Beyond the silo effect : the challenges of collaboration

Women entering the maternity arena in Australia and other Western regimes have suffered incidentally from what is known as the' silo effect'. This refers to a clash between the training regimes of the 'old' professionalism and the 'new' professionalism. Under the 'old' professionalism, hierarchies were erected between medicine and the so-called semi-professions such as nursing and social work (Tully and Mortlock 2004) resulting in what Degeling et al (1998; 2000) have documented as oppositional modes of decision-making, styles of working, roles and accountabilities. Within the last decade, a 'new professionalism' has emerged in many Western regimes, including Canada, NZ, the UK and The Netherlands. (Romanow Report 2002; Street, Gannon and Holt 1991; Victorian Department of Human Services, Australia 2004) depicted by a flatter more egalitarian structure of multidisciplinarity .. An example in Australia is the Future Directions in Maternity Care document released in mid 2004 by the Bracks Victorian Labor government. In Australia, the move towards the 'new professionalism' can be attributed to a confluence of macro economic factors including the swing away from hospital-based training and towards university-based training for nurses and midwives, the ripple effects of three decades of feminism, the professionalisation of midwifery, the attrition of midwives from the workforce, the rise of health consumerism from the late 1980s and the crippling costs of professional indemnity health insurance for obstetricians leading to a crisis in recruitment.