 I just want to welcome everyone, all the midwives across the world and student midwives that are listening at the moment. Let me know if you can't hear Dan and myself throughout the presentation but we'll try our best as two of us here giving a presentation so we'll try our best for you to be able to hear both of us. I'll pass over to Dan. Hi everyone, happy International Midwives Day. I've just completely smelling a life-long cavity sting. I've had a baby at 10 past 11 and it's about 12 o'clock now I think so flashing the desk here for this important time to cheer with other midwives. So first we'd just like to acknowledge the students National Midwives Day and we're pretty excited here at Mama. We're having a celebration right after this this afternoon so we'll have a great celebration this afternoon for all the midwives across the world. We just wanted to give you a little bit of background to start with. I'm Dan and myself and here we are and where we came from. So I'm only younger than two in the photo and my name is Kelly Langston and I've been a midwife for 60 years now and I started my journey training through Bachelor of Midwifery and Nursing combined and then I did two years in a public hospital and then I was mentored out into private practice by Dan and another midwife and a year and a half ago we started a practice together called Mama. So that's a little bit about me and I'll pass on to Dan for a bit about her. Well I'm an old one of course and I've been around Melbourne for ever. I started at the Queen Victoria Hospital which is no longer there and I'm a monastic girl. My daughter's a midwife and they're monastic girls and that's very nice. I'm at Kelly and I was there as a midwife so the way and knew that we should make a practice together and we have and we've made a first visit to the clinic really in Victoria both. It's been quite interesting but that's me and I'm going to work here until it succeeds. I got there so we'll just go to the next slide for you. Here we go. So that's who we are and where we came from and how we got here. There's just a little bit of background about where we come from or where we're practicing in. We're in Australia right down the bottom in Victoria and as you can see there's all these statistics but in 2009 from 72,400 births in Victoria majority of them were planned public hospital birth, 57% and then 30% planned private hospital birth. We don't have many birth centres left in Victoria so that centre is not there but there's a very small centre as well and only 284 women were planned planned birth and there's only a couple of small group practises in Victoria who practised planned birth. The physical care options for women in Victoria are midwife in public hospitals, medical care in public hospitals, one-to-one registry in public hospitals and shared care in DPs birth in public hospitals. Shared care was midwife birth in a public hospital. The shared care actually isn't really clear there because it's as a native care only, not post-native care and not birth. Private obstetricians in private hospitals, we can't get into private hospitals only to support people. Private obstetricians in public hospitals that's actually a big conundrum in Victoria or in Melbourne at the moment are very hard for private practitioners, obstetricians included to get access to the public births. It's a big problem. I think there's five in most of our big hospitals. Care in public hospitals support from private midwives. Is this about that? So as midwives, there's about eight of us and we do all these models of care and probably people who've been come to know us, been known to people, have heard those midwives. We try very hard not to wear their hats. We try to wear the hat of the midwife number one and to sort of make a model of care based on a well-deserved or partnership approach to her family, the community, etc. needs. So when we started out, the event said to start a midwifery centre. It was one of the reasons that we started was because in Australia in 2010 we got access to Medicare leave aid, which meant that midwifery care was a lot more accessible to women and families across Australia. So we jumped on board pretty quickly and then I was one of the first, or two of the first midwives to get Medicare in Victoria. So we were a pretty team. And then we started on the day to find a midwifery centre that was essentially located and big enough for the family. We started looking for a cottage with exterior and leg-like wedges and sort of a beautiful little path leading up to a beautiful door that open with a stone and fillet. Instead we started with a big, ugly building. But the really big ugly building that we found turned out to be quite practical for us. So we went and we went along with it and got a whole lot of our clients and friends and family down for a few weeks on the road and knocked down some walls and put up some other walls and painted this huge ten room centre that we're now in. It's a property that we're leasing from the council so the price suits us as well. So once we found the plan, we really needed to go about getting everything in place to get some other midwives working with us. So we started to get other midwives what we call eligible. So that's getting them ready for practicing with Medicare. What you