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MABC Member Update December 2013

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Christina Harris

on 7 January 2014

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Transcript of MABC Member Update December 2013

Promote the growth of midwifery in BC.
Universal access to midwifery
care is an essential component
of health care services in BC.
Ongoing development, sustainability and promotion of midwives and midwifery services in BC.
Increase the professional and political profile of midwives within the BC health care system.
Advocate for women and women's health issues.
2014 – 2017
MABC Strategic Plan
Growth of the Profession
Increase midwifery involved care in BC.
The MABC has set a goal to increase midwifery involved care to 35% by 2020. In order to achieve this, the MABC will continue to work to increase the number and diversity of midwives practicing in BC.
Support practicing midwives to work to their desired capacity
Increase access to midwifery across diverse populations in BC
Support the integration of internationally trained midwives
Increase the diversity of practicing midwives
Support domestic education of new midwives in BC
Full Scope Practice
Status Report
Open Discussion
Pre-AGM Contract Negotiation
Midwife Survey Results
Professional Integration
Have midwifery universally recognized as a primary maternity care profession in the planning and implementation of relevant BC health care policies and services.
Midwives are under-represented in decision-making forums which are vital to the integration of midwifery care into the BC health care system. The MABC will encourage and support midwives to participate in these planning and implementation bodies.
Identify and prepare midwives for effective participation in decision-making
Increase representation at provincial government level
Increase representation at the health authority level
Increase representation at the community level
Support the policy initiatives of Canadian Association of Midwives (CAM)
Sustainable Practice
Facilitate sustainable midwifery practice
(both urban and rural).
Midwifery is a demanding profession, requiring significant expertise and
commitment of time. In order to recruit and retain midwives, the MABC will advocate
for fair payment structures and supports to enable midwives to continue to provide
autonomous, high quality care for BC women.
Take a leadership role in identifying and preserving the essential principles of midwifery care
Increase retention supports for midwives
December 2013
Consult MABC members and stakeholders on current midwifery issues
Prepare for and
conduct negotiations on behalf of membership
Advocacy for Women
Identify barriers and strengthen advocacy for women
seeking maternity and well-women care in BC.
Midwifery care is fundamental to maternal and newborn health. Every woman
in BC should have access to midwifery services.
Participate in community-based research and knowledge translation
Create opportunities for women to engage with MABC
Advocate for women's voices in policy development
Capacity of the MABC
Build the capacity of the MABC to better
serve the membership.
In order for the MABC to continue to improve our services to members and support
the growth of midwifery in BC, we must increase our staff capacity and infrastructure.
Explore expansion of office and investment in infrastructure
Human resource and professional development
Work towards a clearer division of work into departments or portfolios
Acupuncture in Labour
Specialized Practice certification required under the Midwives Regulation; listed as an advanced competency in “Competencies of Registered Midwives”

Framework for certification is in place

Certification course approved and available through http://acupunctureformidwifery.com
Induction & Augmentation
of Labour in Hospital
Specialized Practice certification required under the Midwives Regulation
Listed as an advanced competency in CMBC “Competencies of Registered Midwives”
Framework for certification is in place, course development in progress.
Hormonal Contraceptive Therapy
Specialized Practice certification required under the Midwives Regulation; listed as an advanced competency in CMBC “Competencies of Registered Midwives”
Framework for certification is in place, Certification course is approved and will be available through BCIT in 2014
Intrauterine Contraception
Request to add restricted activity to Midwives Regulation made to Ministry of Health (MOH) in 2013 – awaiting MOH reorganization to resubmit request
Framework for certification is in place. A pilot project proposal is in process to allow midwives to train and practice under supervision
Controlled substances for use
in labour & early postpartum
To be included in Schedule A – Federal drug regulations were changed end of Nov 2012, now changes to Provincial regulations required
CMBC Standards, Limits & Conditions for Controlled Substances have been drafted
Once regulation is amended on-line education module & exam will be required for current practitioners - will then be entry-level competency examined in CMRE
Epidural Monitoring
in Hospital
Not governed by CMBC Specialized Practice regulation – midwives may take courses available in hospital and become certified within hospital
Frenectomy: Newborn
Request to add restricted activity to Midwives Regulation made to MOH in 2013 – awaiting MOH reorganization to resubmit request

