Editorial

Article Outline

• Copyright

This is the third issue of the new Woman and Birth title and the first to be on schedule. I appreciate the patience of members and readers as we have worked through the issues of raising the academic standards, changing publisher to an international company and putting the journal online in the international arena. One of the effects has been that initially fewer papers have been accepted for publication. I’m pleased to tell you now that the number and quality of papers have both improved and are predicted to continue to do so. This issue contains four stimulating articles that are at a high level of scholarship. I am confident that readers of Women and Birth will feel informed, challenged and educated by the experience.

We have always been taught that health professionals who act as good Samaritans will be protected at law from claims of negligence. Helen Newnham troubles that comfortable belief in her paper that reviews the common laws and considers whether a case in 1996 has created a new ‘duty to rescue’. She discusses the implications for midwives who do get involved in an emergency situation in the community.

Mary Carolan raises some important methodological issues when she discusses the contested status of women's stories as evidence for practice. Her paper evaluates the use of stories as part of midwifery's formal theory and discourse. She asks us to consider if women's stories are a suitable form of evidence? We know that ‘subjective experience’ doesn’t rate in logico-empirical science where randomised controlled trials are the supposed ‘gold standard’. In my view RCTs are excellent for testing the effect of a specific, definable and controllable intervention; like a drug trial. Many questions of great significance, to midwifery and women, however, are not about interventions; they are about experiences, attitudes, values and beliefs.

There is a huge gulf between what indigenous birthing traditionally entails and what indigenous women are subjected to when they enter mainstream health services. Sue Kruske, Sue Kildea and Lesley Barclay have written a thoughtful paper about the need for maternity system reform at the local, state and national level in order to make birth for indigenous women culturally safe. In my view, there will be no improvements in indigenous perinatal mortality and maternal morbidity until maternity care is culturally safe. Yet each of us can make a contribution to cultural safety by adjusting our attitudes. One important step is to recognise how we are products of our culture and how that culture has benefited us to the disadvantage of indigenous people.

In her paper Caroline Homer laments the state of midwifery services in Australia because of their focus on the view and needs of health service providers rather than on the views and needs of childbearing women. Caroline argues for the type of care that women want and that is woman-centred continuity of midwifery care. She presents a number of strategies to help ensure this needed reform in maternity service provision. In reflecting on Caroline's paper from my situated regional perspective I wonder what this means for rural health services, where there is an acute midwifery shortage. Although we can argue that less midwives would be needed with continuity of care midwifery that won’t be achieved in the local GP obstetricians and the Directors of Nursing refuse to change models. Truly, there is work for all of us to do in changing attitudes and beliefs as a precursor to changing models of maternity care.

Midwifery in Australia and internationally, is continuing to assert itself as a profession whilst simultaneously working with women as individuals, groups and communities to bring about woman-centred birthing service. Women and Birth is one part of that national and international effort.