can see there under the headings of Medicare, NPR is the midwifery practice review. It's the way that we can review our practice with the Australian College of Midwives. And insurance is another essential for a part of practitioner. We also needed to establish some strong relationships with DC obstetricians and obstetricians in setting up the centre because as part of women accessing Medicare rebates, they need to have an arrangement. We need to have an arrangement with a doctor for that woman's care for them to be able to access the rebates. So that's been a big part of setting up the centre as well as establishing the relationships. And then of course we needed women and clients. We've been out there in the community telling women who we are and who midwives are and what we can do for them. And in the last couple of years it's women are really testing on what midwives can do for them at the base. One of the reasons we chose Queensland in Melbourne was because it was inner city and it was needed to be hospital. And we also were pretty keen on helping the women from the Horn of Africa in the flat, the Housing Commission flat, which there's a few of them here. Thank you, we already had one Housing Commission home this time, but that was actually fabulous and we're definitely going there for more. We just posted signs up in the flat in what's the name? In Somali to say, come and meet us over at Mama. We want to see when you have your babies. So we hope that's going to take off. Kelly has done a great job with seeing people eligible to become eligible midwives and I think I've brought a big client base over here. Now our client base this year is mainly from around Australia, which is fantastic. We'll go on to the next slide. There we go. Someone doesn't want to watch it. I had a picture of our fence and we've got a banner up here with all the alternatives and services on it and we spent a lot of time using our friends to get the signage right and we're pretty proud of the signage. The allied health professionals who work with this are we have a psychologist, a counsellor, a couple of acupuncturists, two methods, a therapist, a chiropractor, we have yoga and Chinese medicine, homeopathy and an acupuncturist are available at the theatre. We also have high-rat basis students and we have medication and lots of childbirth education here. We also have people who probably have any odd baby ulcers. So the centre as you can see in that picture is quite large. There's a downstairs and an upstairs section. We've got ten rooms for consulting, one large room that we do yoga and education classes in, a room for breastfeeding that's got five lovely recliner chairs, an outdoor space that we've got a garden where we grow some lovely herbs and things for breastfeeding and car park which we've got ten spaces as well so it's really accessible to women. I think we've started here. We've been at, we've been privileged to get 250 births and it's a very, well I think, most I think, 40% of them are being hybrids, 40% shared care and birth support in public and private hospitals, you know, the rest. The hybrids have doubled in Victoria since we started. When statistics come out next year they've doubled. I think there's a bit of a trend anyway. A lot of the midwives in Victoria have been going to court and people have been saying that hybrids have been going to court so there's some things but then they somehow wouldn't know you could have a hybrids and nothing like that since if you didn't know you could have a hybrids we thought some hybrids would be good for the court. So it's funny, isn't it? Then you probably should be better than them for that. People will really, really come to us a lot for hybrids and we think that if we had access to public hospitals that wouldn't happen. We think if mum and midwives could access the Medicare item number and use the public hospitals for birth that we would have many more hospital births. But one of the most exciting things that we've found some of our statistics across the last couple of years is that no matter where the woman chooses to have her baby, whether it's a home birth or in a private or public hospital, if one of the mum and midwives is with her we have very similar outcomes across the board which is really exciting. It really shows that it's not the closest birth but it's the caregivers that make a big difference. Yes, never getting medicated has been one of our biggest challenges going into starting a centre and using the Medicaid rebates. There's been a little bit of discussion that people have been talking about what Medicare rebates we can use. In Australia we've got access to Medicare rebates for antenatal birth and postnatal care in theory but in Victoria so far no one can access the birth rebates because you need to be doing primary care in a public hospital and at the moment no midwife in Victoria has visited that in public hospitals. It is a lot easier in more rural settings where the midwives and the hospitals work very closely together but in a big place like Victoria we've found it's very, very challenging to get into the hospitals and discuss how they'll benefit as well as how they'll benefit out. The birth rebates feel seemed like it's a way up in Victoria, in Central Victoria anyway. The antenatal and postnatal