Please take the time to fill in a Global Midwives petition. The petition will be officially handed over on 6 September to the Foreign Minister’s office (or delegate).

To the Heads of States and Governments:

“As midwives, we have seen first hand how crucial it is that a woman has expert care when she gives birth. We know the dangers women face if they experience complications that mean childbirth can be life-threatening for mothers and babies.

There are not enough midwives in the world, and this global shortage means millions of women risk their lives and that of their babies each year by going through pregnancy and childbirth without expert midwifery care.

Thousands of mothers and newborn babies die every day because of this critical shortage of midwives. This cannot be allowed to continue any longer.

If births were routinely attended by midwives or health workers with midwifery skills, with the right equipment and the right support, the lives of 1.3 million newborn babies and 350,000 mothers would be saved every year.

When world leaders meet at the UN General Assembly this September to measure progress on the global strategy for women and children’s health, we urge you to take action and strengthen or increase your commitment to the education, recruitment and retention of midwives and health workers.

By making and implementing these ambitious commitments, you can help end this needless loss of life.

We are calling on global leaders to invest more in midwives and health workers with midwifery skills in the right places, at the right time, with the right education, the right support and the right pay!”

Fill in the petition here.

Image credit: Nickzeff via Flickr.

Don’t forget to enter our Nurse Uncut 2nd year anniversary contest to win $500 from ME Bank!

Midwives encouraged to keep pregnant women smiling!

]Midwives will play a vital role in improving the oral health of pregnant women, thanks to an innovative online education program developed by The Centre for Applied Nursing Research and Sydney Dental Hospital.

The Centre developed the program as part of a new midwifery-led oral health initiative that incorporates oral health guidelines into normal midwifery practice.

The program, which has been endorsed by the Australian College of Midwives, offers 16 Continuing Professional Development points for midwives across Australia. It incorporates an online education program consisting of pre-reading material, video and photographs of the dental assessment process, and knowledge testing for midwives.

Australian College of Midwives national spokesperson, Associate Professor Hannah Dahlen, said the program offered an exciting opportunity for midwives.

‘Midwives are the leading health professionals caring for childbearing women and, thanks to this program, they can play an important role in ensuring women’s oral health care is made a priority during pregnancy,’ she said.

The program is currently being trialled in south western Sydney, with plans to roll it out across NSW and other states over the next few years.

Further information in prenatal oral health for pregnant women can be found here.

As a midwife, do you currently promote good oral health to your patients?

 Don’t forget to subscribe to our weekly newsletter!

The NSWNA and NSW Health have worked extensively to adapt the UK model to NSW maternity services.

Birthrate Plus focuses on women’s needs rather than midwife activity and is based on a standard of one-to-one midwifery care. Midwife time is increased to reflect the additional needs of the higher risk categories of women.

Birthrate Plus will be implemented in three phases.

Phase one: Hospitals that participated in the trial, with no significant changes to models of care since the data collection for the trial. Birthrate Plus will be implemented by June 2011.

Armidale • Shoalhaven • Orange
Dubbo • Sutherland • Port Macquarie • Campbelltown • Wagga
Wollongong • Maitland • Liverpool
RPA • Westmead • RNSH

Phase two: Hospitals that participated in the trial, but with significant changes to models of care since the data collection for the trial. Birthrate Plus will be implemented by December 2011.

RHW • Lismore • St George
Nepean • JHH • Gosford

Phase three: Hospitals that fit the criteria and did not participate in the Birthrate Plus trial. Birthrate Plus will be implemented by June 2012.

Blacktown • Hawkesbury • Blue Mountains • Bathurst • Mudgee
Manly/Mona Vale • Hornsby
Auburn • Bankstown • Canterbury
Fairfield • Bowral • Queanbeyan
Goulburn • Tweed • Murwillumbah
Mullumbimby • Coffs Harbour
Grafton • Tamworth • Manning Base
Broken Hill • Moruya • Griffith

HOW WILL BIRTHRATE PLUS WORK?

1. A Birthrate Plus project manager is appointed at each maternity service.
2. The Birthrate Plus Manager from NSW Health visits the project manager at each service to provide information and plan the tool’s implementation. They decide the starting date for the collection of data.
3. Data is collected by midwives for four to six months. The period for the collection is agreed with NSW Health.
4. Data is collated by the Birthrate Plus project manager.
5. Data is analysed by NSW Health.
6. The results reveal FTE numbers and determine the numbers of midwives required.

