pauline costins - juris doctor of law & acm (wa) vice president - the use of the wa homebirth...
DESCRIPTION
Pauline Costins Juris delivered the presentation at the 2014 Obstetric Malpractice Conference. The Obstetric Malpractice Conference is only national conference for the prevention, management and defense of obstetric negligence claims. For more information about the event, please visit: http://www.informa.com.au/obstetricmalpractice14TRANSCRIPT
![Page 1: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/1.jpg)
Homebirth Policy WA
Pauline Costins (Eligible Endorsed Midwife) RN: RM: Juris Doctor
1
![Page 2: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/2.jpg)
Discussion points
2
! Maternity services plan ! History of homebirth in WA ! Publicly funded Homebirth in WA ! Inclusion criteria & Exclusion criteria ! Decisions inconstant with the policy ! Referral pathways / Transfer to hospital ! Women’s right to choose and refuse ! Convention Elimination Discrimination Against Women
(CEDAW) – Human Rights ! Legal issues ! Case Study
![Page 3: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/3.jpg)
3
![Page 4: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/4.jpg)
Objective of the homebirth policy
4
! “working together across Western Australia. A Policy Framework is to improve care provision of pregnancy and in childbirth”
![Page 5: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/5.jpg)
Background
5
! 2008 – Review of homebirths in WA ! Highlighted that women have a right to choose a
maternity care option that suits them ! Develop systems that support safe and satisfying systems
of care ! Provide a diversity of options for women
![Page 6: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/6.jpg)
Definition
6
! This policy defines homebirth as “ a planned event where the woman chooses to give birth at home, with care provided by a midwife”
![Page 7: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/7.jpg)
WA Homebirths
7
! Approximately 200 women have a homebirth ! 0.06 – 0.8% of all births ! Transfers
! Pain relief ! Obstructed labour
![Page 8: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/8.jpg)
8 http://www.health.wa.gov.au/publications/documents/perinatal/WA_Mothers_Babies_2010.pdf
![Page 9: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/9.jpg)
Who provides homebirth
9
! Publicly funded by ! Community midwifery program (CMP) North Metropolitan
Area Health Service ! Midwifery Group Practice, Bunbury Hospital WA Country
Health Service (WACHS)
! Private fee paying home birth service ! Private / independent Practicing Midwives or ! Eligible / Endorsed midwives (Medicare Provider number)
![Page 10: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/10.jpg)
Who should have a homebirth?
10
! Inclusion Criteria ! Is over 18 ! Has the capacity to give informed consent ! Lives within a geographical boundary no further than 30 mins
from a maternity service ! Regular antenatal care from first trimester ! Booked into a homebirth program by 35 weeks of pregnancy ! A singleton pregnancy
![Page 11: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/11.jpg)
Inclusion criteria
11
! Cephalic presentation – 37 – 42 weeks ! Has current Ambulance Cover ! Suitable home environment
! Clean running water & electricity ! Vehicular access ! Hygienic sanitation ! Working phone
![Page 12: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/12.jpg)
Exclusion criteria
12
! Previous obstetric history ! Caesarean section ! Postpartum hemorrhage ! Shoulder dystocia ! Retained placenta requiring manual removal ! Perinatal death at term or a normally formed infant
![Page 13: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/13.jpg)
Exclusion criteria
13
! Medical history ! Pre-pregnancy BMI < 18 and > 35 ! Any significant medical condition ! Uncorrected female genital mutilation
! Social determinates of health ! Domestic violence ! Alcohol and or drug dependency
! Other considerations ! Will not accept blood and blood products ! Previous baby with GBS neonatal sepsis ! Newborn or child at risk of harm
![Page 14: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/14.jpg)
Care pathways for pregnancy and homebirth
14
! Antenatal Care ! Terms of Care agreements
! Three times during pregnancy ! At enrolment ! 28 weeks ! 36 weeks
![Page 15: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/15.jpg)
Terms of care - agreement
15
![Page 16: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/16.jpg)
Care pathway
16
! Intrapartum ! Two health professionals must be present for the birth ! Providing immediate support and clinical assistance in
emergency situations ! Collegial team spirit among midwives ! Improved documentation at births ! Safe working hours ! Consultation ! Attention and surveillance
![Page 17: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/17.jpg)
Care pathway
17
! Postnatal ! Care of the mother after birth ! Care of the baby after the birth
![Page 18: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/18.jpg)
A decision that is inconsistent – with this policy
18
! The woman has the right to rescind consent at any time and the decision made needs to be acknowledged and supported.
! Go through appendix 6 “In the course of labour or urgent situations when the steps for discontinuing care have not been undertaken or completed, as stated in this policy and the letter of withdrawal, the midwife may not refuse to attend the woman. Equally where a woman refuses emergency transfer of care in the course of active labour, the midwife must remain in attendance. Documentation of the ongoing consultation with the obstetrician/specialist throughout the labour and birth is essential.”