rebates have been very well done. Well, I was leading the Medicare. Medicare has also given us a lot of power there. You know, I was of two minds about Medicare but if I could get money for our services, if women could get money, I just thought this had to be done but we actually don't get Medicare that women do but I think that's a fantastic thing. I'm all for it now but it really does give you power to say it's a provider number and that you can get Medicare rebates and it really is making the difference, you know, stand up and be accountable. So the next challenge that was had was writing for the challenge of collaboration. So when Medicare rebates first came up in Australia it was a big challenge for people to understand what this collaboration meant. And in theory it means that midwives and doctors will work together to get good care for women and work in a collaborative relationship for the best outcome for the woman. But in some situations it sort of turned out as a bit of a, I guess for one of the better words, a bit of a power struggle for doctors feeling like if they sign off a collaborative agreement with a midwife they might be somehow responsible for the care that the midwife gives whereas it really should be that it just creates a pathway for that midwife to risk their arms for a doctor if they need to do that. So the only way that women can get Medicare rebates is to have this collaborative arrangement with a doctor going on. But as we've gone on the last year and a half to come out for two years in September for the midwifery centre here it's something that the word is getting out and we're getting a lot more collaborative arrangements in place. Mostly there are collaborative arrangements with DP, DP obstetricians and private obstetricians. And for the last year or so we've had a DP obstetrician that's worked at the centre here with us. And so he's been great to provide that referral process for us. We have collaboration with hospitals in the antenatal period but we haven't had success in any other area. I think I see a lot of people are talking things about Medicare Equals Rules. Oh, I agree. And C&C guidelines are Equals Rules and you drive this license Equals Rules and I don't know everything Equals Rules but if we do have these rules and we think they're fair and we're in partnership with women with the rules you can use them to your advantage. First there's just recently the Victorian part of human life. There's rules in that. We can use them to our advantage. So just by complying to some rules as long as we're not going against women's wishes I think it's OK this Medicare thing. I'm sorry to say you won't say it's sort of uptight about it but I think it's just resistance to change which I've been an expert in. But I think rules can be, knowledge can be power and rules can be power too. It's used correctly. So in Melbourne we've got three tertiary centres that take on a varying amount of clients at the Women's Hospital in Monash. They're somewhere up around seven and a half thousand women per year that go through there and I think the Matthews isn't far off that. They're big tertiary centres and we now have shared care with two of them the Women's Hospital and Monash Medical Centre and we're very, very far off having shared care with the Mercy Hospital for women because they're an extremely conservative hospital and they tend to do the last dump on board with any big chains like this. I can't say much about the Mercy Hospital. They have excellent nursing facilities and they really encourage breastfeeding. That's nice. But the Mercy Hospital has both midwives going and helping us with midwives and helping women who want to work with us at their institution. This hasn't been forthcoming in any way whatsoever. So we put the same energy into negotiating with Women's Hospital in Monash in the Mercy and we've been welcomed at the Women's Hospital at the Monash Hospital in a capacitive care position but the Mercy Hospital has actually slowed the door on us. When we're there on these downfalls with midwives not wanting to work on calls I don't think it's just midwives not wanting to work on calls. I think it's the procedures or the actions changing the lifestyle that comes with working in that model to you. As a mother of many children as a Susanhurst and as a midwife in a birth certificate I've had to go into the field of call so it's part of my life. But watching Kelly's struggle with that and it was saying, oh they'll come and work with us they're not doing calls. It seems that it is a problem. And I think that case load is done with this handle properly and I think there's a better way to do case loads than it's done anywhere and I think that the individuals within the case load model should put stuff in the hat what they would like to do and what they could do. For instance, someone might like to be on call five nights or six weeks with someone else and you know one week. People actually like to do that sometimes but it's so prescriptive, I'll always call. But what do you pay for on a call? How do you do that? That's been a real downfall. That downfall, which isn't up there has been people coming in that's staking up everything they've got to offer and then leaving and going off on their own which we are college of course because it's