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Consultation into National Framework for Maternity Services

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The 2010-2015 National Maternity Service Plan has now expired and the Maternity Care Policy Working Group has been established by the Government to develop a National Framework for Maternity Services (NFMS).


A consultation is underway into the development of an enduring NFMS. This review will affect the way maternity care is provided, and will affect you in the long term. Please take part in the survey so midwives' voices are heard. 


ACM wants to see this become a national plan, with accountability for actions and timelines, delivering values of equality, respect and kindness, and which considers cultural safety and addresses racism. We want to see nationally endorsed evidence-based guidelines. 

We would like to see that the Vision of the Framework includes key values that drive the principles, such as kindness, respect, trust, dignity, cultural appropriateness etc. 

One of our concerns is that the Government plans to change the national Plan to a national Framework, and mandate the states and territories to develop their own plans. In other words, the national Framework will provide a vision and principles, but it will be down to each individual state and territory to decide what to incorporate into their plan; timelines, outcomes and evaluation. This is very concerning because this will lead to further variation and fragmentation of maternity services around the country; lack of consistency in the implementation of evidence-based guidelines; difference in identified outcomes, targets and timeframes; potential difficulties in transparency, accountability and reporting.

Therefore, we would like you to lobby for the continuation of a national Plan which will articulate national objectives and targets, time lines, measurements, accountability and reporting. Or that the Framework includes nationally agreed actions and outcomes, and a commitment to the use of nationally-endorsed evidence-based, women-focused guidelines.  


We would urge you to complete the survey because your contribution is important to make sure that the principles, values and models that we hold dear as midwives, midwifery students and consumers are incorporated into the Framework.

We have drafted some suggested answers that you are very welcome to base your answers on:

What do you think the purpose and function of a National Framework for Maternity Services is?

  • To articulate the principles and vision for the maternity services in Australia. 
  • However, a Framework lacks the direction and details that Plan contains ie clear direction about responsibilities, accountability, reporting and measurable outcome achievement.
  • A national Framework will require locally developed Plans that implement the Framework. 
  • This leads to re-invention of the wheel around all the states and territories which is far more expensive and time-consuming than one nationally developed Plan.  
  • Will lead to further fragmentation and inconsistencies in how maternity services are delivered, and guidelines are applied.
  •  I support the development of a National Plan that contains: nationally agreed actions and measurable and reportable outcomes, as well as a nationally endorsed evidence-based, women-focused guidelines for practice.

How would such a framework benefit women across Australia?

A national framework or plan will only benefit women if it:

  • is women-focused, recognising women’s needs and individual requirements; 
  • is developed and implemented in partnership with women;
  • is respectful of women and supporting the respectful provision of care based on informed choice, consent and refusal;
  • emphases the necessity of evidence-based care;
  • promotes access to midwifery care for all women, preferably with a named midwife;
  •  promotes culturally appropriate care, based on ‘birthing on country’ principles for Aboriginal and Torres Strait Islander women. 

A number of opportunities have been identified regarding maternity services in Australia which could make an impact on the experience of consumers. Please rank these opportunities in order of the degree of impact these could have on the consumer if realised: 
(Please drag and drop into your order of degree of impact)

 
Ensuring equity of health outcomes, access to services and cultural responsive services are all very important opportunities. 
The following are being considered as components that may be included in a NFMS. Please rank these components highest priority to lowest priority.

(Please drag and drop into your order of priority)
 
National agreed outcome measures and performance measures are very important to include as they drive the planning and implementation of services; provides a framework against which outcomes may be reported, which in turns makes healthcare services accountable for their performance. 


What is your vision for a National Framework for Maternity Services?


Vision should include values on which maternity services should be built including kindness, respect, trust, cultural respect, dignity etc. 

What are the principles that should underpin a National Framework for Maternity Services?

  • All women should have access to midwife-led, public and private continuity of care which is gold standard model of care, demonstrated to greatly improve many health outcomes related to both woman and baby.
  • Health services should be accountable for their failure to implement midwife-led, public and private continuity of care models.
  • Agreements that facilitate admission rights and collaboration for eligible midwives should be fully implemented and consistent with clinical privileges for medical practitioners. 
  • Health services should be made accountable when eligible midwives are unable to gain access to collaborative agreements.
  • Midwives able to practice to their full scope of practice which includes employed midwives able to order investigations and prescribe appropriate medications. 
  • Early career midwives are supported to transition directly into continuity of midwifery models of care. This is a recruitment and retention initiative as graduating midwives wish to work in this way and leave with the dissatisfaction of fragmented models. It is also an ongoing way to grow continuity models of care as more midwives are transitioned into this way of working.
  • Homebirth models of care provisioned so that women have the choice of birthing at home.
  • Insurance solution found for private midwives so that they can offer the choice of birth at home.
  • Access to hospitals when appropriate for private midwives in situations of transfer from birth at home, in order for safe, quality care to be provided. 
  • Central point for both provisioning and measuring care for vulnerable women, rather than piecemeal and unmeasurable approach which is currently in place. 
  • Access to maternity services in rural and remote areas close to home as limited maternity care is still much safer than no maternity care in rural and remote settings.
  • Commitment to Primary Level Maternity Services and midwife-led units for low risk women.
  • Birthing on country programs for Aboriginal and Torres Strait Islander mothers are established and evaluated. 
  • Increased number of Aboriginal and Torres Strait Islander people in the maternity workforce across all disciplines and qualifications.
  • All training, education and ongoing professional development includes a cultural competence/safety component – all staff to under cultural safety training education. 
  • Zero tolerance to racist behaviour and attitudes to staff, women and families. 
  • Measures taken at both pre-registration and post-registration level to support health professionals including midwives to work in rural and remote areas.
  • Models of care in rural and remote areas should be implemented that support the employment of early career midwives, as well as registered midwives who do not have nurse registration.
  • Midwifery is recognised as a distinct profession.
  • Development of a national workforce plan which measures national maternity and midwifery workforce.
  • Funding provided to progress national maternal and perinatal mortality and morbidity reports.
  • Standardised information shared nationally with child and family health.
  •  Midwives to be registered as authorised users of the MyHealth record system.
  • National program for screening for domestic violence, along with education and tools for midwives and all health professionals. 

The World Health Organization defines a risk factor as: “any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury”. Do you think this definition is relevant and all-inclusive when pertaining to antenatal health risk factors?

No. 

Pregnancy and birth is neither a disease or injury therefore, risk factors must be defined in the context of, for the most part, a healthy woman undergoing a normal life event, not using the lens of sickness.