Birthrate Plus was trialed at RPA Hospital where Jacquie Myers works as a childbirth educator. Jacquie said the trial showed Birthrate Plus is a very comprehensive tool that covers all aspects of a woman’s care in maternity services.

‘Up until now we’ve had no effective mechanism to measure workloads and address staffing issues. Midwives are totally fed up. At RPA we’re very eager to see this in place. Birthrate Plus has been a long time coming.

‘The data collected for the trial shows RPA definitely needs more midwives on some shifts – especially after hours. Birthrate Plus provides a clear-cut mechanism that ensures a reasonable workload for midwives.

‘I hope it sets a precedent that flows through to the private sector.’

Are you a midwife? How will Birthrate Plus effect you?

Don’t forget to subscribe to our weekly newsletter!

Birthrate Plus means midwives in NSW public hospitals will finally have a reasonable workload.

The new public health system award includes a staffing tool for maternity services in NSW public hospitals implemented progressively from June this year.

NSWNA Assistant General Secretary Judith Kiejda says it has been a long and difficult road to get Birthrate amended for NSW but the benefits are well worth the effort.

“We’ve not only achieved ratios for Public Health System nurses but we’ve also won a major breakthrough for midwives so they can also control their workloads.”

It will deliver extra midwives in many birthing units across NSW and will assist in the planning of maternity services.

What is Birthrate Plus?
Birthrate Plus is a midwife planning tool that provides a comprehensive assessment of the staffing needed to provide the care required by a woman in maternity services. All aspects of midwives’ roles are considered from outpatient clinics and ante-natal services to birthing units and post-natal services.

Midwifery Manager of the Birthrate Plus Project, Nursing and Midwifery Office of NSW Health Julie Mate says the tool provides a clear picture of staffing requirements for a service. It provides a retrospective assessment of all the events and factors arising in labour and birth using a score system based upon clinical indicators of the needs of women and their babies.

“Birthrate Plus will give managers of maternity services a tangible tool to help them staff their units appropriately. The tool will also identify problems in service planning and the deployment of midwives. There may be cases where Birthrate Plus shows there is correct staffing in a maternity service but midwives are still under pressure.”

This may be an indication that the distribution of midwives is a problem, she said, better planning and reorganisation of the service may be required in these cases and NSW Health would recommend to managers that planning needs to be examined.

Birthrate Plus has been operating very successfully in the UK for the past 25 years. It’s provided great data that allows very effective planning of services.

Agreement between the NSWNA and NSW Health followed a pilot project conducted in 20 hospitals to test the appropriateness of the Birthrate Plus tool in the NSW setting. The pilot project identified a number of facilities with serious staffing issues in maternity services.

“It’s taken some years to get there. However, we’re finally here,’ said Judith Kiejda. ‘I know a lot of midwives are frustrated by the delay but fine-tuning was needed after the pilot in 2008.”

• The Birthrate Plus pilot project determined that a ratio of 1:1, one midwife to one woman should be the minimum standard of care in maternity services.
  Julie Mate explained that this ratio increases as risks increase. “We have identified five categories of case mix from low risk to high risk. A woman’s case mix category carries right through from labour and birth to post-natal care. Staffing in these areas is based upon this case mix.”
• Management will be responsible for filling staffing shortages identified by Birthrate Plus, and to improve service planning through the deployment of midwives and improvements in skill mix. Vacancies due to sickness or annual leave should be replaced with midwives of the same classification.
• If management does not respond adequately to the identified staffing issues, members need to report it to the Reasonable Workloads Committee at their facility. The Reasonable Workloads process under the new award provides a robust process to address staffing issues.
• Birthrate Plus will be implemented progressively in most maternity services in NSW between now and July 2012. It will be introduced first at the hospitals that participated in trial.

In tomorrow’s blog post we will go into more details about how Birthrate Plus will be implemented in NSW Hopsitals.

Are you a midwife? How will Birthrate Plus effect you?

Don’t forget to subscribe to our weekly newsletter!