certainly a lot of hard to swallow at times. And now on to our trial. I think the biggest and best, I think we both agree that the biggest thing that we've achieved is that there's so many more women now sticking out and knowing what midwishly care is and that's clearly just them getting out there and being at all the horrible baby shows and all of the places we don't like to go but just getting midwishly care and midwives out there has been a big part of what we've done and just increasing the awareness about midwives. One-to-one support is something that we offer but of course we always have a backup midwife so practically it's always, they always get a midwife that they know and that it's not the place of birth that makes the big difference to the outcomes, it's that the woman is supported in her decision making and supported to birth the way that she wants to, wherever she wants to be. And I think the midwives would have been working with us and for us have had increased job satisfaction. I know that the down in myself in the last year and a half or two years there's been many, many challenges that aren't to do with midwishly necessarily. There's more to do is running a business and starting at the first entry in Victoria and all of the challenges that come with those things that have pushed us to the limit. But I know that whenever I'd rather love to go to a beautiful birth or to support a woman to achieve what she wants to do at any point, we just get back to what we love doing and we're happy so we do have increased job satisfaction. So there almost comes the end of our official presentation but I think there might be plenty of time for discussion and we can answer some questions as well. Yeah, let's go from just the two of us. The two of us last year were at 120 births together and with the silent manager who we can't maintain and reporting all the money back into the centre, of course. Now we've got eight midwives. We've got many more women attending. We've got clinics in three locations and a rural one as well in South Victoria and we've got student nurse placement, international student midwives coming and having placement with us and people are starting to know us. We would like to be more involved with the ACM and the ANF and bodies like that. We realise that we need to know a lot about what happens in infrastructure in health in Victoria and we're learning at a great pace. We've learnt a lot about politicians but there's no time to talk about that goodness now and we're really hoping that every woman knows that she can find a midwife and that she can get some help from the federal government to pay for that midwife. Our plans for the future are to embrace which is in Victoria even more and to embrace the graduate midwives and the young midwives and to really work with women in partnership to get something going. We've had 56 babies this year and one of those was an emergency... or two now, two of those were emergency seekers and 50 of them were normal for going for living. It's got to say something. It's got to say something. We'd like to see if we had one complaint or if we would have one if... Okay, thanks for listening. We'll go to the questions now. I hope you used the national list on this last day. So Maxine asked about the federal statistics on place of birth and how they haven't been influenced, how they haven't influenced their outcomes. So as we said before, it's got about 40% home birth rate at the moment and the rest are 50% in public or private hospitals. So the big statistics, I guess, that people want to know about are things like the variant rate, the back rate. They see the rate across the board in the public and private system is somewhere around 30% to 50%, but with women in it, with us involved in the one caret around 10% to 15% and that would be enough for the statistics. Um... Still birth? Oh, haven't. No, still birth, though. Not that we'd mind. We'd be very privileged to work with people having still birth, of course. We do like that we work with people with miscarriages. We said, say, come and see the 12-week sale. Come and see the things that got the two lines. We'd like to see them. Our other statistics in the private hospital is the private obstetrician. Selective, of course. Selective private obstetrician. Pretty nice and tough girl. Welcome to us with open arms. They have pools in all their bathrooms now. We can take our pools in and they're very inclusive of private lives. Unfortunately, they don't make the sign of things to say that you're only a support person. I just sign it. But that makes a big difference and the obstetrician who do work with us are very happy that we're having normal birth in the private hospital. That's about it. So, Denise, how do you find the plan? Do you mind having a variable question? No, that's it. Denise, I've enabled your microphone to use and ask you a question. Denise is a home birth midwife in New Zealand and also is civilly involved as well as writing and attending Manifesto in New Zealand at the moment. I'm actually an Australian midwife. I was involved in the Community Midwifery Program in Perth and was an independent practicing midwife in Perth as well here in New Zealand and because the political football is only on one level here. There's one national government. My experience