A U S T R A L I A N COLLEGE OF MIDWIVES INCORPORATED
THE GLOBAL PERSPECTIVE OF A WESTERN AUSTRALIAN MIDWIFE
Hamish Darby (post-graduate)
The arbitrary province of 'low risk' maternity cases
o v e r which midwives claim property needs
clarification. What constitutes low-risk? Western
Australian mothers can expect maternal mortality
of 1 in 16,700 live births (HDWA XIIth Annual
report 1995 Pg 57) "...but for a w o m a n in West
Africa, in areas where fertility is high, that risk may
be as high as 1 in 15." (Kensington 1996 Pg 114).
Can families of n e w reproductive technology be
considered for inclusion? Walton & Hamilton
(1995) certainly do not equate low risk with
intervention. The reported incidence of acute and
long term complications resulting from elective
caesarean sections in this state requires some
explanation of their growing n u m b e r in the
absence of substantive justification.
Changes in midwifery practice r e c o m m e n d e d by
the influential 1993 "Changing Childbirth" paper
such as the right to admit, refer and prescribe
have been reluctantly implemented where their
use is overwhelmingly supported by the economic
rationalism of corporate health bodies, with little
political pressure wielded by an itinerant
midwifery complement and referrent p o w e r from
community lobby groups w h e n their platforms
fleetingly align. Walton & Hamilton (1995) state
that midwifery is becoming so regulated that "...no
innovation is possible unless it has been tried,
tested and implemented elsewhere. Generally
speaking, most practices that midwives will want
to undertake will fall into this category."
"To be sure, midwives will continue to be
c o n f r o n t e d with p r o b l e m s relating to self
regulation, r e i m b u r s e m e n t and malpractice
insurance." (Vonda 1988 pg 406). Recognition of
accredited midwives right to rebate under the
medicare legislation places midwives in the same
realm of accountability as other claimants.
Dingwall (1993) states the only standard of care in
a deregulated system would be "...that of a
reasonably skilled Obstetrician."
J U N E 1997
May & Mahlmeister (1995) state that only a quarter
of Obstetricians have escaped litigation and a third
have been sued more than three times. Australia
seems to be following the alarming United States
growth of malpractice litigation. The figures below
are from an Australian medical defence c o m p a n y
that did not distinguish specialities until 1992:-
1996 Annual Indemnity Premiums*
General Obstetric
Non procedural $1,600
Procedural $4,000 $5,000
Specialist $11,500 $25,000
*Medical l:'ractitioners w i t h a g r o s s I n c o m e o f $60,000 o r m o r e p e r year.
The implication of this trend might be that
General practitioners will shy away from shared
care. Midwives are well placed to absorb this
duplication of services. However, regionalised
health authorities may b e c o m e reluctant to absorb
the cost of pecuniary awards on behalf of their
staff and professional organisations are also likely
to show the strain.
Discussion
Benjamin Franklin is quoted as saying "There is
nothing that can be said to be certain, but Birth,
Death and Taxes." I wish to demonstrate how
deeply this triptych infiltrates the fabric of our
culture.
Let's look again:-
9 Birth - the certainty of existence
9 Death - the certainty of temporal mortality
9 Taxes - the certainty of material substance
I am going to postulate that not only do these
semiotic devices bear a relationship to each other
ACMI JOURNAL PAGE 29
 AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
but also to the society in which the association
persists. Ken Wilber (1986) demonstrated that
such phenomena of human culture may evolve
across generations in the same way that the
personality of individuals matures throughout
their life-span.
The dominant paradigm has a perpetual interest in
keeping this association invested with its own
rituals and values. Our own Western culture, for
example, keeps the promise of comfortable, safe
childbirth associated with an escalating
commitment to expensive sophisticated
intervention. Many mothers are intimidated into
accepting birth as "an operation to remove the
baby at the appropriate time."
With the readers licence, this pattern of
oppression and revolution is analogous with an
historical precedent. The medieval church
demanded a 'tithing' or ten percent tax on all
goods produced by tenants of episcopal land.
Further donations were required to fund the
observance of birth (baptism), death (funeral) and
reproduction (marriage). This was in a time of
high infant mortality, when multiple baptisms
would have to be purchased for the grace of each
child. The Anabaptists broke away from the
reformed church in the 1500s, founded on the
parishioners mass-refusal to pay for baptism,
preferring to baptise each other. The sect endured
considerable persecution for heretical belief in
their right to perform ritual cleansing, usually only
performed by the elite disciples. Simultaneously
"...ordinances were being passed requiring
midwives to call surgeons if birth could not be
accomplished. Most of these ordinances were
church administered" (Vonda 1998 pg 403),
transferring rites of life passage from the ancient
clerical patriarchy to the new scientific, as
represented below:-
TRANSPERSONAL ARCHETYPE
Birth if taxes paid
ANCIENT EXAMPLE Sanctified Birth (baptism)
if dues paid to priesthood
MODERN EXAMPLE Scientifically controlled births are
comfortable and convenient
PAGE 30 ACMI JOURNAL
The Anabaptists survive today without threat to
the established priesthood. Perhaps there is also a
place for maternity care without the affirmations
of an apparently omniscient ubiquitous
technology, upon whom "...commentators are in
danger of giving consent, throughout silence, to
their oppressive effects." Porter (1993, pg 37).
