Midwifery is catching

I am outing myself as an old schooler there by thinking in terms of terms and semesters still - my school has only just this year changed to having 144 study periods (I kid you not) and this semester is study period 2, and next semester is study period 5… just to confuse people. Anyway, this is week 5 of term one of twelve, and I have a new ticker to celebrate:

Yeaaaahhhhh, that makes me feel just thrilled . Ok how about another one for my first placement:

That’s better! I have volunteered to be placed in a rural hospital, so I may end up in the Spencer Gulf area though I’ve also said that Woollongong would be nice and convenient to Sydney/Canberra for visits. I have volunteered to do that for a number of reasons, the main ones being that I think a rural placement would be fascinating, and also because it may mean that a local student who is unable/unwilling to fit into a rural placement because of lack of transport, family duties, job commitments or a dislike of going outside of Adelaide has a better chance of getting a placement with the group midwifery practice. That said though, given the model of the gmp, I can see that many of the students who don’t have transport, or are the main caregiver of children, may really struggle with that model of midwifery care. The alternative model of set rotating shifts has definite benefits for the midwifery-student it seems!

Last week I had my first practical class and I am of two minds about it. On one hand, I can see that what we learnt will be of great help to us, as our first placement will be kind of hard/pointless if we can’t take a BP, know what a vaginal examine kind of vaguely entails, and at least have seen someone palpate.

But - and it’s probably a small but - my group had a mixture of nurses and mature-age students (erm yes, including me!) and fresh-out-of-highschool students. The first group took over and showed everyone their skills without going slowly enough for the others to follow (especially the more shy/timid ones), and some of the latter were really and utterly wigged out by the fake pelvises. Many had never been faced with sharps for eg and were all over the morphine saline injection station while three of us wielded syringes. Even though the lab rules clearly state closed-toe shoes, someone had thongs on and narrowly avoided having a syringe dropped in/on their toe, and yet still managed to remain pissed that I’d asked her to step away from the three of us lest someone get hurt.

It was a small but, and really, the whole two day experience was fantastic in terms of getting one step closer to being with women. It was so intersting to meet some of the external students who have come from all over the country to study this course. It was amazing to see our lecturer’s eyes lit up when she spoke of birth and women and pregnancy.  

A comment on my blog recently said lots of things but one thing stuck in my mind, even amid the car accident aftermath and such. That post was born mostly from feeling completely and utterly ungrounded by and from everything at the time, and my really questioning what was driving me in this direction. I don’t want my course to become a means to an end and yet already it is partly feeling like that - if not because many people assume that I am doing nursing first, then because of downright reluctance from older nurses that I have had interactions with to accept direct-entry midwives, and other people questioning my drive for doing this (misplaced baby lust apparently!).

And let me hasten to add that in the end, I loved working with my group, I did them proud, and we are a lot closer for it! 

"My other tip is this: don’t worry yet about what kind of midwife you want to be. Trust me when I say that you don’t have enough knowledge yet to know this. Your heart will lead that quest in time. Focus for the time being on the work in front of you. It’s important and will help shape that midwife you will become. Keep putting one foot in front of the other, don’t over schedule yourself (I do this too), and read things which remind you in the best, positive way, of your calling.

So I did. I got a few books to inspire me in the best positive way I can. I made contact with people who will keep me grounded. I have made peace with the fact that many of the people in my course will probably end up being medwives because they are not inspired to be anything more - and that that’s something I have to be ok with. Just like they’re going to have to be ok with me pursuing evidence based care about strep B testing, glucose challenge testing, physiological third stage, breast is best, ultrasound, weighing during pregnancy and a heap of other things!

Women should choose where to give birth after discussing the risks and benefits with their midwife or doctor, recommends draft guidance from the National Institute for Health and Clinical Excellence (NICE).

The latest version of draft guidance on care during labour being developed by NICE, which advises on treatments in the NHS, says that women should be offered the choice of planning to give birth at home, in units run by midwives (birthing centres or birth units), or in hospital wards run by consultant
doctors.

 Women should choose where they give birth, after being given the opportunity to discuss the risks and benefits of all settings with their midwife or doctor. They should be reassured that perinatal mortality during delivery is low in all settings, although the quality of information comparing the
potential risks and benefits of each birth setting is variable.

The draft guidance sets out the information that women should be given when making their choice of where to give birth. This includes research showing that women who plan birth at home are more likely to have spontaneous vaginal birth, less likely to require caesarean section, and more likely to retain an
intact perineum than those planning birth in an obstetric unit. Women giving birth in midwifery units have higher rates of spontaneous vaginal birth and intact perineum.

Women should be told that when unanticipated obstetric complications arise, either in the mother or baby, the outcome of serious complications is likely to be less favourable in women who labour at home than when the same complications arise in an obstetric unit.

http://www.news.com.au/couriermail/story/0,23739,21485893-5003406,00.html

THE failure of Federal and State governments to reform failing maternity systems has spawned a new political party.

The What Women Want party is the brainchild of maternity services advocate Justine Caines, from Scone in rural NSW.

Ms Caines, a mother of six, said yesterday the party would field Senate candidates for each state and House of Representatives candidates in selected marginal seats. "The states share the same issues - soaring caesarean rates, the closure of rural maternity units and absolutely no choice for women," she
said.

"There is no (Medicare ) funded choice for women to access midwifery services.

"Less than one per cent of Australian women can access continuous care from a midwife."

Ms Caines, a mother of six who has worked as a policy adviser in the ACT government and in the union movement, said Medicare funding of midwives would pave the way for a transformation of maternity services.

"A transformation in terms of access to midwifery care and in terms of reducing the cost to Medicare of unnecessary obstetric interventions including caesareans, inductions and the associated cascade of other surgical interventions that often follow inductions," she said.

About 100 people signed after the party was launched Saturday morning.

"In Queensland we have plenty of supporters in key seats we’ve identified like Bonner, Rankin, Moreton, Brisbane," she said.

Marginal National Party seats in the Gladstone area - Hinkler and the new electorate of Flynn, tagged as notionally National - would also be targeted.

Ms Caines said it was an "absolute disgrace" the National Party had not stood up for rural maternity services, many of which had closed in recent years, forcing rural women to travel long distances for maternity care.

Nearly 40 rural maternity units have closed in Queensland in the past decade.

Outspoken Queensland maternity reform advocate, Dr Jenny Gamble, said the time was ripe for the party which she believed would be strongly supported.

It had been two years since an independent review of Queensland’s maternity services had recommended sweeping reforms and that review had followed 19 other previous reviews exposing systems failures.