is with home birth when you have a large lot of women and everything else the other thing that comes home is the connection, the attachment of the baby and the mother and the whole harmony stuff that just doesn't happen when you transfer to hospital or when you're in hospital and you're not nesting. The thing is the baby survives alright but as a fetus we're not thriving and I think midwives really need to look at the whole defense of home birth as nesting, as traversing and the other as the option and I just won't come home until we've got home birth. Maybe I'll stay here forever at that rate. Thank you. So there was a question from Chris that she'd like to hear more about the case studies model because she's seen on our website. I'll put our website up at the end of this as well and I'll contact if anyone wants to contact us but yes we do have local midwives for our satellite clinic so we've got midwives down in Alwood and we're also looking down at Clayton up to Carol and Spring because they're the heady areas and they're helping me to help as well as got shared care. So we'll set up practices and help the midwives get established and then we'll get on to another venture. Are there any other questions if I'm asking where the client box is? Janet and Kelly I was going to ask about perhaps because there's quite a few student midwives on today perhaps we could talk a little bit about whether those placements... Absolutely. So Liz has done... since we started last year actually we've taken on student midwives and we've tried to only take on as many students as we can facilitate at one time so it's really one student for one midwife. So we usually have a couple of students on at the time and if the students are willing to be on call they can literally just follow us. Of course as long as the women are happy with it they can be with us for birth. They come to the clinic, whichever clinic they would like to go to for the antenatal and postnatal visits. They can come along to education classes and then whatever competencies they need to get ticked off we try and focus on those areas for them but it's a lot slower pace here obviously than the hospital they don't get the numbers that they get in the hospitals but as far as the feedback that's gone I just love the experience and learnt a whole lot of different things about midwifely skills and more natural ways to go about things at this place. Last year we tried to get some funding for a graduate midwife but we were there too. Actually we're offering two graduate places but I think we're going to either or we're just going to do it. There was a student in the comments saying how amazing her placement would be was so that's good to be here. That's great. I don't know if anybody else has got any questions. Chris had a follow up about the caseload did you see that one about fearing caseload obviously maybe about how you bet each other up. Dan and myself in another midwife are the midwives that are really on call full time so we take on however many women we think we can handle and I suppose it's because we do a lot of support in hospitals as well as home births the load is supporting the woman in hospital and then being cared for personally in the first couple of days by the hospital it's a bit different to the load for women who are having home births so we take on however many clients we feel like we can eat and then we've got other midwives that want to do part time on call so they sort of will do a lot more antenatal and personatal care so they will also support women when they can. So maybe it's a bit of fragmented here as Kelly's explained from our part time business that comes from here because we don't employ these wives everyone has to own big courses in women so what makes up for that is we have a lot of community based things in London we have a lot of black coffee mornings breastfeeding, dropping women and women just come in because they want to see us and we have lunches with them and things like that so we mess up with our women who are breastfeeding because we don't have a life enough paid visit. Some of the comments are saying about how breast and powered women are in Australia at the moment would you guys have any sort of comments about that and how I mean obviously you work really pilotly to actually make sure women are empowered so it's obviously a hard feeling over there. I think I would like to comment on that because it's refreshing our minds at the moment we see at least one or two women a week who want to be brief about a traumatic birth experience with people so co-authored sitting here twice a week. We are totally disempowered by birth in Victoria because it's depending on who they get on the day but we've just had someone just yesterday who got told her nipples don't work who got told she hates it and she hated it I think when I was really disempowered by birth in Victoria I was really disempowered because you know what who do they tell? Who do they talk to? If you went up a hospital and you want to stay something where do you talk to? What do you do? With Kelly and I spending shoulder to shoulder with women we feel disempowered. It's a real problem and I would like to say something like the terms of coalition or consumer group really take it up again. You know we used to have it if