Hospital visiting access for independent midwives

Joy Johnston, FACM IBCLC

March 2000

This is another story from my practice, to illustrate the urgent need for access of independent midwives and our clients to public hospitals. It is appropriate that midwives provide primary care, and that every pregnant woman has access to emergency obstetric services. When a woman needs the secondary level of specialist care it is only reasonable that her known midwife continues with her through what can be a daunting and distressing sequence of events.

My client had experienced a small and painless bleed vaginally at 35 weeks, in her first pregnancy. I am her midwife, and the plan had been for homebirth. I listened to the baby, and heard a steady and healthy heartbeat. I wondered what was happening. The bleeding had happened only briefly, and had stopped. Did she have a placenta previa, or was labour about to start?

The woman and her partner were happy to go from my office to the hospital. I wrote a note to the doctor, photocopied the early pregnancy blood test reports, and phoned to let the hospital know my client was on her way. It seemed important to the three of us that a specialist assessment be made.

Upon arrival at the hospital the cardio-tocograph monitor was used, and after 20 minutes of perfect trace the monitor straps were removed. Then, without any warning, there was another, larger bleed. The baby’s heartbeat could not be detected. Ultrasound confirmed that the baby had died.

The obstetric Registrar called me, giving me what information he could. The staff at the hospital did all they could to support the young couple through their sadness. There was no-one to blame. Even the choice to plan homebirth, which has been described as ‘suboptimal’ care by those who oppose independent midwifery, could not be given as a contributing factor in the death of this baby.

This tragedy could not have been predicted. Had there been any means of acting to save this little life, it would have been done. The bleeding had come from a vessel in the membranes (vasa previa) which burst. The blood on the sheets was the baby’s lifeblood.

This account illustrates a good working relationship that exists between the hospital, which is a tertiary referral centre, and independent midwives working in Melbourne’s Eastern suburbs. We can provide safe and appropriate midwifery services because we can access expert specialist services at all times, usually without fear of criticism or punitive action. The next step, by which the independent midwife can be officially recognised to practice midwifery within the hospital, should not be a major hurdle. Visiting access, clinical privileges, practising rights, or whatever else it is called should not be difficult to achieve. The woman who wants a BYO midwife is the one who is disadvantaged by the refusal of hospitals to grant visiting access to midwives. That woman is being told that she is not allowed to have control over who is with her, who touches her, and with whom she shares some of the most intimate moments of her life.