I am a midwife. It is 2010. I work for a large public hospital. To be specific, I am employed by the hospital. Like most of my midwifery colleagues in the hospital system, I work with many different medical professionals, obstetricians, GP-Obstetricians, paediatricians, anaesthetists, endocrinologists and so on. Some I like, some I don’t, some I have great respect for, professionally, and some I emphatically do not. I do not work for any of them. To reiterate, I am not employed by an obstetrician. Midwives, by and large, do not work for obstetricians. I know I’m being heavy-handed here, but we are employed by hospital management. We go to work for professional fulfillment, to earn a living, to care for the women and their families, and to care for their babies. It has been several decades now since we have gone to work to be subservient handmaidens to the obstetric staff.
Oh I could go on and on in this vein…we are health professionals in our own right, we can be autonomous practitioners, we have professional codes of practice and ethics, we undergo years of study and supervised practice, we are held to a high standard and undergo professional appraisal every year. We don’t just get to show up, hold a woman’s hand, wrap the baby in a clean blanket, make her a nice cup of tea and empty the bins afterwards. We don’t get to do this job because we’re all so bloody nice. Culturally, socially, there is a commonly heard suggestion: ‘oh, she’s such a nice girl and she really loves babies, she’d be an excellent midwife’. Well that’s crap. Some of us are nice and some of us aren’t very nice at all, but most of us are damn good at the job. Obstetricians, well do I even need to say it? No one cares if they’re men or women (but mention a male midwife and you might as well have three heads), or if they’re ‘nice’, or even if they’re particularly experienced (yet I cannot count how many times I’ve been asked how many babies I’ve delivered – one, my own, the others I’ve caught as their mothers have brought them into the world). And somehow everyone assumes that they’re our employers.
Well they might not have to strain themselves to think differently for much longer. Despite the Government stating, in March, “there is no intention to provide a right of veto over another health professional’s practice” that is exactly what they have done. While they’re proudly advertising their great health reforms of increasing options for women by allowing midwives access to pharmaceutical prescribing rights and Medicare rebates, they’ve carefully put a considerable hurdle in front of any privately practicing midwife who tries to make this happen. Any midwife who wants these rights must not just show that they are collaborating with an obstetrician, but have their practice endorsed by said obstetrician. The first analogy that springs to mind is that of dentists and orthodontists. You go to a dentist for normal tooth care and then get sent off to the orthodontist when things are a little more complicated. No-one is suggesting that orthodontists get a say over whether or not dentists can set up shop.
I’m all for collaboration, for standards, for guidelines, for safeguards, for accountability. I’m not for my colleagues from another profession having a say over how I get to practice. We have a regulating body for that already. And I doubt that they’d appreciate the reverse, if each private obstetrician had to get a midwife’s endorsement (oh, the hilarity – ‘Dr X? He’s lovely but he does routinely cut episiotomies on every first time mother’. ‘Dr Y? Not a great bedside manner and tends to suggest formula feeding in case the baby sucks to hard on the mother’s nipples’). Fortunately we all get a say over whether politicians get to keep their jobs.