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Cecile's Comment 
						
				
				
						The Marion Davis Library in Auckland was the venue recently of a meeting attended by approximately 70 midwives. The meeting was the result of several earlier gatherings held to discuss issues of concern regarding midwifery practice in NZ. A number of midwives have asked me for a summary of the items discussed, so I will attempt to give one on these pages.
				
				
						Prior to the meeting, a list of the midwives’ concerns from the earlier sessions 
						was circulated, so that people were updated on previous discussions. I was 
						disappointed that the only two areas of concern itemized were recertification 
						and the review process. Participants were able to voice their 
						concerns – but only on those two topics – to a panel 
						representing NZCOM and the Midwifery Council.
				
				
						The following issues were discussed:
				
		
		
				
						1. Practice across the Scope requirement 
						Concerns 
				
		
		
				‐ 
				seen as being unreasonably burdensome and often 
		
		unworkable; difficult to rotate staff; midwives not wanting to 
		work in certain areas because they felt unsafe; how can, say, one episode over 
		3 years maintain competence? Difficult for part 
		
				‐ 
				time / older midwives to 
		
		comply. Midwives are leaving because of this. 
		
				Response: 
		
		Council is currently reviewing the Recertification programme as the 
		first 3 years are up in March. Feedback 3 years ago was that this was how 
		midwives were perceived, both by themselves and by consumers. 
		Practising across the scope requirement need not be time 
		
				‐ 
				consuming – just  
		
		involves a bit of time to update yourself. The numbers of midwives have 
		remained roughly the same over the last 3 years at around 2500; there is no 
		evidence yet that significant numbers are leaving. (Editor’s note: With new 
		
				graduates entering the workforce, numbers should have been increasing, not 
				remaining static)
		
		
				Midwives were urged to contribute to the current review. It was stressed that 
				Council desired to keep midwives in practice.
		
		
				
						2. Allocation of Points for recertification 
				
		
		
				Concerns 
		
		
				‐ 
				Current allocation is arbitrary, appears unreasonable at times,  
		
		does not always reflect time & effort spent. e.g. 5 points for a 3 
		‐ day 
		conference; 10 points for some single study days. 
		
				Response: 
		
		Council invites written requests for points. More points are 
		allocated if accompanied by a written reflection. (5 points can become 10 
		points with a reflection) A paragraph is all that is needed. Send in your special 
		request. Conferences include a lot of socializing! Therefore they attract fewer 
		points.
		
				
						3. Why can’t midwives identify their own learning needs and be treated like 
						the autonomous practitioners they are? 
						Response: 
				
		
		Midwives themselves wanted to be told what to do; they asked 
		Council for a structured programme
		
				. 
				(Editor’s note: I don’t remember being asked – do you?)
				
						4. Review Process 
				
		
		Concerns raised re being reviewed by people unfamiliar with 
		the area the midwife works in. 
		
				Response: 
		
		This is not always possible to avoid, because of lack 
		of availability of reviewers: But the midwife can overcome this 
		problem by presenting herself to the reviewers and explaining 
		her work environment. This is her review! Midwives were 
		invited to put their names forward to be reviewers. Overall, the 
		panel stated that MSR feedback was positive. Send them your 
		thoughts! 
		
				
						Judith then posed a question for consideration:
				
		
		
				
						5. Is the MW Recertification programme harder than that of other health 
						professionals?
				
				 
				Response (from Judith’s own research) 
				No– the only programme that is easier  is the nurses’ programme.The cost is also not greater – again, with the exception of nurses. (Editor’s note: Has anyone else researched this?)
		
				Members were reminded that the Health Practitioners Competence Assurance Act (HPCAA) is now up for review. You can make submissions NOW, if you want anything changed.
		
				There was further discussion about process having become draconian –
				midwives want more of a say; the process should be more facilitative;
				midwives should define the value of their study.
				It was pleasing that the DHBs were providing more educational opportunities  for midwives.
		
				
						6. Length & Frequency of Reviews 
				
		
		- Annual MSR excessively burdensome & time ‐ consuming for LMC midwives; 
		‐ 
		even more difficult (and costly) for those with smaller caseloads. 
		
				Response: 
		
		Council is more than delighted to have a look at this. It’s been quite
		difficult to manage. Council would like to go on to a different cycle.  - If review panel authorizes, e.g., a 2 ‐ 3 year review to areviewee, Council endorses this. This is already happening, withpositive results.Members were reminded that three years ago, things were verygrim for midwives. The public wanted us to activelydemonstrate our competence.  NZCOM/MCNZ want a more manageable process – but alsowant to reassure the public that they can have confidence in us.7. Whose responsibility is it to monitor outcomes of MW reviews & practice?  Does MSR have a monitoring role?Response: It was agreed that the roles of NZCOM & Council sometimes getconfused. The Council is the regulatory body; and while MSR is not the core business of NZCOM, it is a monitoring process. However there has never beena punitive result originating from a review. NZCOM can only recommend can’tsay “You must”. ‐ If we really value autonomy then we must have selfregulation. Autonomy vs Accountability: Autonomy comes at a price. ‐It means I can give a rationale for what I do. ‐ NZCOM is YOU – it’s All of us. Autonomy also involves participation. Stats are only a part of MSR. ‐ Most consumer feedback is enormously positive.  - Most MW’s face the challenge, and challenge back. Midwife Shortage in Auckland – MW’s want acknowledgement from NZCOM & Council. Concerns ‐ MW’s aged 50 years+ have given/are giving up because“it’s just become too hard.” We have lost valuable midwives as a result. Response: Write to council re your individual situation. Remember Council is seeking input from members NOW. Council wants MW’s to be able to keep working.Final word from Council: Council wants to set up a programme that 1) ensures competency and 2) works for midwives They look forward to receiving your feedback AND a word from a Consumer at the meeting…Sees lots of tired, stressed midwives! Advises midwives make MSR preparation as simple as possible MSR tries to meet midwives halfway – but some of us are apparently quite frightening! “The women of NZ deserve you all. Just move on.” Editor’s Additional Notes: It was regrettable that, due to time constraints, so many issues of concern were not dealt with. e.g., The frustrations of the Section 88 Notice; the Partnership Model (which one highly esteemed midwife has labelled “The sacred cow of midwifery”); the problem of bullying in all levels of the profession; concerns about midwifery education the whole midwifery infrastructure. Midwives – and New Zealanders – tend to allow things to happen to them because of apathy, or because “I’m just not a political person”.We have been invited to make our views known, and we must all do so now.Cecile O’Driscoll