Fridays Nurse Uncut blog post on caesarean sections, natural births and NSW Governments’ policy to reduce the number of caesarean births received a number of comments on the Nurse Uncut Facebook page.

In Australia, the surgical birth rate is about 30 per cent, but the NSW government has pledged to reduce the number of caesareans to 20 per cent by 2015.

Spokeswoman for the Australian College of Midwives, and a practicing midwife for the past 21 years, Hannah Dahlen said some women need to have caesarean sections, but it should be women who really need them.

Comments from readers include:

“As a first time mother, you trust medical professionals to do what is best for mum and bub. Unfortunately they often put themselves and the risk of lawsuits first instead. The risks of caesareans need to be fully explained to a mother because it is in no way the ‘easy’ option – its major surgery! If mothers knew 100% of the complications I doubt the rate would be so high.”

“There is nothing risk free or natural about c/sections. Women aren’t making an informed choice about Caesars when their obstetrician lies to them telling them it is safer than vaginal birth. I’m not talking about medically indicated C/S”

“W.H.O recommends only a 10% caesar rate in developed countries. Quite a money spinner & time saver when you can knock over five Caesars by 12pm and still fit in a round of golf!”

“One problem I find is that we interfere with the natural process of labour and birth too much. For example I have found that it seems many inductions of labour which require amniotomies, syntocinon drips, epidurals etc often end up on the theatre table with ‘failure to progress in labour’ or ‘fetal distress’. We are often throwing interventions at women at every turn during labour rather than psychologically supporting and guiding them along as they labour.”

“I do realise that there are times when interventions are very necessary…where a labour is going pear shaped and you must intervene for the health and welfare of the mother and baby. I have seen that occur. But it seems so far that my experience has led me to believe that we interfere too much and are too quick to provide certain interventions on women who are progress in a normal healthy pregnancy, labour and delivery.”

We would like to hear your thoughts on this important topic!

Are too many caesareans being performed in Australia?

If the important thing is the well-being of mother and baby, does it matter? What issues need to be investigated?

Image credit:  bethykae via flickr.

Don’t forget to subscribe to our Nurse Uncut newsletter 

Slender Australian model Miranda Kerr gave birth to her 4.42-kilogram son Flynn drug-free; and actress Kelly Preston gave a drug-free, silent, birth to son Benjamin.

The Australian model and American actress are two of a number of high profile women who have spoken out about their natural birthing experiences in the past 12 months, challenging the stereotype that celebrities are NOT “too posh to push”.

Spokeswoman for the Australian College of Midwives, and a practicing midwife for the past 21 years, Hannah Dahlen was in the media recently saying the perception that celebrities favoured caesarean sections stemmed from the media attention given to stars such as Victoria Beckham, whose three sons were delivered that way.

Miranda Kerr has been praised for giving a realistic description of her birthing experience on her website saying “I gave birth to him naturally; without any pain medication and it was a long, arduous and difficult labour.”

In Australia, the surgical birth rate is about 30 per cent, but the NSW government has pledged to reduce the number of caesareans to 20 per cent by 2015.

“Some women need to have caesarean sections, but let’s make sure the women who have them really do need them,” Dahlen said.

She stressed that mothers shouldn’t “feel they are any less of a woman or mother as a result”.

Dahlen said managing fear was an important part of child birth.

Techniques learnt at calm birth, hypnobirthing and meditation classes could be useful to focus the mind. To aid the physical symptoms, she has seen good results from warm showers, massage and the use of bean bags and exercise balls to help the mother get into different positions.

“People have tried to get away from calling it painful; they’ve called it waves and surges, but its pain and its intense pain. However, it is normal pain, its pain with a purpose.”

Do you think it is right that NSW are aiming to reduce caesarean births? Or do you think the right thing is to let mothers choose for themselves how they want to deliver their baby?

In the end, is the most important thing the delivery of a healthy baby? Or are their other aspects that need to be investigated?

Image credit:  Amanda Sprogis

Don’t forget to subscribe to our Nurse Uncut newsletter 

Australia model and celebrity Miranda Kerr has hit the headlines once again, for a great cause.

The pregnant actress is fronting the campaign for Fight for Fistula, a birth complication which can spell death in developing countries.