![Page 19: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/19.jpg)
Appendix 6
19
![Page 20: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/20.jpg)
Planned Hospital Care
20
! If the birth is planned to take place in the hospital maternity support. ! the obstetrician remains the primary care giver. ! The woman is to make her own way to hospital and meet their
midwife at the hospital. ! It is understood that the Homebirth Program midwife
will not attend the woman at home if the woman believes that she is in labour but will direct her, or her support person that the midwife will meet here at the hospital.
! Establish if an Ambulance is required and advise the woman or support person that one will be called for her if necessary.
![Page 21: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/21.jpg)
Consultation referral and transfer
21
! Risk factors ! Antenatal factors ! Intrapartum factors ! Postpartum factors
![Page 22: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/22.jpg)
Transfer to hospital
22
! Consent process ! How to transfer ! Urgent ambulance assistance ! Non-urgent ambulance assistance ! Private vehicle transfer
![Page 23: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/23.jpg)
Refusal to transfer
23
! Clinical situation has varied from normal ! The client must be referred to the Terms of Care
Document ! Consult with another midwife & share the information
with the client and support people ! Document ! Still declines
! Request second midwife ! Notify on-call hospital ! If an emergency situation is anticipated call an ambulance
![Page 24: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/24.jpg)
Roles
24
! Primary midwife ! Support midwife ! Doula ! Receiving hospital
![Page 25: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/25.jpg)
Professional and legal requirements - midwife
25
! Experience ! Competencies ! Continuing professional development ! Indemnity insurance ! Documentation and record keeping ! Reporting, evaluation and audit ! Clinical incident reporting
![Page 26: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/26.jpg)
Essential equipment for a homebirth
26
![Page 27: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/27.jpg)
Food for thought
27
! Autonomy v Paternalism ! Human Rights ! Convention of Elimination Discrimination Against Women
(CEDAW) ! Fetal rights v Maternal rights ! Consent v Cohesion ! Language of Fear
![Page 28: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/28.jpg)
Legal issues
woman midwife
28
! Consent v Cohesion ! Language used – fear
based ! Right to refuse treatment ! ‘born alive rule’ ! Contributory negligence
! Scope of practice ! Competence ! Ethics ! Collaborative care ! Criminal code – s290 ! Negligence
![Page 29: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/29.jpg)
Human Rights and CEDAW
29
! Right to privacy ! Freedom from discrimination ! Article 2: Country duties (CEDAW) ! Article 3: Equity (CEDAW)
![Page 30: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/30.jpg)
Case study 1
30
! Normal pregnancy ! Booked for a homebirth with private midwife ! No Medicare ! Collaboration with tertiary hospital ! Booked back up hospital at 20 weeks ! ? Small for dates at 30 weeks refer to hospital post ultra-sound
scan for review and plan ! Individualised Growth chart – within normal limits ! Progress as normal ! Labour commenced ! Problem second stage ! Progressed to birth
![Page 31: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/31.jpg)
Case study 2
31
! Booked with private midwife for hospital birth continuity of midwifery care.
! Previous large baby 4.2kg, shoulder dystocia and 2litre hemorrhage.
! Booked at local hospital ! Required tertiary hospital care ! Client refused care of tertiary hospital ! Negotiations ! Terminated contract with private midwife ! Free-birthed
![Page 32: Pauline Costins - Juris Doctor of Law & ACM (WA) Vice President - The use of the WA Homebirth Policy as a guidance for Privately Practicing Midwives & Consumers](https://reader033.vdocuments.mx/reader033/viewer/2022060116/558431e5d8b42ac0658b51e1/html5/thumbnails/32.jpg)
References
32
! Women's and Newborns Health Network – Policy for Publicly funded homebirths including Guidance for Consumers, Health Professionals and Health Services (Revised October 2013). Government of WA Dept of Health 2013.
! Preparing for the First Birth: Mothers’ Experiences at Home and in Hospital in Australia. Hannah G. Dahlen, PhD, RN, RM, BN (Hons), M(CommN). Lesley M. Barclay, RN, RM, BA, MEd, PhD. Caroline Homer, RM, PhD. J Perinat Educ. 2008 Fall; 17(4): 21–32.
! Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. Christine Catling-Paull, Rebecca L Coddington, Maralyn J Foureur and Caroline S E Homer, on behalf of the Birthplace in Australia Study and the National Publicly-funded Homebirth Consortium. Med J Aust 2013; 198 (11): 616-620.
! http://www.health.wa.gov.au/publications/documents/perinatal/WA_Mothers_Babies_2010.pdf