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    Joy Johnston

    I wonder why virtually noone is making any comment about the midwifery changes announced in last Tuesday’s budget – indemnity, Medicare and limited prescribing?

    The silence covers the newspapers, TV and radio programs that I have accessed, as well as midwifery and maternity-related email lists.

    I have been with labouring women in two Melbourne hospitals this week – Mercy and Box Hill – and most of the midwives I have spoken to were not aware that anything has happened. Others seem scared that the reforms will be subjected to excessive gatekeeping, effectively setting hurdles that are too high for ordinary midwives to aspire to.

    Although I am disappointed and frustrated that homebirth has been sectioned off as a ‘no-go’ zone, for reasons that can not be taken seriously by anyone who understands evidence, I am really pleased that the government has taken such a big step to dismantle the medical monopoly of maternity care. And in my mind the announcements of reform were more wonderful in the wake of the report of the maternity services review which said a lot of nothing and skirted around the real issues.

    The budget press releases from the College of Midwives, as well as from Maternity Coalition and Homebirth Australia were, imho, worded in a politically correct way. I am confident in ACM’s representation of the interestes of midwives, and our scope of practice. By definition, midwives are able to practise in any setting, including the home.

    Until the homebirth issue is sorted out I am wondering what will be done in situations or locations where the publicly funded homebirth models are not available. I expect there will be some midwives prepared to go ‘underground’, while others will seek to comply with the new rules. Noone can force a woman to go to hospital. Some women will probably use the system for what it provides, and decide at the last minute in labour whether they go to hospital or give birth unattended.

    I have been actively working for maternity reform since 1993 when I started my private practice. We have a long way to go, but from where I sit the 2009 federal budget is the biggest step forward that I have seen so far in my lifetime. I hope the bill passes in the Senate, and I hope those who represent midwives’ and women’s interests in bringing in the reforms will be wise and courageous.

    I have many questions, and I, like others, will have to exercise patience. I have enjoyed the independence that I have had in midwifery in the past 15 or so years. I accept that there will be changes in how I can practise, if at all, after the middle of next year. I hope that by the end of this year I will still be taking bookings for births beyond 1 July.

    My blog url is http://villagemidwife.blogspot.com/ , and Midwives in Private Practice http://midwivesvictoria.blogspot.com/

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