Sunday, October 30, 2011

what will the students do ...

... after graduation?

New graduate midwives in Victoria are facing great difficulties in securing employment.

A facebook site has been set up to support student midwives who do not have a 'graduate year' position available to them. The fb group lists 44 as students without a grad year, and a couple of hundred 'friends', all since the site was created a week or so ago.

Midwives Australia has put out a press release, calling on the Victorian Health Minister, Hon David Davis, to intervene on a range of maternity issues, including this one. "... due to a lack of funding 60% of newly graduated midwives have not been offered a ‘graduate place’ in maternity units across Victoria.”

A student who spoke to me said that there were some graduate places in private maternity hospitals, and country hospitals.  There are a limited number of graduate places in the level 3 and level 2 teaching hospitals in Melbourne and large regional cities, and these places are quickly filled when offered.

Here are a few points that to me are obvious, but probably need to be stated:
  • there's a need for consolidation of learning when new midwives graduate.  The 'grad year' is the usual pathway.
  • midwives who complete a grad year in a teaching hospital are more likely to be employed in other hospitals, as the scope of learning opportunities is thought to be greater.
  • virtually all hospital jobs in midwifery have aspects of 'medicalisation' of childbirth, which conflict with international midwifery standards of optimal practice
  • private hospitals in Victoria are owned and controlled by obstetricians, who usually have an expectation that the midwife is an assistant or a nurse, not a professional in her own right  
  • midwives who have graduated with a Bachelor of Midwifery (B Mid) degree, who do not also have a degree in Nursing, may be unable to gain employment in rural hospitals, as the workload requires both nursing and midwifery
  • many graduates of B Mid courses have a preference for primary maternity care, and would like to set up their own private practices.  There is a VERY limited career pathway for Victorian midwives to enter private practice, particularly if earning a living is a significant element in making career choices.

I hesitate to attempt to comment on a very complex problem.   While the ideal for a new graduate who has grasped to importance of a trusting relationship between each woman and her known midwife, to work in a group practice with well established mentors, that option may not be available to most.  The majority of newly graduated midwives need to find employment in mainstream maternity services.

I would not speak against going to country hospitals, if they are offering grad places.  Moving out of your comfort zone, and experiencing life from a totally different place, can help establish a person in their professional identity.   Every woman giving birth needs a midwife - whether that midwife is with her briefly in labour, or encouraging her through challenging days postnatally as part of shift work, or as her known midwife. 

In a similar way, I do not see private hospitals as something to be avoided.  About 30% of births in Victoria are in private hospitals.

Every birth represents a woman, and her child(ren).  Maternity care that is 'woman centred', and midwifery that is 'with woman', accepts the woman as and where she is.  Women are 'patients' in hospitals of all descriptions because that's the world we live in.  A midwife who finds a way to be 'with woman' will consolidate her knowledge of midwifery, and establish a strong professional identity, regardless of the place of employment.

My personal journey has included twelve years of part time night shift work, at the Women's, then at St Georges hospitals.  During these years my children were growing up, and I needed to put them first.  I used to long for the day when I would be able to work with individual women, and when the opportunity for private practice came I claimed it eagerly.  During the early years of being self employed I worked 'bank' shifts for private hospitals - Mitcham and Knox. 

If there are students and new graduate midwives who read this, who are fearful about your own journey into midwifery practice, I encourage you to speak with experienced midwives, and consider all your options - not just what you see as the ideal.  You see, we don't live in an ideal world.  We must always navigate unexpected obstacles in life's journey.  In learning how to live with uncertainty, and how to maintain your vision while taking necessary steps towards your goal, you will develop personal strengths that cannot be learnt any other way.

Update 4/11/11
A graduate midwife wrote:

Thank you so much Joy for your support and guidance.  What you have written is accurate in that "what will the students do"?  

We are all working hard together to create options.  A unity of old and young, able to move away from Melbourne and those that have families and commitments that do not offer the opportunity of anywhere else other than Melbourne. 
The figure appears to be 66% of students that do not have a graduate year. 
I think it is very important to note that, as you stated, ALL women need a midwife.  Our skills give us the ability to be "with woman" in the best way we can.  The ability to support and assist in breastfeeding is such an important tool to a midwife.  There is much we can do, this includes private hospitals.  What all students must remember is that one year of experience will open up a very different set of opportunities employment-wise.  For me?  Should I be offered a position in a private hospital?  Although not what I had planned, I will take the position and be grateful for the opportunity and do my best for a year.

Dear Reader, please let me inform you that while I support and care about students and new grads in this predicament, I have not 'signed up' as a 'friend', or hit the 'like' button - or done any other facebook-style action to identify myself with this cause. This is a personal matter for me - I restrict my use of the fb social media to keeping up to date with the posts of my children and other Gen X and Gen Y family members. My reason is simply one of choice. I do not like the use of the word 'friend', or other aspects of this medium.


Janelle said...

Thanks for this post Joy. After reading Sheila Kitzinger's book "The Midwife Challenge" as a 17 year old I began my journey towards my dream of becoming a homebirth midwife. Twenty years on and three children later I am still not there! I currently work two shifts per week in a private hosptial. After a few of years struggling with the necessity of shift work and the demands of my own babies at home, I am excited to say that I am rediscovering my passion for midwifery and loving my work. I do not like all the intervention in the private hospital setting, but I have learnt to be content with doing the best I can. I can endeavour to make a difference for each woman I have the privelege of caring for and to learn from them all I can. I still have my dream, but my kiddies need me and so the time to realise my dream is not yet.

Joy Johnston said...

Thankyou Janelle - I am so pleased to hear of your journey in midwifery. It makes sense to me, that midwives who are teaching women to be intuitive about their bodies and their babies, will apply the same principles to their own lives and the needs of their children.

Anonymous said...

I tried to post a comment but being technically challenged I'm unsure how this works..

Anonymous said...

Hi Joy I am about to be a newly qualified midwife and have been lucky enough to secure a graduate position with a private hospital. It took me some time to decide if I should accept this position if it was offered to me as Private maternity care is not exactly the route I wish to follow. My decision to accept this offer was for some of the reasons you listed above and some reasons that I feel are often neglected.. The role of the midwife is to be 'with woman' it doesn't say that to do this it must be in a certain location.. Just as a woman should have the right to birth her baby at home, she should have just as much right to birth her baby in a private hospital if she so chooses... So I will be there supporting these women and educating them to make informed choices regarding their care.. Yes I may not gain as many skills as I might in a level 2 or 3 hospital but I am still being given an option to consolidate my skills.. Much more so than if I undertook no graduate program at all.. I encourage all midwives to be out there to explore all their options for a graduate year and take any opportunity that may arise to take them one step closer to where they wish to be..

Joy Johnston said...

Thanks for this comment anonymous - I'm pleased you were able to work the process out.
Although working in a teaching hospital gives you great experience with the latest technology and research, the knowledge of working in harmony with spontaneous/physiological processes in normal birth is learnt over time, being 'with woman'. This can happen in any setting.
My best wishes to all new graduates.