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 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.

career in midwifery?

wet and happy after a job well done!
[Thanks Miranda for the pic.]
Click here for Miranda's comments Why I Chose Homebirth

A young woman is considering a career in midwifery.

She is drawn by the ideas midwives write about:

• forming a partnership based on reciprocity and trust with each woman; 
• learning how to work in harmony with the woman's own natural processes; 
• promoting health in a holistic way; protecting the woman's birthing potential; 
• and providing a smooth interface between primary maternity care and medical intervention when there is a valid reason to interrupt the natural process.

The young woman has some doubts, recognising a potential clash between her own views on western medicine and the mainstream health system. She likes the idea of working as a private midwife attending well women in their own homes, but she realises that there is a journey that has to be taken in achieving a midwifery qualification, with study and experience that includes the medical/hospital system. She writes:

I'm worried that the "system" wont change, if not become even worse. Do you think it's going to become easier or even harder to practice midwifery in the way that you promote? IE- do you think i'll always be paddling up stream or, is there light at the end of the tunnel?

I have brought this discussion through to the blog, because these are questions that many are asking.

A slogan from the International Confederation of Midwives is

"The world needs midwives now more than ever"

even though ...

• The system may become worse.
• It may become even harder to practise midwifery in a woman-centred way.
• We may feel as though we are always paddling up stream.
• We may not be conscious of light at the end of the tunnel.

It is idealistic and unhelpful for midwives to focus only on the strong, healthy women and babies: women who are able to give birth spontaneously and joyfully in their homes.

Midwives, and authentic midwifery practice are needed in mainstream health care, which in this country means hospitals. True midwifery is needed for the women and babies who can't afford a private service, for women and babies in developing countries where the rates of maternal and perinatal deaths are many times that in Australia. True midwifery is needed for women who know they will need caesarean surgery in order to have the best chance of being 'delivered' safely.

The current batch of challenges in Australian midwifery are the result of a socialist government's attempt to improve maternity care. Socialist policy does not value the individual's concerns or iterests in the way that many people in the free world understand to be important. Centralised government regulation of midwives and other health professionals is likely to lead to bureaucratic red tape that restricts some midwives and women in the way the want to give birth. It is likely that we midwives will feel that we are always paddling upstream.

Governments will change. Regulations and laws will change. Women continue to need midwives who are 'with woman', regardless of the laws, regulations, or philosophies of the government.

"The world needs midwives now more than ever"

Today I received by email the picture of Miranda, with her newborn baby, and permission to use it in blogs. What a beautiful reminder that, for each midwifery partnership, there is light at the end of the tunnel. There is new life at the end of the hard work. There is beauty, and hope. Thankyou, Miranda.


ps
If you are interested in the state of affairs for private midwifery in Australia, and links to search for a midwife online, please go to the APMA blog.

learning about breastfeeding

A young midwifery student who I will call 'B' wrote to me:

Today I had work on the postnatal ward, and I had one of my "What would Joy do?" moments, as I had a particularly hard case to deal with, well for me it was hard.

I was caring for a woman who had a baby girl at term. There was some concern about possible infection, so baby was admitted to the newborn nursery soon after birth. I found the mother in her bed crying. I found myself having to be 'with' her in a very human, tangible way that I find hard to put into words.

After having a talk and her calming down, I wanted to help her with breastfeeding. The issues I saw for this mother were:
a) separated from her child
b) bottles and formula
c) sick baby
d) the fact she had only expressed once since her baby had been moved to special care 24 hours before and had minimal skin to skin/ feeding attempts since.

I showed her how to hand express, showed her how to use a pump, and helped her attach her baby in the special care nursery.

It was just one of those cases where I especially wanted her to succeed in feeding, which was what she desperately wanted too, and I wonder if there is anything else I can do for her?

This is an all too common scenario that student midwives face. I congratulate 'B' on the way she has been working through her thoughts in this situation.

A key to supporting this mother and baby are to understand breastfeeding from the baby’s point of view, and to help the mother to see that perspective too. Babies want milk; they want it in abundance and from their mothers' breasts. Any artificial substitute is inferior in the baby's mind, as well as being inferior from a nutritional perspective.

A student midwife working in a hospital has very little authority or ability to change the culture within the unit. Did that baby really need to be separated from her mother? Were all the medical processes that followed the separation necessary and helpful? ...

The ideals of the Baby Friendly Health Initiative, or the Mother-Friendly Childbirth Initiative, empowering women as mothers and promoting bonding, breastfeeding and health are not very useful to a person like 'B' working a shift in a postnatal maternity ward. 'B' needs a strategy by which she can impart hope and encouragement to the new mother until her child is returned to her care.

As soon as baby is well enough she will be looking for her mother's milk. It is usually possible to revisit the unhurried, skin-to-skin experience as could have happened in those magical hours after birth, when a baby intuitively seeks and takes milk. The midwife who is confident in understanding a baby's approach to breast feeding will also be 'with woman' in that natural process.