Image if this was the type of maternity care system we had. Where midwives and doctors (specialist O &G's and GP's) worked together in 'Collaboration not competition, Viva la health care revolution. if only we could have more people in Australia that could think like this.
This is my dream for maternity care in Australia. Where maternity care is about collaboration, not about power struggles. Where birth wars cease to exist and women are truly at the centre of their care, making their own decision - unbiased, empowered and collaboratively. I had the priviledge of working with an obstetrician who has this philosophy and I feel that it was a win win situation for all. - the women, the staff and the organisation. It will be interesting to see what happens in the coming months in relation to 'eligible midwives' and collaborative arrangements with Drs.
I have also worked in good collaborative relationships with obs and gps in the UK. Unfortunately in Australia power and money seems to make it difficult + obs and gps want to take on the role of the mw and over see the care of healthy women. Collaboration works when the autonomy is 'given' to the mw and the boundaries are set by those in power (not women). As an independent midwife I attempt to collaborate but it is usually one way. I have had GPs refuse to continue seeing women who choose home birth; refuse to prescribe drugs; ring me to tell me they do not support home birth and will not be called out in an emergency (like I would ring them?); attach RANZCOGs statement against home birth to a woman's blood results when she went to collect them... the list goes on. I have come across 2 good GPs who respected the woman's choice to home birth. One even arranged entonox for the woman. I guess the point I am making is that whilst collaboration is optional for obs/gps but not for mws it is reliant on practitioners who have everything to lose and nothing to gain through collaborating with mws outside the system. Why should they? Here is an example of what 'eligible' midwives can look forward to: http://australianprivatemidwivesassociation.blogspot.com/2010/12/gp-withdraws-collaboration.html I acknowledge there are birth wars but it seems impossible to get involved in them when attempting to provide choice for women. I don't want to fight. I just want women to lead their own care and practitioners to respect this.
ReplyDeleteI think collaboration works not when the autonomy is given to the midwife but when it is given to the woman. I aim to collaborate with the woman not as an equal but as her servant. There is only a birth war because Drs and midwives alike are arguing over the control of birth. The woman is the only person who should be in control. If we understood that, all choice would be equal and collaboration easy because it would see the health practitioner take up the role they were designated to do.
ReplyDeleteThe only winner should be the birthing woman.
Lisa - I was being tongue in cheek re. it is only allowed when autonomy is given to midwives. This is the only way obs will accept collaboration. Women are never given autonomy in their maternity choices. They already have it but often don't know they do.
ReplyDeleteBy the way - that should have said it is impossible NOT to get involved in the birth wars when women are blocked constantly by them.
I agree women should be in control of maternity care and if that was central all else would fall away. However, I can't say that I consider myself a 'servant' in the mother-midwife relationship. I admire that you can work this way. I consider myself an equal with her having greater knowledge about her body/baby/birth and needs than me. During birth I am in servant role I suppose, but I want a say in when I do antenatal visits etc. I have a family and life too. As a woman and midwife I have boundaries and I am up front about them with women. I am happy to follow women not guidelines but I need women to take responsibility for their birth choices and have realistic expectations about what I can do ie. this is their birth and they are the expert - not me. I bring experience of attending births, trust, patience and mw skills if required. They must do the rest - and can and do perfectly well.