The star is married to Orlando Blume and due to have her first baby early 2011

Fistula is caused when a woman endures a complicated, prolonged delivery without sufficient access to proper medical care.

“For the 3.5 million women suffering from Fistula the injuries leave them incontinent and in most cases their baby dies,” she says in her campaign.

Watch the video below.

The campaign, organised by Virgin’s not-for-profit arm Virgin Unite, co-incided with V2 Night B4 Halloween, a charity event on Richard Branson-owned Necker island which raised money for the Fight Against Fistula.

The model, who reportedly follows the Nichiren branch of Buddhism, is no stranger to public awareness campaigns. Her charitable work includes Wildlife Warriors Worldwide and Children International and last year Kerr posed naked, chained to a tree, for the Australian issue of Rolling Stone magazine, in order to attract public attention for protection of the koala’s natural habitat.

Find out more about the Fistula here.

Are you a midwife or nurse who works in maternity care? Is fistula an issue in Australia at all? What do you think of the campaign?

Image credit: hugo971

Make sure you’re updated with the latest on Nurse Uncut, subscribe to our FREE NEWSLETTER

The Australian Nursing Federation (ANF) says the federal government need to provide more incentives for nurses and midwives who move to regional, remote, and rural locations.

Doctors receive up to $120,000 to move and as much as $47,000 each year to remain, yet nurses and midwives are not provided with federal incentive packages at all.

A lot of the time, as we’re sure you know, nurses provide the bulk of the healthcare in regional and remote areas, but there is not the same level of support for them.

Some incentives are paid to nurses and midwives on a state by state basis but these are much lower than those paid to doctors.

ANF federal secretary, Lee Thomas, says rural Australians deserve the same healthcare options as everyone else and an incentives program would boost numbers of nurses in those communities.

“Why should someone in a regional or remote setting be forced to drive long distances or wait for weeks to see a GP when they could potentially have access to a highly experienced nurse or midwife?”

“We are calling on the federal government to support the nursing and midwifery (and) help boost access to healthcare by attracting more nurses.”

We would love to hear from nurses or midwives who work in rural areas.

Are you offered any incentives? If not, would it make a difference or do you love working in the community for other reasons.

Did you used to work in a rural area, would financial incentives have encouraged you to stay?

Join our latest contest: Are you our chattiest nurse? Get the chance to win a relaxing weekend at Port Stephens!

Make sure you’re updated with the latest on Nurse Uncut, subscribe to our FREE NEWSLETTER

This post was proudly brought to you by the NSW Nurses’ Association.

Yesterday’s blog post discussed how one of our readers, Susan, a third year Bachelor of Nursing student at the University of Newcastle was disappointed at the cancellation of its postgraduate Diploma of Midwifery.

Susan also raised concerns about the change in NSW Health barring 3rd year students from applying for student midwife positions.

“Had they been able to gain one of these, they could have continued their studies through another university. But no, once again bureaucratic red tape stands in their way.”

“What difference does it make if they are not registered at the time of interview? They will be RN’s at the beginning of employment,” she goes on to say.

“Students have asked for explanations, but been given no satisfactory answer. They are told that midwifery is moving away from nursing and should be considered a separate discipline, yet at the same time are also told they need to consolidate nursing skills first.

They are told to apply for New Graduate RN jobs, yet also told that they should step back and leave the limited New Grad jobs for those who actually want to be RNs.

So what are they to do? Sit on their bums and wait until next year when they can apply for student midwife positions?

Most of these students feel as if their whole career plan has crumbled before their eyes. Most students cannot possibly do the BMid, as they have families of their own, and simply cannot afford to do further unpaid clinical work – far more in fact than the BN’s clinical component,” she says.

We approached the University and Head of School for Nursing and Midwifery Dr Pamela van der Riet said they appreciated the changes in the course has impacted some students and they are “committed to working closely with them during the transition to the new arrangements.”

She said the reasons for the changes are, primarily, that the NSW Nurses and Midwives Board changed their accreditation standards for programs leading to registration as a midwife in ways that meant the Graduate Diploma could not be re-accredited after it ceased on 30 June 2010.

Students who were enrolled before that date could complete the Graduate Diploma of Midwifery, however no further students could be enrolled under that program.

