RANZCOG - Please give feedback - Collaborative agreement for midwives

RANZCOG has developed a template for Collaborative Maternity Care Agreement between Eligible Midwife and Specialist Obstetrician or General Practice Obstetrician for use by Specialist Obstetricians or GP Obstetricians and Eligible Midwives.

It is very important to give your Feedback.

It is acknowledged that the template agreement will not be suitable for all settings and that not all Obstetricians will wish to enter into a collaborative arrangement, but all comments will be considered.RANZCOG

Please send feedback to Rupert Sherwood by email to ganderson@ranzcog.edu.au or by fax to +61 3 9419 0672.

Sending your response is important, this is how your voice and numbers count, please be proactive, read the document in its entirety... and give your feedback.

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”.

KEEPING BIRTH NORMAL:

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 read....in 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.

Birth - Childbirth as an athletic feat - Wellcome Collection

Check out the link below.... just click on the title it will take you to the website; it is a 1939 educational film, a class of expectant mothers practise ante-natal exercises designed by Kathleen Vaughn at the London County Council's Paddington Hospital. See the midwives uniform and the exercises.... I do not in anyway recommend these exercises.... I was just sharing a piece of history.. Do you think times have changed?


Birth - Childbirth as an athletic feat - Wellcome Collection

International Midwives Day Celebration on Saturday 2nd May 09

The Australian College of Midwives WA Branch invite you to attend our celebrations at UWA:

ARE YOU COMING?

International Midwives Day
Saturday 2nd May 2009

“Celebrating our Land our People and our Profession”

This promises to be a day to remember - Inspiring presentations - A good laugh
Great food
Johnson & Johnson Midwife of the Year Award presentation
Spot prizes and raffle

Maternal and perinatal outcomes for Aboriginal women are grim. Can we truly make a difference for Aboriginal women – Heather Hancock believes we can!

Nyoongar women share their amazing stories of birth in their communities

After lunch it’s Joyologist Bronwyn Williams – a guaranteed laugh and life changing workshop


The Maternity Services Review Paper…..its time for us to find a voice and a way forward …come and debate the issues with our presenters, leading health professionals including Graeme Boardley, Robyn Collins, Janice Butt, Wendy Candy and consumer Debbie Slater.


For Registration Brochure click here www.midwives.org.au

PLEASE consider coming along and bring a friend too!

Aboriginal spirituality and the land

A powerful explanation of the spiritual connection of Indigenous people to the land can be found in a publication of the now abolished ATSIC [13]:

We don't own the land, the land owns us. The land is my mother, my mother is the land. Land is the starting point to where it all began. It's like picking up a piece of dirt and saying this is where I started and this is where I'll go. The land is our food, our culture, our spirit and identity.
—S. Knight [13]