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The accreditation of independently practising midwives a brief history
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
THE A C C R E D I T A T I O N OF I N D E P E N D E N T L Y P R A C T I S I N G M I D W I V E S A BRIEF HISTORY J u d i B r o w n - - Registar
The accreditation process for Independently Practising Midwives began in 1986-87 w h e n in Australia and particularly in the Eastern States there was an increasing focus o n which was termed "alternative maternity practices". The National Health and Medical Research Council, was, at that time, developing a report o n Home Birth and the New South Wales (NSW) government was instigating a review of birthing services in that State. The Australian College o f Midwives was asked to consider developing strategies for the accreditation of independent practice by Ursula Bayliss, w h o was at that time employed by the NSW Department of Health. It was understood by the then ACMI Executive Committee that this was an 'official' request from a government department. In an attempt to support Independent Practitioners, ACMI agreed to develop guidelines and the NSW Midwives Association began the initial consultation. A document containing criteria for accreditation was subsequently developed and c o m m e n t s were sought from all State and Territory Branches. I am told however, that the response was disappointing, with little interest being shown. Progress continued to be slow and the draft guidelines were re-examined in Sydney in late 1988 at a meeting of the ACMI Executive Committee. In 1989 a final draft d o c u m e n t was agreed and I believe that this followed extensive input from Independently Practising Midwives in all States. I was present at a meeting in South Australia for example, that was called by the then Branch Executive, w h i c h i n c l u d e d a l m o s t all the Independently Practising Midwives in Adelaide. Together, we examined the guidelines and made c o m m e n t to the ACMI Executive Committee. At a meeting in Sydney later that year, the South Australian Branch was invited to set up the Registrars' Panel and as the South Australian Delegate I was appointed as the Inaugural Registrar. DECEMBER 1994
From there began a period that was, although difficult at times, of immense importance and satisfaction to me personally. I came to k n o w the majority of IPMs from all over Australia and I was impressed by their enterprise, energy, and attention to detail as w e l l as their c o m m i t m e n t to the w o m e n and families in their care. One of the first undertakings for the Panel was to conduct a national mailout to over 200 hospitals and health agencies, with the information that ACMI had undertaken the accreditation of IPMs. It was stated in the correspondence that ACMI believed that accreditation: 9 provided a public recognition by peers of an achieved standard of clinical expertise 9 recognised a valid sphere of practice in Australia 9 provided a professional award which can be used as a basis to verify the maintenance of a high standard of practice, for potential clients, for hospital accreditation and for claiming medical rebates. 9 provided a demonstration of a continuing update of knowledge and skills within midwifery practice. The response to this initiative was tremendous. The panel received over one h u n d r e d formal inquiries f r o m Directors o f Nursing, Administrators, Universities, Government Departments and IPMs themselves. In requesting more information, m a n y individuals congratulated the College for taking the initiative and developing such a process. Accreditation was up and runnning and although there were some very real concerns held by a n u m b e r of IPMs many applied for accreditation. As hospitals and health agencies began to offer visiting rights to midwives, many of those institutions were requesting accreditation to ACMI as part of their o w n criteria. It was a busy time for the panel in not only processing the n u m e r o u s applications but in attempting to deal with the fears of some IPMs that their freedom of practice would be in some way ACMIJOURNAL
PAGE 5
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
discriminated by accreditation and that a panel w h o had no IPM representation could not provide a correct and fair system of assessment. T h r o u g h o u t this time members of the Panel made every effort to be sympathetic and supportive and were genuinely c o n c e r n e d that the process of accreditation be a positive move for the profession. Over the past few years, as I have c o m e to k n o w many of the IPMs personally, I have found them to be on the whole very forthright and assertive individuals. If the process of accreditation was not to their liking or was perceived as slow or inefficient then they told us so. A n u m b e r of practitioners also wrote to say thankyou and to tell us of progress made in obtaining visiting rights to particular hospitals. This news was pleasing and encouraged the panel to continue the work that they saw as their o w n personal contribution to their College. Feedback received from IPMs nationally has resulted in a n u m b e r of changes being made, particularly over the last 18 months. The criteria have been reevaluated and n o w include more emphasis on continuing education and peer review. The panel has been enlarged to include membership of two IPMs and a consumer. A new application form, designed by a South Australian IPM is to he implemented. This form will prove we believe to be more 'user friendly' and allow the process to be less time-consuming for IPMs and the Panel alike. In order to meet the expressed needs of IPMs w h o have difficulty accessing continuing education, particularly for such skills as perineal suturing, ACMI has used a grant from the Federal Government to develop discrete distance education modules, in
partnership with the Southern Cross University. These modules include: 9 9 9 9 9
Perineal Suturing Neonatal Assessment Maternal Assessment Childbirth Education and Parenting The Midwife as the Primary Care Provider and Advocate.