I suppose 50s, 70s I'm talking about but you know we got really on our feminist high level because now listen to us, really listen, listen to us. It's the money that the government keeps for birth and we want it. We don't want green books, red books or blue books. We want some power in birth and I think women are disempowered by birth in Victoria. I'm really sad about that but any person who's said this review will tell you that. There's this question here for Sam and I'll just get it to Lee. Is that about from Benin? Hi, Benin. Benin says are these women gay to see the ministers of health? You know, who do you see? I don't even know who to see. I don't even know who to see about why can't I get rights in the hospital. You know, there's a sense of there's all these little tricky things. I heard I ring up before seeing the ACM. I don't know. Who do they ever come here when they're rights? I don't know. The women, this toilet charter of human rights in a recent conference about human rights has given me great energy to pursue this because Medicare, people who have had Medicare who we are fighting for them to care so care in our hospitals without having to pay first-tasking. It's really full-on that will we need politically inclined lead rights to help us? Like Liz Wilkson, Queen's Day, she can actually share her moments. She knows everything about Queen's Day government. If someone don't know something about the Queen's government, come and help Kelly and I because part of her name isn't and the number I ring up the other day, that lady may have been there two years. I said, you need to be active this way. I really would like to include our appearances that way. We just go to the hospital and the hospital tells us and we're so strict of it and this is probably the intake of hospital care. So it's a bloody process. Follow the process. Process and policies don't go with sex and reproductive things. They just don't work. And Liz Wilkson, breastfeeding and children running around, policies and procedures go out the window. They're in for politics. How do you do that? The bottom stock is to the live base. I thought I'd do the last thing I did in the magazine saying bring your local lead by support and get the stock as well. It's a really heated discussion. It's unfortunate that it seems when women get involved in politics they leave their uterus at the door. And so they don't seem to be as pro-women or pro-boys or pro-birth as they might be if they weren't in politics. I think we all must realise I hope this is a big voice out there that we all should realise how powerful women are. We are the most powerful thing there is. We need to do this. We are the most powerful thing too. We are really powerful things and we need to get into dealing and do something. I'm still a little busy here. When you say type and do this it was probably better asked about. But we can get out there and really make a difference. I would like to walk down the street and say everyone would say, oh my goodness, there's the mean life. How are you doing it? Everyone's staying on their feet and they're really good at this actual business. I think the mean life is getting more and more known. We just built a page by a filming company to make a film about the mean life. I think the mean life is really getting out there. What do you mean by that? Can you just clarify what you mean about disability insurance and this? I think she's raising hands so I'll just enable her microphone. Hello? The Julia Dillard has been talking about a disability insurance and my question is will this act like ACC? Here in New Zealand, part of my professional indemnity insurance is that I pay in to ACC for every woman that I look after as a midwife and so do all the other self-employed midwives in this country. That's how in New Zealand they can afford professional indemnity. We also have a higher levy when we join the College of Midwives but that is also how they've got self-employed midwives because they can see. So my question is does the new national disability insurance look like it might have some impact on say both injury for example and therefore on professional indemnity? Well we haven't really looked at that in that depth but the problem with that new disability scheme at the moment is causing great concern is if that money isn't spent on disabilities we're just a list of the money in the bucket though. So I think it's something that could be looked at. So I don't think it's been no one's fault and that's the interesting thing and we could take that up with our politicians. New Zealand has had so many beautiful things and a beautiful country. It hasn't been I don't know which lindle that is but yes that's two lindle it hasn't been released yet but I've been watching that one quite closely and it's such a long hour at this week and it's such an aggressive group and it's yes. I think we could probably go on for everyone's talking about what we can do to change and make a better system over there. I just wanted to thank you guys Ian and Kelly so much for your presentation it's really great and obviously really important to keep you know really good and to clean the relationships and obviously keep fighting for women and general and their voice around what they want to do to be and happy Mid-Wednesday everyone.