Whether certification required depends on Ministry decision re: entry-level competency or specialized practice
Point of Care Ultrasound
Sexually Transmitted
Infection Management
Surgical First Assist at
Cesarean Section
Specialized Practice certification required under the Midwives Regulation; listed as an advanced competency in CMBC “Competencies of Registered Midwives”
Framework for certification is in place
Course development in progress. Fee item will be required.
Vacuum Assisted Birth
Specialized Practice certification required under the Midwives Regulation; listed as an advanced competency in CMBC “Competencies of Registered Midwives”;
Framework for certification is in place
Discussion of certification process is ongoing
Investigating possible course offerings
Well Baby Care to 12 months
and Well Woman care
Both are legislated role expansion not scope expansion
Request made to Ministry of Health (MOH) in 2013 – awaiting MOH reorganization to resubmit request
Likely to be integrated as entry-level competency with educational update for current midwives needed
Contract Negotiations
Cost of Living Increase
Midwives have not received a cost of living increase since 2009

Past two government mandates have provided no option for compensation increase

Gathering data on government mandate
Working Conditions
vs Compensation
Evaluate the working conditions of midwives practicing in BC including number of hours worked per average course of care, sleep hours & safety

Considering variations in practice (rural, urban, volume, solo, shared care) - how might compensation methods vary?
Home Birth Supports
Second Birth Attendant fee item: Data analysis, midwife feedback

Medications and Supplies fee item: More work needed on system to improve access to meds & supplies
Rural Midwifery Locum Program
Too early for full report, still gathering data

Proposal will focus on optimizing program with analysis of usage: barriers & incentives, +/- impacts on midwives

Ministry support for program thus far

If continued funding may explore ways to utilize program to facilitate urban locum coverage
New Rural Practice:
Support Grant Program
First grant awarded to joint Hazelton / Smithers application
Interest in program is growing
Need for mw human resource planning with Health Authorities
Outreach and preparation work = significant
Proposal for continued funding with amended program

* ConsiderWilliams Lake!! *
Fee Schedule
Collaborative Maternity Care
Address compensation for midwives working with physicians in consultative / shared care relationship

As per MOH Maternity Action Plan, tasked with addressing collaboration & compensation issues

Interim measures to support collaboration could include joint planning committee, pilot programs, fee items
Retirement Options /
Access to Pension Plans
What are the challenges in planning for retirement

Explore options for accessing government or other pension plans, may be self-pay, subsidized or otherwise matched

Current crisis of midwives approaching retirement without adequate planning or supports in place
Overall Cost Saving
Potential of Midwifery Services
Using existing data and the Perrin-Thoreau report update report to include projections to 2020
Focus on home birth, c-section, length of stay data = cost savings
Report may include: new fee items, home birth data, collaborative practice, alternate payment models, fee 'shifting'
Address status quo vs expansion of midwife numbers
Communicate the continued cost savings of midwives while increasing supports to practice and sustainability measures.
Preceptor Compensation & Payment for Supervision on New Registrants
Ongoing work, specific compensation proposal involves conversations with UBC, Ministries of Health & Advanced Education
Fee Item 'Shifting'
Include totals based on current numbers of courses of care
Highlight benefits to providers in rural & urban communities
Highlight benefits to health system & MSP in revising funding totals
Consultation/assessment of other midwife/physician/NP client
C-Section first assist
Consider how & where to fit preceptor compensation in
Alternative payment models may involve fee items
Alternate Payment Methods
Proposal would be comparable to physicians' alternative payment models, for midwives providing care in low volume communities
Sessional Rates
Funding allocated for midwives to participate in HA / MOH / PSBC committees and maternity care planning work
110 members responded to the survey
34% rural midwives = representative of membership
Expanded Scope
Midwives were asked to prioritize specialized expanded scope skills

Terminology note: Move from 'expanded' to 'full' scope = less sensitivity

More details to follow later in presentation

Full Scope Skills as Prioritized in Survey
Narcotic analgesia in hospital
Contraception management
Induction or augmentation
of labour in hospital
Providing well woman care
STI management
Well-baby care for the 1st year
Vacuum assisted birth
in hospital
Surgical assist at c-section
Fee Structure
MOH supportive of a restructured payment model as long as total billing amount remains the same

