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

1995. I’d emigrated from Scotland to Australia, my first job in a private maternity hospital was confronting, the routine, unnecessary interference in labour and birth I found awful. I couldn’t stay.

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

A job came up on a pilot Midwifery Continuity Of Care (MCOC) scheme within the hospital, I jumped at the chance. Four midwives booking 16 women a month, antenatal, early labour and postnatal care all at home, birth in the hospital then home again in six hours, if the woman 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 a lovely way to work, the power dynamic different too, invited into their homes as a guest, replacing conveyor belt antenatal clinics.

Another important benefit, minimal disruption for women labouring in the comfort, privacy and dim lighting of their own home, the optimal environment for birth hormones to work, visits from us reassuring or confirmation birth was close, time to go to hospital!

The 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?

Paging husband answered the door, led me through to a dimly lit bedroom, woman in the ensuite shower, calm, in the zone.

Thought she might still be in early labour but 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, small tear stitched, tea and toast given then back home after the requisite six hours, a brand new family on cloud nine!

This first perfect birthing scenario, affirming for me and a reminder 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 have support by a care provider they’ve come to know, who’ll be with them at the birth but Australia’s mix of private/public/GP-shared care is confusing, a postcode lottery particularly if MCOC, birth-centre or private midwife care is wanted. Women in rural areas really miss out.

For some women, choosing a medical expert to make their pregnancy decisions, take charge, feels safest, optimal. Maybe the prospect of labour pain is terrifying, they want the choice of epidural asap.

Those were not the women we attracted.

Women who didn’t want to follow rules, routine guidelines or hospital policies came to us. A relationship with a known midwife was particularly important, especially for those with anxiety or trauma from a previous birth or 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, 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 needed was a little TLC, a midwife in the vicinity to reassure, to help them continue under their own steam.

Our 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 belly dancing hippy mama, so calm, remember the swaying stopped, the letting go of her husband, whispering baby was coming, walking over to the bed, climbing up, birthing baby into her own hands.

The 8yr old big – sister – to – be, 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.

A twin pregnancy, the woman’s second, both babies head down, she insisting on no IV or continuous monitoring, standard hospital recommendations.

White-haired Consultant in the room unfazed, registrar on edge, antsy, annoyed policy wasn’t being followed, annoyed with me (common vibe) disrespectful of the innate strength, resolve and ability of the woman herself.

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

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

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

Another time checking a woman 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 was already born, in ambulance on way to hospital! Oops!

Initially on this MCOC journey I attended lots of smooth problem-free births then eventually had a run of the more challenging, something always going wrong and despite knowing my practise was good, hard not to take personally.

One baby needing unexpected resuscitation and transfer to intensive care where he stayed for a few days. He was fine in the end and scrutiny of my documentation and care reassuring but my nerves were frazzled.

Next, an imminent birth, a shoulder dystocia, a babies head delivered, stuck at the shoulders, emergency buzzer, room full of people, baby born (will spare the awful details) resuscitated, transferred to special care nursery, the woman haemorrhages. Afterwards, home visits, listening while the she relived and relayed the details over and over.

Several births in a row, women retaining placentas needing surgical removal in theatre. One on night shift, birth-suite heaving, multiple emergencies happening at once, she bleeding, my shaky hands placing an IVC. Where is everyone?

Unexpected huge postpartum haemorrhage, woman had birthed in the shower, blood splashing on the floor leaving a red trail as we walked back over to the bed, emergency buzzer again.

Another woman after labouring for hours, working hard, invested deeply in a vaginal birth, crying, distraught. She needed a caesarean.

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. Much delicate debriefing is needed after.

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

These events all happened over a short period, took a massive vicarious toll. I mean, how could they possibly not?

We debriefed amongst ourselves in the team, no midwifery supervision, no professional support. Nothing.

Tending dead little babies and distraught parents one minute, grocery shopping the next, nothing to see here.

My older, wiser midwife self knows the course of events at births can’t be controlled, it wasn’t about me. The hospital system, it’s guidelines, it’s processes, the dominant birth culture, the woman’s personal story and beliefs all had a massive effect on these births but I blamed myself when things went wrong, jumped off the cliff with women, too invested, boundaries too blurred.

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

The hospital took over when the pilot ended, changes were made, no consulting midwives on the ground (common theme in healthcare) teams became too big for real continuity.

The service disbanded, i was long gone, properly burnt out, left to have my own baby, didn’t look back.

Many years later there’s a thriving midwifery group practice in that same hospital. Two MCOC teams where I work, the still hugely popular birth centre, women referring in asap, places still allocated on a ballot.

Several thriving private midwifery businesses in the city too, the midwives have visiting rights to hospitals, attend women wherever they choose to birth, home or hospital, offer extended postnatal care too.

Private obstetrician’s and midwives work together in some hospitals offering continuity, win:win if private OB care is your choice AND to know the midwife with you for labour.

This, from midwife Jo Hunter

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

Midwives who provide/are providing this kind of service, I admire so much, (most of them wouldn’t have it any other way!) but ultimately, regrettably it wasn’t for me.

When my own baby arrived my priorities flipped. Maternity leave up, I signed on the casual pool of my nearest tertiary hospital. The higher hourly pay-rate but no sick-leave or holiday pay won’t suit everyone, not if you’re a single parent or main bread-winner but luckily worked for me.

Next, my own birth stories.

Lindsey Crossan Registered Nurse/Midwife