A Community Midwifery Service QLD 1997 – 1999

An accurate quote ❤️

Midwifery is both joyful and painful. We see the best and worst day of people’s lives in our everyday experience. We are incredibly lucky to be part of women’s lives when things are bright and jubilant, but also when they are darkest and most difficult. It allows us to see the light and shade of life in its sharpest exposure

Alexandra Ryan

I’d emigrated from Scotland to Australia in 1995, first job in a private maternity hospital was confronting, midwifery staff lovely but the routine, unnecessary interference in labour and birth I found awful.

Next job, a large Catholic/public/private hospital birth-suite, always caring for two women in labour at once, pressure on to transfer to the postnatal ward as soon after the birth as possible, not good for woman or midwife.

A job came up on a government funded pilot Midwifery Continuity Of Care (MCOC) service within the hospital, I jumped at the chance.

A team of four midwives booked 16 women a month offering antenatal visits , early labour care and postnatal care (at home!) with the proviso of birth in the hospital, home again in six hours, if wanted.

Looked forward to the challenge of working at my full scope, the words of trail blazing midwives ringing in my ears, Caroline Flint, Mary Cronk, Nicky Leap, and activists, Sheila Kitzinger and Ina May Gaskin (to name a few)

Meeting women at the start of their pregnancy, following them all the way through to the birth and beyond was delightful, a nicer way to work and the power dynamic different too, women more relaxed inviting us midwives into their home as guests, replacing long waits in busy antenatal clinics.

The very first time my pager went off (1996!😆) was an evening after dinner, the message from a labouring woman’s husband asking me to visit, unsure if they should head to hospital?

The beauty of this system was minimal disruption for women labouring in the comfort, privacy and dim lighting of their own home, the optimal environment for birth hormones to work well, visit from us reassuring or confirmation birth was close, time to go to hospital!

Paging husband answered the door, led me through to a dimly lit bedroom where i spotted a copy of Ina May’s Spiritual Midwifery lying on the bed, the woman herself in the ensuite shower, calm and in the zone.

Thought she might be in early labour but on examination her cervix was a surprising 8cm dilated, she happily agreed to transfer in. No drama, no fuss, not a bit like the TV!

I arrived at the hospital first, prepped the room, dimmed the lights, checked equipment, mum-to-be headed straight back to the shower where she spent the short remainder of her labour, birthing not long after, fabulous support from husband, minimal needed from me.

Baby breastfed well, a small tear was stitched, tea and toast given then back home after the requisite six hours, a brand new family on cloud nine!

A perfect birthing scenario, affirming for me and a reminder that if given the right circumstances and support women can be self – sufficient, birth under their own steam without the full weight of the maternity system interfering. Reflecting back she would have been a perfect candidate for home-birth.

Every woman should have the opportunity to be supported this way by a care provider they’ve developed a relationship with but Australia’s mix of private/public/GP-shared care is confusing, a postcode lottery if MCOC, birth-centre or private midwife care is wanted.

For some women, choosing a medical expert to make pregnancy decisions and take charge feels safe, optimal. Maybe the prospect of labour pain is terrifying, so they make the choice to have an epidural asap too.

Those were not the women we attracted.

Women who didn’t want to follow rules, routine guidelines or hospital policies came to us. Often a relationship with a known midwife was important, especially for those with anxiety or trauma from a previous birth or with a history of sexual abuse.

Knowing who’d be supporting them at the birth, knew their story, had their back gave a sense of power and control where historically they’d had none.

The actual birth of a baby is quick but the hours of labour leading up can be long, hard work, there’s a need to dig deep, the marathon analogy perfect. Some women are self-sufficient, happy just to have your presence, others need verbal reassurance, massage, rubbing, warm compresses, all the physical support you can offer.

I spent many a looong hour with primips at home in spurious labour who went on to have straightforward vaginal births. Taught me so much.

These are the scared women we turn away from hospital , telling them to come back when in “established labour” when often all they’ve needed was a little TLC, a midwife in the vicinity to reassure, help them continue under their own steam.

Our dominant culture maternity system doesn’t understand this, doesn’t frankly have the available staff or room, can’t offer this care.

Many women spend hours or days in early labour, yet this time is not deemed worthy of professional care or recorded in maternity notes.

Rachel Reed, Reclaiming Childbirth As A Right Of Passage

I’ve many birth stories in my head from this time.

The experienced belly dancing hippy mama, so calm, remember the swaying stopped, she briefly looking me in the eye told me baby was coming, walked over, climbed onto the bed and birthed baby into her own hands.

The 8yr old girl present at a birth, her mum labouring, kneeling on the floor leaning over a recliner, us both peering at the vulva seeing babies head appear for the first time. She so excited, not in the least phased ❤️

The twin pregnancy woman, (had one child already) both babies head down insisting she didn’t want an IV and continuous monitoring, standard hospital recommendations.

The older Consultant in the room unfazed , registrar in charge of birth – suite on edge , annoyed policy wasn’t being followed, annoyed with me, disrespectful of the innate strength, resolve and ability of the woman herself.

Debrief afterwards , consultant happy with the outcome said he enjoyed seeing this woman birth her twins so easily. Hope it also informed the practice of his junior colleague in a positive way

Sometimes first babies come MUCH quicker than expected, how often do you hear of women warning their birth attendants baby is coming and not being believed?