69% of respondents said they would consider restructuring the payment system as a possible solution to identified barriers they experienced in their practices
Potential Benefits of Restructuring
Less 'birth heavy' fee schedule
Better division of pay for work performed
Time to analyze fee schedule vs value of midwifery services
Updating schedule could allow intra and interprofessional collaboration and consultation, reflect realities of practice
Potential Cautions of Restructuring
Thorough analysis needed to ensure equal or improved overall compensation for all midwives
Could work with government and own consultants
Would be first time 'opening' midwives fee schedule but is common and expected in other groups' negotiations
Would need to work within acceptable timeline: initial agreement may lead to creation of working group w. MOH
Open Discussion
Collaborative Care
Increasing numbers of midwives working in collaborative care models, both formal and informal arrangements

71% of survey respondents expressed support for developing compensation models for variations of collaborative care

Current fee model needs to evolve, to support a variety of collaborative care and interdisciplinary practice scenarios

"There must be flexibility to different care models
depending on what each community's needs may be."
Six Priorities for next Contract Negotiations
BC midwives who act as preceptors work an average of 150 hours to support each student and are not paid for this time

MABC has advocated that preceptorship be compensated at approximately one course of care or $3,050 per semester
82% of survey respondents agreed with this proposal

"It is necessary – students keep us fresh
and mindful of our practice."
Continuing Education
75% of survey respondents have accessed MABC's Continuing Medical Education fund through MESP

MABC to request further funding to develop and expanded CME program, options may include 2nd attendant content

95% of survey respondents supported this proposal
Rural Support Programs
The increased need for practice supports for midwives practicing in rural and remote communities has been acknowledged as a priority issue by MOH & MABC
Midwife Priorities for Rural Programs
Rural Locum Program
Rural Practice Start Up & Support Grant Program
Isolation Outreach & Travel Assistance
Rural Education Action Plan (REAP)
Rural Continuing Education Support
2014 – 2017 Strategic Planning
CN Planning Survey Results
Full-Scope Practice Status Report
Contract Negotiations & Vision Plan
Specialized Practice certification required under the Midwives Regulation as antibiotics are in Schedule B

Framework for certification is next in line for development, ideally will be developed & available through UBC, funding / resources required
Request to add restricted activity to Midwives Regulation made to Ministry of Health

POCUS course already exists & is available

Midwives may take course, but may only use in an time-bound emergency in labour until regulation is amended
Continued support for the growth and development of rural midwifery
Improve MABC member supports
Develop and expand continuing education programs
Support the sustainability of home birth services
Political Advocacy Plan:
Vision for Midwifery in BC
Multifaceted campaign to increase awareness of the benefits, cost savings, public and stakeholder support for midwifery services in BC
Vision for Midwifery in BC
We will provide government with:

A forward-looking, public articulation of our goal to raise midwife assisted births to 35% in our province by 2020, along with the health and financial benefits for women, families, communities and as a bottom line, the health care budget

A package of proposed solutions and policy prescriptions to consider in order achieve this goal and the benefits it offers for government and stakeholders such as the Health Authorities

Proof of the increased level of awareness of and support for midwifery services in BC, via a grassroots campaign using a blend of conventional advocacy, direct communications and social media strategy to place midwifery squarely on the government’s agenda as we approach our contract negotiations in 2014.
How will we be heard?
We intend to:
Build on our successes over past two years in a positive, solution-focused way

Generate and leverage public dialogue and support for midwifery services among our clients, their families, communities, health care providers, researchers and academics, the general public and other stakeholders who care about the future of maternity care in BC

Launch a social media campaign to raise awareness and promote our message

Promote midwifery services at every level of government

Create an undeniable momentum that supports the growth of midwifery services across the province while providing positive solutions for change, sustainability of maternity services and health care providers

How can Midwives Help?
Campaign will roll out in January 2014 - watch inbox for timelines, action items messaging and tools to help make the most impact in advance of negotiations

Regional, local advocacy will be cornerstone of campaign -
MLA's will need to hear directly from midwives and women in their ridings

Expand your social media networks in advance: self, family, friends, clinics

Think of those issues that are of most importance to you as a midwife and what your government representatives might want to hear


What Exactly are we Saying?
Our strategy proposes a new vision for midwifery and maternity care in BC that supports our key goal to grow the profession and number of midwife assisted births to 35% by 2020

We will target more qualitative improvements, such as:
Making the profession more sustainable for midwives
Further integrating midwifery into the provincial health care system, and
Expanding the scope of our profession to maximize maternal, newborn and well-women health outcomes in both urban and rural communities

All in keeping with our strategic plan and the MOH's Maternity Action Plan

Resulting in high quality maternity care and significant health care cost savings

Full transcript