midwives in the making

(c) Picture used with permission

Yesterday I had the privilege of presenting a 1.5 hour talk on private midwifery practice to the midwifery students at Deakin University in Burwood. I love having the opportunity to inspire the next generation of midwives.

I know some visitors to this blog are studying midwifery, in many countries. In today's post I want to give you an outline of my presentation, and links to some of the key documents.

The parts of the presentation were:

• Overview and introduction: developing a strong 'midwife identity'
• Private midwifery practice, changes in legislation with Medicare rebates and other changes for eligible midwives. Go to Midwives Australia for more information and links
• Planning for birth: philosophy of birth based on the statement that "In normal birth there should be a valid reason to interfere with the natural process" (WHO 1996); decision-making concepts of 'Plan A' and 'Plan B', birth preparation meeting handout
• DVD of a beautiful home/water birth [One picture used here with permission - the visual image is sooo powerful!]
• Highlighting aspects of midwifery practice that can apply only when the whole labour progresses under natural hormonal, unmedicated processes: physiological third stage, and baby's transition from the womb
• Questions

Please follow these links if you are interested in the topics mentioned. I intend to prepare a post on 'Planning for birth' at my private midwifery blog - will do that as soon as I can.

For the record, my relationship with the Deakin University School of Nursing and Midwifery is that I am employed as a casual lecturer, and as a tutor and marker for some of the midwifery Professional Development Unit Learning Packages. Several years ago I prepared one of the Learning Packages on the midwife in the community (PDU 323) and more recently I have written a Learning Package on Caseload and Homebirth midwifery, which is being processed in preparation for release.

The making of a midwife

I have recently finished reading Patricia Harman's memoir (pictured here), Arms wide open: a midwife's journey. I have enjoyed the journey.

As I progressed through the book I welcomed insight into the way Patsy, an idealistic hippy wild child in the early 1970s, learnt about life and in that learning, she found midwifery.

I welcomed insight into the realities of the American counter-culture, war resisters, commune life, living without what most of their peers would call the basic necessities of life.

I welcomed the honesty of statements by Patsy, now a grandmother with a nice home and a day job, no longer attending births, such as "You'd think by my age I'd have everything figured out, but I don't have a clue and I'm more confused than when I was thirty."  I concur.

I found to my surprise that Patsy's midwifery journey reminded me in many ways of my own. I was at the same time, learning about life, and discovering my midwife identity in a sort of mirror image journey.

Here's what I mean by a mirror image journey.

Patsy and I must be about the same age, and we gave birth to our babies at about the same time. I was living in Michigan in those formative years, the 1970s, in a little brick house with a basement, surrounded by tall oak trees that shed mountains of brown leaves each 'Fall'. I raked leaves in autumn, shovelled snow in the winter, planted spring gardens, and enjoyed home grown veges in the summer.

While Patsy learnt how to stay warm and well in an isolated primative log cabin, I, who had spent most of my life in the sub-tropics in Queensland, learnt how to live with central heating, and cook in a kitchen that had green carpet on the floor.

While Patsy and her companions had dropped out of education, I had already graduated as a midwife in my home country. Noel, my husband was a graduate student at Michigan State, working on the fascinating and previously unnoticed protective effect of colostrum in the newborn calf. I was absorbing scientific literature and knowledge as fast as I could, broadening my understanding of reproduction, and particularly the needs of mammalian newborns.

Like Patsy, I attended the local Lamaze birth preparation classes and learnt psychoprophylaxis and Lamaze breathing. Unlike Patsy, I did not discover homebirthing. I gave birth to my first three children in the local hospital, was moved in second stage to the delivery/operating room, positioned with legs in stirrups and hands held to boards by big pieces of velcro. I was told to "take a deep breath and push push push!"

While Patsy raised her children in a loosely knit 'family' of a commune, I was away from all my family, became a full-time mother, and was satisfied with that role. Apart from the help offered by a few neighbours and friends from our Church, I needed to be emotionally and physically self-sufficient.

While Patsy developed a sort of faith in the forces of nature, I continued in the Christian faith in which I had been nurtured.


My awakening in midwifery came later, in the early 1990s, when I thought that my four children no longer needed a parent to be at home for them all the time.

I was able to move without difficulty into homebirth, even though I had not given birth at home myself.  The knowledge that stood by me had been instilled in my mind over the years of my own childbearing, building on the foundation that I had learnt in my student days at the Royal Women's Hospital in Carlton.  The years of breastfeeding had given me insight into mother-baby bonding and nurture.  The years of parenting had given me an understanding of what it means to promote health, and work in harmony with natural processes.  The years of part time shift work, usually nights, in hospital maternity wards, had taught me that I wanted to be 'with woman' - that the 'one night stands' I was having in the hospitals were not optimal in any way.

Like a butterfly emerging from its quietness in the crysalis, I had metamorphosed, and came out of that space ready for action.

Enough from me for today.  Your comments are, as always, welcome.

ps Arms wide open is Hardcover, or eBook, 324 pages.  Publisher: Beacon Press. ISBN: 978-0807001387
http://www.patriciaharman.com

Midwifery - much more than a job

Midwifery is the calling, the profession, the vocation that has claimed my attention and inspired me throughout most of my adult life. During the past two decades I have learnt to apply the basic knowledge and skill that I had when employed in a maternity hospital to the individual women whom I have been privileged to attend.

Midwifery is much more than a job.

When I was employed by the Women's in the 1980s, working a couple of night shifts each week, I used to feel as though I was having one night stands with women, being close to them at such significant moments in their lives, and walking away from them at the end of the shift. This was before I had noticed any professional discussion about caseloads, or continuity of care. I now see this feeling as evidence of my developing *midwife identity*. For twelve years I had a job as a midwife in a public hospital. A job that I could walk away from when the time came, and return home to my young children and my husband.

When the time came for me to move away from that *job* and set up my own *practice*, I experienced a sense of freedom that I had not previously imagined. I went into private practice like a duck to water. I could not have been in a better place, and my emerging identity as a midwife was sealed and flourished. I found that I could write and teach, sharing the knowledge I had acquired from study and from giving birth and nurturing my own children, and the principles upon which that knowledge was based.

I accepted that, in order for a private midwifery practice to be viable in this country, I needed to charge a fee that reflected the commitment I was making. When I was employed in midwifery there was always a pay packet at regular intervals. Now I would not be paid unless women paid me. All I can say is that I have not missed the regular salary one bit. Even as the main breadwinner for our household, the steady stream of clients who employ me to be 'with woman' have provided sufficient income for my needs.

The terrain of private midwifery practice in Australia is changing now. Midwives are now able to demonstrate to the regulatory authority that we are suitably competent in all aspects of basic midwifery, and through that process become eligible for private clients to claim Medicare rebates. The legislation around Medicare, particularly the requirements for collaborative arrangements, has been criticised by me and many others who have read it. The process to provide Medicare rebates is potentially arduous, and there are questions that are still unanswered.  But there is a process, and it is there for midwives to apply.

I know of a small group of midwives who are progressing towards the Medicare eligibility goal - some may already have achieved it.

I have stood back a little, attempting to line up options for collaboration with public hospitals. This is not to focus only on what I need, but to establish pathways for other midwives.

Some of my colleagues have become concerned that midwives who accept Medicare eligibility will be compromising midwifery standards, and women's rights to informed consent or refusal.   I will be watching closely to see that this does not happen.