Locally, a marginalised portion (0.4%) of the
Western Australian community are choosing
childbirth in the most natural possible
environment. This represents a refusal of the
dominant paradigm as much as it represents a
selection of alternatives. It is a caveat on health
funding.
The first crack in the scientific v e n e e r of
anachronistic maternity services "...is that is
enables them to live without the delusive support
of subjective certainty." (Russell, 1952, pg 81),
whereas with few exceptions (eg. Leboyer)
midwives are pioneers of the mandate o f -
approximating the birth experience families
imagine for themselves.
Midwives cannot be exempted from the action of
advocacy. They live the dilemma of being the first
figures in an un-reassuring landscape. The
midwife shares a deeply reflexive knowledge of
the expectant woman's values, enabling an erudite
empathy with the progenitor herself.
References
A.C.M.I. Competencies: Version Three. 1995
Australian College of Midwives Incorporated
Journal 1995 Vol. 8, #4, Pg 21.
Barclay, L. 1985 Australian Midwifery Training and
Practice. Chapter 1 in: L. Kitzinger The Midwife
Challenge. 5th Ed. (pp. 86-96) London: Pandon
Press.
D e a t h if no taxes paid
Eternal life withheld (damnation)
if tithes not paid
Midwife attended home-births
associated with mortality
JUNE 1997
 AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
Dingwall. Robert. 1993 Negligence litigation
research and the practice of midwifery. Chapter 10
in : Alexander, J. Levy, V and Roch, S. Midwifery
Practice.. A Research Based Approach. Hampshire:
MacMillian Press.
May, K.A. &Mahlmeister, L.A. ( 1 9 9 4 ) M a t e r n a l
and neonatal nursing family centered care. Third
Ed USA: Lippincott.
Perinatal Statistics in Western Australia Twelfth
A n n u a l Report. D e c e m b e r 1995. Health
Department of Western Australia, Maternal and
Child Health Studies Unit, Health Information
Centre, (1994 Midwives notification system).
Russell, Bertrand. 1952. The impact of science on
society. London: Allen and Unwin Pub.
F E L L O W S H I P T O T H E A U S T R A I . I A N COI.LEGE O F M I D W I V E S
Members o f the College are invited to apply f o r Fellowship.
Applications close 31 May, 1998
FELLOWSHIP
FELLOW
O'iteria./'or el(qibiliO~J'or admission to Fellowship:
1. Continuous financial menlbership of the
Australian College of Midwives Inc. (ACMI)
for the last five years.
2. Evidence of formal a n d / o r continuing
professional development other than that
gained from initial midwifew registration.
3. A significant contribution for the benefit of
the midwifery profession and/or the health of
women and their families, as demonstrated
by:
a. professional and personal development of
self and others within the sphere of
midwifery practice
b. commitment to the ACM and other related
organisations, including significant
contribution and participation at state,
national and/or international level.
4. An outstanding contribution to professional
excellence in midwifery through consistent
professional excellence in midwifery care
and practice, education, management,
research, scholarship and/or other
outstanding development.
JUNE 1997
Vonda, R.L. 1988. Midwifery: Past to Present.
Journal Of Professional Nursing. Vol 4, #6 pp 402-
407.
Walton, I. & Hamilton, M. 1995. Midwives and
Changing Childbirth. Cheshire UK: Books for
midwives Press.
Wilber, K. (1986). Up from Eden: a transpersonal
view of human evolution. Boston: New Science
Library.
Willis, E. 1989. Medical Dominance. (revised Ed.)
London: Allen & Unwin Pub.
CATEGORIES
DISTINGUISHED FELLOW
l)istinguished Fellow is awarded to any meml)er
of the Australian College of Midwives who, in
the opinion of the College of the day, has made
a n outstanding contribution to midwifery for the
benefit of the midwifery profession and/or the
health of w o m e n and their families.
l)istinguished Fellowship is conferred for the
lifetime of the individual and can only be
revoked by the Executive Committee of the
College.
HONORARY FELLOW
I lonorary Fellow is awarded to an individual
who is not a midwife and in tile opinion of the
College of the day, has made a significant
contribution to midwifery for the benefit of the
midwifery profession a n d / o r the health of
women and their families.
Further information of the Fellowship criteria
and the application form may be obtained from
the Executive Officer, ACMI, Suite 23,
431 St Kilda Rd, Melbourne, Vic., 3004.
Telephone (03) 9804 5071, Fax (03) 9866 13 70.
ACMI JOURNAL PAGE 31