Hate to say it but I’ve been there, particularly remember a calm quiet labourer sitting on the dimly lit loo, me thinking there was hours to go and then bingo, before I knew it babe was out and in arms!

Another time checking a second time mum at home thinking she’d have ages, going off to a postnatal visit saying I’d be back , then soon getting a page to say baby already born, in ambulance on way to hospital! Oops!

Our service also provided antenatal visits at the local prison, confronting the first time going in through huge metal gates, checked at security, then spat out into the general prison population, “clinic over there sista!” quaking in ma boots, trying to look all confident 😆 pregnant inmates always so grateful to see us.

Refugee clinic also part of our remit, families so welcoming and grateful for care, offering coffee and cake and (with interpreter present) often regaling us with heartbreaking stories

Antenatal visits at the Aboriginal Medical Centre . With poorer outcomes in maternal and neonatal morbidity/ mortality it’s so important for Aboriginal and Torres Straight Islander women to have their own dedicated service with appropriate care givers.

This service has been ongoing in my current hospital for many years now, a small group of midwives giving continuity and culturally sensitive care. Still in Australia the gap is unacceptably huge

Initially on this MCOC journey I seemed to attend lots of spontaneous problem-free births (good for confidence and ego!) but then had a run of attending more challenging ones, something always going wrong and despite knowing my practise was good, hard not to take personally.

One baby needing unexpected resuscitation and transfer to ICN where he stayed for a few days, scrutiny of my documentation, of events reassured me i’d done everything right, all well in the end with baby but my nerves were frazzled.

Next a shoulder dystocia where babies head delivers then is stuck at the shoulders, an emergency situation, the woman haemorrhaged, baby needed resuscitation and transfer to special care nursery.

Several births in a row women retained their placentas needing surgical removal in theatre.

Unexpected huge postpartum haemorrhage , woman had birthed in the shower, big bloody trail over to bed, emergency buzzer pulled.

Another woman after labouring for hours, working hard, invested deeply in a vaginal birth, crying and distraught as it became clear a caesarean was needed.

Some women will ultimately need this surgical intervention (can be life-saving!) but if the possibility hasn’t been considered can be devastating, even with a healthy babe in arms, their whole sense of self completely changed. Much delicate debriefing needed after.

I know now I couldn’t always control the course of events, but back then blamed myself when things went wrong, jumped off the cliff with women all the time, too invested, so many blurred boundaries (my older wiser midwife self knows the system and culture around birth has a massive effect too and the women’s own story. It wasn’t about me)

The absolute worst, caring for one of our women whose baby unexpectedly died at 34 weeks, helping her deliver the baby, preparing it for the mortuary, visiting her and her partner in the weeks following.

This all took a vicarious toll, of course it did! 😖

Also being late 1990’s QLD, gold standard care in pregnancy and birth was still thought to be from private obstetricians so hospital staff were either intrigued or annoyed by us, some midwives thought we overstepped the mark, many doctors were not supportive, some downright hostile.

On top of this, being a pilot study there were red tape and staffing issues and our manager (personal/private issues?) didn’t seem able to be 100% supportive.

No midwifery supervision (as in the UK) hours unprotected, no firm 12 hour limit, debriefing all difficult births and situations amongst ourselves. A recipe for burnout.

I’ve such fond memories of the midwives I worked with. Strong, committed, caring, funny women. We had each other’s backs, often felt like us against the rest of the hospital.

The outcome of the service? The hospital took over funding when the pilot ended, gradually making midwifery teams far too big, real continuity of care no longer possible.

The service eventually disbanded , not sure exactly how and not sure exactly when but now 2022 there’s been another thriving midwifery group practice in that same hospital for many years.

Imagine it was started by midwives coming in from elsewhere (UK? NZ?) used to practising in this way, passionate about the benefits for women.

Two small midwife teams exist at my own current hospital and the birth centre is still hugely popular, places still allocated on a ballot system, important for women to be referred as soon as they know they’re pregnant

A large private practice midwife business in the city is booming, those midwives have visiting rights to hospitals, attend women wherever they end up birthing. Home- birth services are offered too with the bonus of extended postnatal care in the home.

Private obstetrician’s and midwives work together in some hospitals offering continuity , a win:win if you want private OB care and also to know your midwife

I like this idea from midwife Jo Hunter about funding

Give the funding to the woman so she can then choose which way she wants to go? Whether she chooses to pay for a home birth , chooses to pay for a hospital birth , chooses to go to a birth centre , chooses an obstetrician , chooses a private obstetrician. That will enable her to have the power – exactly where it should be

Jo Hunter

Take my hat off to the dedicated, energetic midwives who’ve provided this kind of service, many for years, ultimately it wasn’t for me, after three years I left burnt-out, working as community postnatal midwife for a few months before my own first baby was born.

When he arrived my priorities flipped and when it was time to go back to work again I had to figure out a plan.

If you’re an RN/RM (Australia) who likes working at the clinical coalface but can’t tolerate shifts or night-duty and don’t feel the need to be part of a team (soooo many positives!) the choice of casual or agency work is a great option. Not for everyone but it’s worked for me and my family 😊

Lindsey Crossan Registered Nurse/Midwife