Additionally all State Branches have been requested to consider the needs of IPMs w h e n planning their education programs. The importance of supporting research by IPMs has also been demonstrated by ACMI. Several IPMs have been awarded research grants through the Australian Midwifery Scholarship Foundation. Many IPMs are n o w applying for re-accreditation and a n u m b e r of midwives w h o have been apprentices to midwives in established private practice are n o w applying for their o w n accreditation. I n d e p e n d e n t Midwifery Practice in Australia has never been an easy road to take. There are still many obstacles to be overcome, which include indemnity insurance and medicare rebates. The College continues to push for public and government recognition of the work that midwives already do in this country and the fact that midwives can provide further options in maternity care that w o m e n and their families want and need. I believe that the Accreditation process has been and will continue to be a positive initiative for Independently Practising Midwives and for the College.
F E L L O W S H I P TO A.C.M.I. The National Executive Committee is seeking expressions of interest from members w h o may be interested in applying for Fellowship. Information and application forms may be obtained from: The Executive Officer AUSTRALIANCOLLEGE OF MIDWIVES INCORPORATED Suite 23,431 St Kilda Road, Melbourne, Victoria 3004
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ACMIJOURNAL
DECEMBER 1994
THE A C C R E D I T A T I O N OF I N D E P E N D E N T L Y P R A C T I S I N G M I D W I V E S A BRIEF HISTORY J u d i B r o w n - - Registar
The accreditation process for Independently Practising Midwives began in 1986-87 w h e n in Australia and particularly in the Eastern States there was an increasing focus o n which was termed "alternative maternity practices". The National Health and Medical Research Council, was, at that time, developing a report o n Home Birth and the New South Wales (NSW) government was instigating a review of birthing services in that State. The Australian College o f Midwives was asked to consider developing strategies for the accreditation of independent practice by Ursula Bayliss, w h o was at that time employed by the NSW Department of Health. It was understood by the then ACMI Executive Committee that this was an 'official' request from a government department. In an attempt to support Independent Practitioners, ACMI agreed to develop guidelines and the NSW Midwives Association began the initial consultation. A document containing criteria for accreditation was subsequently developed and c o m m e n t s were sought from all State and Territory Branches. I am told however, that the response was disappointing, with little interest being shown. Progress continued to be slow and the draft guidelines were re-examined in Sydney in late 1988 at a meeting of the ACMI Executive Committee. In 1989 a final draft d o c u m e n t was agreed and I believe that this followed extensive input from Independently Practising Midwives in all States. I was present at a meeting in South Australia for example, that was called by the then Branch Executive, w h i c h i n c l u d e d a l m o s t all the Independently Practising Midwives in Adelaide. Together, we examined the guidelines and made c o m m e n t to the ACMI Executive Committee. At a meeting in Sydney later that year, the South Australian Branch was invited to set up the Registrars' Panel and as the South Australian Delegate I was appointed as the Inaugural Registrar. DECEMBER 1994
From there began a period that was, although difficult at times, of immense importance and satisfaction to me personally. I came to k n o w the majority of IPMs from all over Australia and I was impressed by their enterprise, energy, and attention to detail as w e l l as their c o m m i t m e n t to the w o m e n and families in their care. One of the first undertakings for the Panel was to conduct a national mailout to over 200 hospitals and health agencies, with the information that ACMI had undertaken the accreditation of IPMs. It was stated in the correspondence that ACMI believed that accreditation: 9 provided a public recognition by peers of an achieved standard of clinical expertise 9 recognised a valid sphere of practice in Australia 9 provided a professional award which can be used as a basis to verify the maintenance of a high standard of practice, for potential clients, for hospital accreditation and for claiming medical rebates. 