Why are Australian midwives penalised for caring?

medium_4092410288A few weeks ago, I went to Brisbane to speak at the Homebirth Australia conference.  This was an altogether fabulous experience, but it was so sad to hear that some of the best Australian midwives (like in so many other countries) are still being subjected to vexatious reporting and persecution in a number of ways, simply for supporting women’s choices.

I heard story after story of brilliant, caring midwives who did everything in their power to give great care to women and yet who have found themselves on the wrong side of the law simply by doing just that.

I don’t pretend to understand all of the legal underpinnings of these cases, but from discussion with well-informed colleagues I gather that there is a growing trend to assume that the midwife’s continued presence is interpreted as implying that she is complicit in any decisions that the woman makes.  In other words, if a woman chooses to do something outwith the recommendation (like declining to transfer to hospital during a home birth, for instance, or declining induction for so-called prolonged pregnancy), and the midwife continues to stay with her and provide midwifery care, then that midwife is perceived to be condoning the woman’s choice.  Which somehow makes her partially responsible for that choice.

This is absolutely outrageous.

In the UK, we have a duty of care to women.  This means that we stay with them, no matter what choices they make, and even if they make choices that we don’t agree are the best.  In my understanding, that is our legal and professional obligation.  A midwife encountering such a situation would involve their Supervisor of Midwives (SoM), who (in my experience of these kinds of situations) will help check through that the midwife has ensured that the woman has all relevant information and documented everything appropriately.  (I will acknowledge here that not every British midwife is as lucky as me in the SoM department.  My SoM is fabulous and genuinely deserves a medal :D). Once the SoM is satisfied that we (for it is now a shared situation, which I can also tell you from experience can be a great relief for the midwife) have done everything required, the task is then to work out how to best support the woman.  Throughout, it is understood that women are autonomous decision-makers and (MOST importantly) that we midwives and health professionals have a duty of care to them, regardless of whether or not they make the decisions that we think they ought to.

Again, I am very willing to declare my relative ignorance on such issues, but I just can’t understand how any system has so lost touch with the duty of care ethic that, if a woman makes a decision that is outwith normal practice, the midwife is expected to abandon her.  Even worse than this is that, in many cases, the midwives who have been affected by this stance have told me they felt that they weren’t supported by the very groups and organisations who should have been the first to stand by their side and defend their actions and ideology.  Instead, they were advised to withdraw care.

This surely cannot be the way forward?

photo credit: Christolakis via photopin cc

7 comments for “Why are Australian midwives penalised for caring?

  1. May 19, 2014 at 8:13 am

    Hello Sara, thank you for speaking out about the inequities experienced by Midwives in Qld. Sadly, this is often a case of “who you know, not what you know”. Having been to hell and back as a consequence of a similar situation in WA many years ago, I am very sympathetic and empathetic about the gut-wrenching experiences some midwives endure in Qld. “Teething problems” are always expected when systems are changing and evolving, but it should NEVER be at the expense of an honest midwife’s livelihood which HAS happened in Qld recently. Again, thank you for raising the discussion and hopefully awareness of the hardships experienced by the trailblazers. Midwives are – with women, and for women. Always. Lois Wattis

    • Linda Stegeman
      May 19, 2014 at 11:36 am

      The issue is not contained in Queensland, or indeed, Australia. There are many midwives who are in a difficult situation and lose their registrations, livelihoods and even their freedom for this reason.

  2. June Pittman
    May 19, 2014 at 1:08 pm

    Australian midwives continue to be prosecuted because they can. 1. We have no SoM system. 2. Our registration/licensing system is adversarial. 3. We work within a system based on the medical model maintained by Australia’s biggest political lobby group (AMA- virtually 100% representation) 4. ACM not joined by enough midwives around 16% representation – would need a huge influx of members to increase representation and therefore lobbying power. The AMA uses this against midwives in all negotiations. 5. Rogue midwives taking on cases way beyond scope of practice – some after ditching their registration – publication and prosecution of these cases make it easier to report and prosecute midwives who simply care and stay with women who make choices as pregnancy/labour continue with variations beyond normal

  3. joy matthews
    May 19, 2014 at 8:49 pm

    It seems that the trend of demonising the midwife also underestimates the women themselves, of course it’s a tricky area, but informed consent is well supported in the legislation…I know as a student midwife I repeatedly heard the doctors explain the ‘risks’ of not having an induction … the balanced view and relative risks weren’t explained, but fear was generated until the woman complied…I wonder who supports women who have complications as a result of intervention which may not be fully consented in the true and ethical sense of the word “consent’…

  4. Disillusioned hber
    May 20, 2014 at 1:25 am

    Let’s see if this comment will make it through.

    After experiencing and witnessing the behaviour of a certain midwife here in Australia who is supposedly the victim of such “persecution” that you are all complaining about, I find it incredibly difficult to take you all seriously. Many years ago I would have nodding along in agreement with you. But I got to experience first hand what it’s like to be on the receiving end of the kind of “care” this midwife dished out to many women. This midwife is well known and loved by many, is respected by many peers as being incredibly knowledgable in her field and yet she has behaved in some of the most disgustingly immoral ways I have ever seen.

    Seeing her practice and behaviour in person has made me question how many other supposedly “persecuted” midwives are actually behaviour way outside the boundaries of ethics and safety. It has made me open my eyes and stop towing the line that saw me blindly supporting this midwife and others like her.

    Yes, of course there are women out there who had a wonderful experience with this midwife. But how much of that was the midwife’s doing? Or how much of it was the mothers own preparation or, dare I say it, luck? When I spoke out in my (supposed) community about her behaviour and actions I had my reputation systematically smeared and I was completely ostracised. I have since watched the same thing happen to other women who attempted to question this midwife’s appalling behaviour.

    How on EARTH will women ever have the right to an informed choice if the homebirth community behaves in the same way as the medical community, shutting down any dissent, denigrating and dismissing women who speak out against dangerous practice? The answer is, they won’t. Women will continue to be fed lies and half truths, they and their babies will continue to be damaged and killed as a result. Whether that be at the hands of hospital staff or independent midwives.

    I understand wanting to be careful about what we say so as not to play into the hands of those who wish to strip women of their right to homebirth. But we are NOT helping those same women if we flat out refuse to have an open dialogue on the disturbing and dangerous practices of some independent midwives.

  5. Josie
    May 21, 2014 at 6:44 am

    Sara, thank you for saying this. I’m a homebirthing woman who had fantastic midwife care, and there are many more like me. It is dismaying when people accuse others of being underinformed just because their view is different. That happens a lot to women; if you dont want the intervention, then you can’t have had enough information yet! You are right that women need there to be aomething in place that supports us and means we can still have a midwife even if we choose to go outside the guidance. Blessings on you and your work x

  6. Pene Kirk
    May 21, 2014 at 8:47 am

    I had my first child in hospital with an obstetrician in attendance, my second at home with a GP, and my third and fourth with a very experienced midwife. The care and support given by the midwife was unequalled, and it was a privilege to have been able to have my children at home, with her professional care. Homebirth was a very informed decision on my part, and I was, and still am, grateful to have had a capable and professional midwife caring for me and my babies. There needs to be medical recognition, not predjudiced vilification, of the skills and abilities of qualified midwives.

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