, and
• That the medical director of a hospital could be the ‘named practitioner’ (we have this in writing from Minister Roxon dated 27th November 2009) signing on behalf of the hospital medical staff.
• Clinical Privileging is a Collaborative Arrangement which does not require any further sign off from a ‘named medical practitioner’.

You have to ask yourself whether it would be better to let the determination be disallowed and work really hard to try and get it up in a way that we feel is workable from the beginning?
However, the consequence of this means we risk not getting Medicare for midwives in the next three years or perhaps at all.

This is too big a risk to take! We believe that over the next few years we could see thousands of women benefiting from access to Medicare in a variety of different models. Specifically, we see this will increase access to funded continuity of midwifery care which many women do not currently have.

Please be proactive and leave a comment: what do you think? and please leave you first name when commenting: no anonymous comments will be published

Pauline Costins

Tuesday, September 21, 2010

Reflections from a student midwife:

Student Midwife Reflection six months into her course:

Wow what an experience the past six months has been! I have spent the first half of this year on the maternity ward at Southwest Hospital and work with a fantastic team of midwives. I have loved every day of it and although it has not been easy at times, it has been worth every moment.

I have been extremely lucky in my experiences and have been a part of some awesome births and met some amazing women. I have been a part of three water births, a vaginal twin birth including one breech, hypnobirthing and a baby ‘born in the caul’, just to name a few highlights. My mentor Susan is a great midwife whose knowledge and commitment to women and the midwifery profession astounds me. Although I mostly work with her, I realise it is important to work with other midwives as everyone works differently and has different pieces of knowledge which I know will help me to become the best midwife I can be.

Every Friday we have a Midwives Clinic where women who have shared care with their doctors, come to us for a few visits during their pregnancy. This for me is a real highlight, I enjoy meeting these women antenatally, even if it’s only briefly and building a rapport with them as it is the closest form of continuity of care we have here at the moment.

Everyday is constant learning whether I’m working in labour suites, on the postnatal ward, or in the Midwives Clinic, I usually come home mentally exhausted from everything I have learned that day, I feel like a big sponge absorbing everything! I have become much more confident in CTG analysis and breastfeeding education, although I am not as confident with vaginal examinations as each one is so different, so I am endeavouring to improve on that skill!

The hardest part of becoming a midwife for me is the constant battle for ‘normal birth’. I see midwives everyday advocating for their women to allow for the birth that they want and some doctors just need to interfere. It seems that some of them feel the need to ‘rescue’ these women from that ‘horrible thing’ called labour, they don’t seem to realise that it is the most natural part of life. I’ve seen women coping beautifully with a labour that is progressing and a baby not distressed at all and a doctor walk in and insist on interfering in one way or another, which alters the woman’s ability to trust her body and it appears to be only for the reason of doctor convenience. It is frustrating and on going. The doctors are there for those women, who need assistance in the birth of their baby and in obstetric emergencies, and that’s when midwives then step aside and work with the doctors for the safest option of birth, whether it be an operative vaginal birth or caesarean section. It can be draining being an advocate for these women to get a ‘normal birth’, but worth every bit of it when you get a happy and healthy woman with a happy and healthy baby.

The most important lesson that I have learnt is to always listen to the woman. If she states she feels an urge to push, yet was only 2cm dilated half an hour ago, BELIEVE HER!!

So another six months to go until I am a fully fledged midwife, it is scary, yet exciting. I can’t wait to see what to future holds and look forward to the rest of the year!

Written by Aleisha (Student Midwife)

Tuesday, September 7, 2010

Midwives wonderful women......dinner with Marg Phelan

Marg Phelan a midwife originally from Victoria, now living in NT (president of the Australian College of Midwives in 2003) is cycling around Australia to raise awareness for midwives, normal birth, women's childbirth choices and breastfeeding. Marg and her superb team travel on average 100k per day, what a feat.... tonight they were enjoying a glass of red, and the company of the ACM WA Executive, student midwives and colleagues.....

I have just come home having a wonderful dinner with a phenomenal group of women; being a midwife is such a privilege and opens the door to meeting a multitude of people from all walks of life.

The team

I was enjoying chatting to Marg's team, Sue a renal nurse specialist from the NT who is the driver of the bus, Lois a scientist from Victoria who advocates that cycling keeps you young, Rhea also from Victoria an infection control nurse, says she sleeps really well after cycling and its the best way to see the country and Rob who is a midwife also from Victoria who has just joined the group to do the driving from Perth to Victoria says no way am I cycling happy to drive the bus, so that Sue can do some cycling with Marg. Marg does all the cycling and the others take turns or cycle with Marg...I have to say it puts me to shame knowing that the average age of the group is 60 years young.... my legs just ache at the thought of 100k's a day.... oops ladies after our chat about going to bed early the computer went on when I came was calling me......just had to write about you all before Alzheimer's set in....what an inspiration all these women are, such dedication and passion..... how would I describe them.... fantastic, wonderful, remarkable and unique.

A couple of our Bachelor of Midwifery students Beth and Lisa who organised the Mum's bub's and midwives at Point Walter also joined us for dinner....they had the opportunity to chat to the team, it's about the new and the experienced sharing the common goal of midwifery and how to keep moving the profession forward and upwards into the future.....

These sorts of evenings allow us to network, share stories, enjoy a glass of red... and just chat.....

Have a safe journey and we will be watching you.....go girl australia... anyone wanting to help Marg Phelan please visit her website or email her on

Ciao Pauline

Friday, September 3, 2010





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