Monday, March 31, 2014

Definition of obstetric violence/Definición de violencia obstétrica

Lecture by Dr. Amali Lokugamage at the RCOG World Congress 2014 in India.

Obstetric violence  
"Obstetric violence is the act of disregarding the authority and autonomy that women have over their own sexuality, their bodies, their babies and in their birth experiences.
"It is also the act of disregarding the spontaneity, the positions, the rhythm and the times the labour requires in order to progress normally when there is no need for intervention.
"It is also the act of disregarding the emotional needs of mother and baby throughout the whole [childbearing] process"

This video was prepared by Jesusa Ricoy-Olariaga .

Further comment and discussion at villagemidwife blog


The new AHPRA Advertising Guidelines came into effect 17 March, and we await the next move.  See previous posts for the detail of our concerns.

AHPRA has responded to pressure from professional groups.  The NMBA and other Boards are using a system of updated FAQ (frequently asked questions)

Updated on 24 March


There is a clear difference between advertising – which requires an advertiser’s intent to promote a health service – and unsolicited online comment, which does not involve an advertiser’s intent to promote a health service.

This seems to clarify the issue of unsolicited positive comments about a midwife that may appear on social media, on a site that is not under the control of the midwife.

It does not clarify the issue of Birth Stories which are posted on, or linked to, the midwife's website or social media site.  Many birth videos and photo montages identify the midwife.  This has been discussed earlier

The question in our minds will be, does AHPRA consider that everything posted on a midwife's website is advertising? 

Your comments are welcome.

Sunday, March 23, 2014

AHPRA ACTION Campaign: enough is enough!

Readers who have been following the health professional news about the new AHPRA Advertising Guidelines are invited to sign this petition, which petitions AHPRA to remove Section 6.2.3 from the Advertising Guidelines.  SIGN HERE

By way of reminder ... from the Advertising Guidelines:
6.2.3 Testimonials
Section 133 of the National Law states:
(1) A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that – 
 (c) Uses testimonials or purported testimonials about the service or business
For more about this part of the Guideline, go to Birth Stories.

It has occurred to me that even Birth Notices that were very popular in the past, when we all read the daily newspaper, could have breached AHPRA's extremely narrow interpretation of 'testimonial'.  [I think social media has replaced the Birth Notices column in the newspaper!]

In discussing Birth Stories within the (relative) sanctuary of a closed facebook group for eligible midwives, one midwife expressed the opinion that " birth stories belong to women, and [I] do not see why midwives feel they have to publish them, and think they could be construed as advertising if published in midwives' own space."

Time will tell!

Yes, birth stories do belong to women - and if you can show me a birth story that focuses on the midwife and appears to have a purpose or intention to promote (/advertise) that midwife's practice, then perhaps it could be called a testimonial.

The guideline says "Testimonials can distort a person’s judgment in his or her choice of health practitioner."

The overarching purpose of regulation of health professionals is the protection of the public. Protection of the public from rogue or negligent or incompetent professionals and the like. Protection of the public from charlatans and snake oil sellers who would deceive and manipulate unsuspecting potential clients.

The scope of the midwife who works in primary maternity care, and the leading theme in birth stories, is natural, unmedicated, unmanaged, (sometimes noisy, sometimes messy, always unpredictable) birth.  Natural childbirth is unique in the spectrum of health care: it requires the woman to do *it* herself! There are no shortcuts, no special breathing techniques, no therapies, no magic words or products to be bought, that make natural childbirth better than it already is.

It seems to me that AHPRA is looking for a broad brush that covers every possibility in regulated health. I don't think AHPRA is necessarily targeting midwives in the 'patient stories' part of the guideline.

In conclusion (for now), I support the AHPRA ACTION campaign, and have signed the petition calling for the removal of Section 6.2.3.

The National Law, which prohibits the use of testimonials in advertising the service or business of a regulated health professional, continues.   The onus in this matter must be for AHPRA to demonstrate that the statement (comment - positive or negative - that identifies a regulated health professional on social media, midwife's website, YouTube video, or newspaper Birth Notice) must be shown to be advertising the practitioner or the service in order for it to be called a testimonial.

An excellent series of blog posts about 'social media' by Geraldton WA GP Dr Edwin Kruys provide more argument and comment, particularly from the medical practitioner's point of view.  You can follow Dr Kruys on Twitter at

Note: The opinions expressed in this post are those of the writer, Joy Johnston.

Your comments are welcome.

Saturday, March 8, 2014

... more on health professionals and advertising

This post is a continuation of the discussion on Birth Stories a couple of weeks ago on this blog, and on the villagemidwife blog.

AHPRA has published several revised guidelines that are to become effective from 17 March.
For registered health practitioners
Guidelines for advertising regulated health services
March 2014
... "A practitioner must take reasonable steps to have any testimonials associated with their health service or business removed when they become aware of them, even if they appear on a website that is not directly associated and/or under the direct control or administration of that health practitioner and/or their business or service. This includes unsolicited testimonials. (emphasis added)"

An article Medical board’s online backflip 
7th Mar 2014
Neil Bramwell
published in Medical Observer adds another perspective to this interesting dilemma faced by AHPRA: that an aspect of the revised guidelines are not acceptable or workable.
... But [Medical Board of Australia] MBA chair, Dr Joanna Flynn, has now said the policy was only ever intended to apply to proactive advertising or promotion of a regulated health service. “There is a clear difference between advertising, which requires an intent to promote the health services, and unsolicited online comment over which practitioners do not usually have control,” she said.

... However, the MBA now recognises that practitioners are unable to control what is written about them in a public forum.
This article relates to a statement 'Online comment not always advertising'  by the Medical Board at the MBA website.

... the Medical Board "now recognises that practitioners are unable to control what is written about them in a public forum." - good!

Can you imagine a health practitioner trying to follow public forums, then trying to get them to take down anything that mentioned them in connection with clinical issues?

The guideline is branded by AHPRA, and adapted for each of the professional Boards.  I expect the NMBA will follow the MBA.

How did the regulatory authority not see this?  The guideline is clear:
"... even if they appear on a website that is not directly associated and/or under the direct control or administration of that health practitioner and/or their business or service. This includes unsolicited testimonials."
The revised Guidelines for advertising regulated health services need to be revised to remove these unworkable, misguided statements. 

The other issue for midwives is the use of birth stories, which the guideline refers to as testimonials ('patient stories'), which are prohibited under the Act.  I (Joy Johnston) have written to the NMBA about this - we must argue strongly that birth stories that are freely written by the woman are not for the purpose of advertising, and should not be classed as testimonials.

Midwives, please don't take birth stories off your websites; don't delete the name of the midwife; don't ask women to be silent about their experience of birth. We need to stand firm on this one. 

Opinions expressed in this article are those of the author, Joy Johnston.

Additional information 17/3/14
A legal opinion on the matter

Another link added 22/3/14 Sarah Stewart's blog post:  AHPRA provides guidance for the guidance on advertising, but still leave health professionals with concerns
Croakey ‘No comment’: now the Medical Board tests social media landscape with advertising guidelines

Your comments are welcome.