9 provided a demonstration of a continuing update of knowledge and skills within midwifery practice. The response to this initiative was tremendous. The panel received over one h u n d r e d formal inquiries f r o m Directors o f Nursing, Administrators, Universities, Government Departments and IPMs themselves. In requesting more information, m a n y individuals congratulated the College for taking the initiative and developing such a process. Accreditation was up and runnning and although there were some very real concerns held by a n u m b e r of IPMs many applied for accreditation. As hospitals and health agencies began to offer visiting rights to midwives, many of those institutions were requesting accreditation to ACMI as part of their o w n criteria. It was a busy time for the panel in not only processing the n u m e r o u s applications but in attempting to deal with the fears of some IPMs that their freedom of practice would be in some way ACMIJOURNAL
PAGE 5
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
discriminated by accreditation and that a panel w h o had no IPM representation could not provide a correct and fair system of assessment. T h r o u g h o u t this time members of the Panel made every effort to be sympathetic and supportive and were genuinely c o n c e r n e d that the process of accreditation be a positive move for the profession. Over the past few years, as I have c o m e to k n o w many of the IPMs personally, I have found them to be on the whole very forthright and assertive individuals. If the process of accreditation was not to their liking or was perceived as slow or inefficient then they told us so. A n u m b e r of practitioners also wrote to say thankyou and to tell us of progress made in obtaining visiting rights to particular hospitals. This news was pleasing and encouraged the panel to continue the work that they saw as their o w n personal contribution to their College. Feedback received from IPMs nationally has resulted in a n u m b e r of changes being made, particularly over the last 18 months. The criteria have been reevaluated and n o w include more emphasis on continuing education and peer review. The panel has been enlarged to include membership of two IPMs and a consumer. A new application form, designed by a South Australian IPM is to he implemented. This form will prove we believe to be more 'user friendly' and allow the process to be less time-consuming for IPMs and the Panel alike. In order to meet the expressed needs of IPMs w h o have difficulty accessing continuing education, particularly for such skills as perineal suturing, ACMI has used a grant from the Federal Government to develop discrete distance education modules, in
partnership with the Southern Cross University. These modules include: 9 9 9 9 9
Perineal Suturing Neonatal Assessment Maternal Assessment Childbirth Education and Parenting The Midwife as the Primary Care Provider and Advocate.
Additionally all State Branches have been requested to consider the needs of IPMs w h e n planning their education programs. The importance of supporting research by IPMs has also been demonstrated by ACMI. Several IPMs have been awarded research grants through the Australian Midwifery Scholarship Foundation. Many IPMs are n o w applying for re-accreditation and a n u m b e r of midwives w h o have been apprentices to midwives in established private practice are n o w applying for their o w n accreditation. I n d e p e n d e n t Midwifery Practice in Australia has never been an easy road to take. There are still many obstacles to be overcome, which include indemnity insurance and medicare rebates. The College continues to push for public and government recognition of the work that midwives already do in this country and the fact that midwives can provide further options in maternity care that w o m e n and their families want and need. I believe that the Accreditation process has been and will continue to be a positive initiative for Independently Practising Midwives and for the College.
F E L L O W S H I P TO A.C.M.I. The National Executive Committee is seeking expressions of interest from members w h o may be interested in applying for Fellowship. Information and application forms may be obtained from: The Executive Officer AUSTRALIANCOLLEGE OF MIDWIVES INCORPORATED Suite 23,431 St Kilda Road, Melbourne, Victoria 3004
PAGE 6
ACMIJOURNAL
DECEMBER 1994