“An external review of our midwifery programs also recommended that the University increase the number of midwifery graduates to meet workforce demand and that we cease the Graduate Diploma and replace it with a Bachelor of Midwifery from 2011.”

A registered nurse who qualifies for entry into the Bachelor of Midwifery will be offered credit for Bachelor of Midwifery courses that are deemed equivalent by the Program Convenor and the Nurses and Midwives Board.

“We have set up a number of forums and groups to keep students informed. We are conscious that these changes have impacted some students and we will continue to work closely with them as we move to the new arrangements,” Dr van der Riet went on to say.

Susan says the clinical component of the BMid would make it very difficult for anyone to work and do the course, which, after already doing the BN, is necessary for the financial wellbeing of these women and their families.

“The course is geared towards school leavers, and those with no other commitments, leaving mature aged women with families with little option to pursue their dreams.

In a shortage of midwives, should we not be encouraging these motivated women? It has been demonstrated over and over again that mature aged students do far better in nursing and midwifery related courses, yet why is it so discriminatory against them? In my own BN course, I would say that probably 80% of students who remain in third year are mature age.

This is not to say that young school leavers will be bad health professionals, far from it, but the figures speak for themselves.

These students are tired of being swept under the carpet and ignored.

They’ve busted a gut to get through the BN, as directed to do by their University, and all they want to do is go on to be midwives – why has it been made so difficult, by both the University who gladly took their money, and NSW Health who have just stuck their head in the sand.

I know plenty who are ready to just throw in the towel after all of this.”

What are your thoughts on the matter?

Share them with us below!

Image credit: evilpeacock

Join our latest contest: Are you our chattiest nurse? Get the chance to win a relaxing weekend at Port Stephens!

Make sure you’re updated with the latest on Nurse Uncut, subscribe to our FREE NEWSLETTER

This post was proudly brought to you by the NSW Nurses’ Association.

Susan, a third year Bachelor of Nursing student, emailed us about her concerns with the imposed changes in registration and training of midwives at the University of Newcastle.

Susan says the changes have left students, like her, who had intended to become midwives, out in the cold.

“The first issue came when the University cancelled its Post Graduate Diploma of Midwifery and replaced it with the new Bachelor of Midwifery. Not one student at the University was told of this change, and the University continued to advertise the course long after the decision had been made.

Students had been advised by the University that doing the BN followed by the Grad Dip was the way to become a midwife in Newcastle, and at no time were they ever told this was likely to change.

Students such as myself discovered quite by accident that the Grad Dip course had finished, usually from nurses we were buddied with while on placement. Other students were still asking throughout this year, as they too had no idea. One of our 3rd year modules even advertised the Post Graduate Diploma of Midwifery after its cancellation!

The other problem with this situation is that the new BMid does not have an RN entry program finalised, so graduating BN students are left without an option at their home university.

Yes, they can still apply to the BMid, but will have to do the full three years like everyone else, and apply for credit for subjects already done through the BN.

The students are incensed by this decision, which leaves them with a BN degree that they really don’t need, or want. They feel like they have wasted the last 3 years of their lives (or more, 5 years in my case), not to mention $12000 or more of HECS they have now accrued, all for nothing. For 6 years study, they could have been doctors!”

Understandable Susan is very concerned regarding the cancellation of the Post Graduate course; But she says what is worse is the change in NSW Health barring 3rd year students from applying for student midwife positions.

“Had they been able to gain one of these, they could have continued their studies through another university. But no, once again bureaucratic red tape stands in their way.”

We will have more on the barring of third year students in student nurse positions in tomorrows blog post – and a response from Newcastle University Head of School for Nursing and Midwifery Dr Pamela van der Riet as to why they made changes to the midwifery qualifications and the recommendations of an external review of their midwifery programs.

But for now, what are your thoughts?

Are you a student at the University of Newcastle that had been been working towards the Post Graduate Diploma of Midwifery? Have you had to reassess your plans?

Are you a midwife? Maybe you can offer some support or advice to Susan.

Image credit: jstownsley

Join our latest contest: Are you our chattiest nurse? Get the chance to win a relaxing weekend at Port Stephens!

Make sure you’re updated with the latest on Nurse Uncut, subscribe to our FREE NEWSLETTER

This post was proudly brought to you by the NSW Nurses’ Association.