International Definition of a Midwife
Adopted by the International Confederation of Midwives 19 July 2005
A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
For further information, visit the website of the Australian College of Midwives, Inc : www.midwives.org.au
MODELS OF CARE
Choosing a model of care is very important if you are seeking a particular type of birth. Pregnancy and birth are not illness; they are a normal physiological life event for a woman. You need to choose a model of care that is appropriate for you and your circumstances. If you are aiming for a natural birth, choose a caregiver that supports the natural process of birth.
"Let us support one another, not just in philosophy but in action, for the
sake of freedom for all women to choose exactly how and by whom, if by
anyone, our bodies will be handled." Linda Hes
Independent Midwifery Care
This model of care most closely reflects the philosophy of natural childbirth. You will employ a midwife who practices independently. A midwife is THE SPECIALIST in normal pregnancy and birth. As stated by the World Health Organisation (WHO) midwives are the most appropriate caregivers for well childbearing women. Midwives are trained to know deviations of normal and will act accordingly. She will attend all of your pregnancy antenatal care, labour, birth and postnatal care, normally in the woman's home. She will spend many hours with you each and every antenatal visit. You will get to know her well and it will be like you have a friend at your birth. Most independent midwives attend planned home births however some may attend planned hospital births also. In either case, you will be encouraged to book in to a hospital back-up facility of your choice during the antenatal period. Midwives in independent practice often will supply or help you to access a birthing pool for you if you so wish to labour or birth in water. You will be able to freely move around in labour with no restrictions. Your midwife will monitor you and your baby intermittently with a Doppler throughout labour. In the unlikely event of transfer your midwife will come with you. All care throughout pregnancy, labour and birth and postnatally (up to 6 weeks after the birth) is personalised and individualised for each woman's particular needs and values, with the woman and her family as central decision makers.
Birth Centre Care / Caseload Model of Care / Group Practice / Team Midwifery
These terms refer to the model of care whereby you are under a publicly funded midwifery model of care. Birth centres are birthing units within close proximity to a hospital facility for timely transfers to obstetric care if required. These models can be difficult to get into, with a "lottery" type of system for deciding who gets in. Due to such high competition for entry to these models, there are usually strict criteria for who is and who isn't allowed consideration for this model. Your named midwife will usually attend all of your antenatal, labour, birth and postnatal care, with some visits at a clinic and some in your home. If your named midwife is on a day off, your care will be provided by another midwife within the team. This team can include up to six midwives and there are usually opportunities to meet each of them during your clinic visits. However, there is the slight possibility that you may not have previously met the midwife attending your labour and birth. You cannot ask for a particular caregiver in public health. In some caseload models, you may be ‘allowed' to birth in water if it is available. There will be some restrictions on how you labour and birth. You will have to conform to birth centre and / or hospital protocol and common practises and procedures. Your partner will not be allowed to stay overnight with you in the hospital, however, many women are assisted to go home 4-6 hours after the birth.
Public Health
Public health is often viewed as subordinate to private health. But this isn't the case. As a public ‘patient' you will mostly have midwives attending your antenatal care, labour, birth and postpartum. The midwives will spend much time with education and preparing you for birth. You may be required to have a routine booking in visit and a later check with an obstetrician. As midwives are the specialists or experts in normal pregnancy and birth, rest assured that you have the most appropriate person meeting your needs. You will be subjected to shift changes and therefore the possibility of a string of midwives through your antenatal period, labour and birth. You cannot ask for a particular caregiver in public health. Services may be limited; you might have to share toilets or showers with another person. It is unlikely that you will be ‘allowed' to birth in water if it is available. There will be restrictions on how you labour and birth. You will have to conform to hospital protocol and common practises and procedures. Your partner will not be allowed to stay overnight with you in the hospital.
Shared Care
This is when your antenatal care is distributed between caregivers. For example it might be inconvenient to travel to attend the hospital where you are going to birth so you might share your antenatal care with your general practitioner. This may be more convenient, however you might find that care is fragmented with lack on continuity of care providers. You will most likely be seeing a midwife, a general practitioner and an obstetrician. You then birth at the hospital you have chosen.
Private Health
In a private hospital with private cover you can choose your own obstetrician and this person will do your antenatal care. An obstetrician is a specialist in complications that arise before or through pregnancy that may lead to poor outcomes for mother or baby. They are trained as surgeons. You may miss out on much antenatal education because this doesn't fit into allocated time slots and because obstetricians are trained in complications they may have limited knowledge and skills in achieving normal, non-interfered-with pregnancy and birth. Your surgeon will be at the birth but will not be there through your labour, at the very most a quick check in. When you are a normal healthy pregnant woman under a medical model of care you are at risk of the "cascade of interventions" which commonly results from induction or epidural. Private surgeons have a much higher rate of interventions and caesarean section than public surgeons. It is more likely that you will not have a natural birth if an obstetrician is your primary caregiver. Pregnancy, labour and birth are medically managed. It is possible that you will not be ‘allowed' to birth in water if it is available. There will be restrictions on how you labour and birth. You will have to conform to hospital protocol and common practises and procedures. You will most likely have a private room after the birth. Your partner is normally allowed to stay overnight with you in the hospital after the birth.
Freebirth
Freebirthers are few in number but the popularity is growing as rural hospitals close and the health care crisis escalates. Freebirthers do not employ a professional caregiver at all for the birth (ie a midwife or a doctor). They may employ a doula as an extra support person and set of hands. They may or may not choose to see a midwife, doula, and less likely a general practitioner or obstetrician for antenatal care. Freebirthers know and understand their bodies very well and are in tune with what is happening. They know when they need assistance and when their baby and their body are working well in unison. Freebirthers educate themselves in pregnancy and childbirth and empower themselves. Freebirthers trust in themselves, their bodies, their capabilities, their babies and above all, they trust birth.
While freebirth is generally frowned upon many professional bodies, statically perinatal mortality and morbidity rates are very low. In fact it could be argued that the government is encouraging freebirthing as they close down the rural hospitals making the choice of a hospital birth less accessible to women. Roadside births are becoming common place as women are left with no other choice but to travel in labour to a hospital that offers birthing facilities. It makes labouring and birthing at home seem a much more comfortable option for the woman and her family.
What is a doula?
Optimumbirth.com.au says "a doula supports labouring women by attending to their emotional and physical comfort needs and assists in "smoothing" the labour process. They do not have clinical duties or responsibilities but use massage, positioning suggestions and may help her client to research the type of birth she wants". Doula's are not legally able, nor trained, to perform midwifery duties such as monitoring a pregnancy or labour, or performing neonatal resuscitation or any other clinical duty. Midwives and doulas often work together and their skills complement each other's very well.
It is never too late to change care provider to someone you are more comfortable with and who is willing to meet your needs. Remember, you are the employer and above all, no one knows your body and your baby the way you do.
(Adapted from an info sheet from www.gentlebirth.com.au:2008)
