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Australian midwives' frustrations

A recent request on the ozmidwifery mailing list (anyone can join in this fantastic conversation between midwives and others) asked midwives about their frustrations with their work. The response was quick and extensive. Many midwives responded, often with similar gripes, sometimes relating to where they worked in a regular labour ward, a midwifery service (team, caseload or midwife led unit) or due to their geographical location (city/rural).

I thought I would share some of these with readers because midwives I meet in other countries often think that the conditions they struggle with are unique to them, when in reality midwives the world over often share similar situations. Australia may be seen as progressive in many ways and it is true that we have a number of birth options available for women, many more than we had ten years ago, for example. Expanding these services, and making sure they are immune from political whims is a constant battle requiring vigilance and dedication. The age-old territorial struggles between obstetricians and midwives also continue, and no doubt will be a feature of the maternity services landscape for years to come.

Here are some of the issues frustrating Australian midwives:

In Hospitals

• Outdated policies
• Policies based on some, often unknown, persons preferences and not on best practice
• Staff who do not keep their skills/knowledge up to date (Midwife)

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• I hate the language used in the hospital where I work: "will try to breastfeed", "Has lost nearly 10 percent".
• Women who appear to expect things to turn out badly.
• The constrained role of the midwife and lack of belief in all going normally. It too often seems staff are looking for problems rather than emphasising positives. Where I work that means both midwifery and medical staff.
• I loved having babies and breastfeeding, it was truly enjoyable and gave me pleasure. Here the women come in expecting grim times ahead. Perhaps while expectations are so low this will continue. I relish when I get to meet pregnant women and talk of parenting and birth in a positive light, as it seems so rare these days.

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• the lack of respect for the role of the midwife
• the practice of non - evidence based medicine
• that we are teaching student midwives to work in this way

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• lack of evidence based practice
• lack of trust in women's body/birth
• lack of autonomy as a midwife

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• The word 'allowed' should definitely NOT be allowed. Since when has any medical professional ever had the power or the gall to allow, or disallow a woman to do something? They have somehow mistaken their role as advisor or guide, for role of rule maker and enforcer. This awful paternalism by (mainly male) Dr's and carried through by(mainly female) midwives, and disrespect shown to women at a time of their lives when they are doing the very thing that qualifies them for womanhood, is just sickening. The implied power and control that telling someone that they are or aren't allowed is criminal.
• Condescending 'talks' used to manipulate women and their partners into capitulating for the greater good... The "martyr" talk, the "you've got a big baby" talk, the "you'd better have some pain relief now, you're not really coping talk", the "you wouldn't want to put your baby at any risk" talk (as was said, there is no situation without risk), the “don't be a silly girl now” talk...do I need to go on? I've even been witness to the "you're a selfish bitch" talk, in those very words to a teenager who wouldn't consent to antibiotics because she was of unknown GBS status...makes me want to cry. None of us have the right to talk
• Our inability as midwives to band together, get some professional backbone and see [how] all the awful divisive, nasty, bitchy, horizontal violence we throw at each other because of our different vested interests means ultimately our inability to see the woman as a self determining and intelligent human being [who] deserves to be given the information. The AMA [Australian Medical Association] will never have to put too much effort in keeping us in check, we do it for them.

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Birth Centre

• Lack of professional indemnity insurance for midwives
• Horror stories. Young women are so scared to birth because........
• Lack of trust in women’s bodies to birth without epidurals and other interventions

Small rural hospital

• Unnecessary intervention, eg induction for post-dates such as 7 - 10 days past due date (usually ends up with the well-known cascade), or augmentation of labour instead of waiting (also usually ends up with epidural and assisted "delivery".
• Lack of belief in women's bodies to do what they are designed to do, both by doctors and midwives (linked with the above item).
• Use of CTG's in a low risk unit despite evidence to the contrary.

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• My first thought is the excessive number of ultrasounds done. We can have women booking at 12 weeks and they have already had 2 or more for no discernable clinical reason. So many think it is ok etc and ask for more as the pregnancy goes on.
• My next thought is the word “need”. You need this intervention, you need that intervention etc, etc. Similarly “have to have”.
• Related to the above is the expression some women use "they gave me" a c/s or some other intervention. Like a present. Like something nice.

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Home birth

• professionals who don't appreciate that the woman has a right to chose, her care provider her birth space and how her birth happens. Regardless of risk, as long as a woman is well informed and has chosen the set of risks she wishes to accept ( because nothing is without risk), it is our role as midwife is to be with woman, not judge them or try to control them.
• People who make sweeping untrue statements to intimidate women into a choice they think is acceptable or who advise care based on policy and guidelines instead of evidence based research.
• People who think that all the crap we dish out we did because the woman wanted it or asked for it or it was their own lack of education on birth that lead them into this trouble. In reality in an ideal world why should women have to arm themselves with reading education, and a doula before going to birth their baby? Why can't they just believe they can do it and go and rely on the system to hold the space for a great birth?
• I have one more. I get so frustrated that people think homebirth midwives are mad lefty hippy's when in reality we are well educated professionals with passion and conviction to stand up for what we know to be right and support women to birth gently and safely. The hospital system treats us with contempt and advocating for women rights, even if it's not the system’s decision or even the best decision, is what all midwives should be doing.

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There are some powerful feelings being expressed here. It is important to find a means to express these frustrations as this is a first step to finding some solutions. Some of these issues will be addressed at a forthcoming conference to be held in Melbourne from April 27 - 29. The program for the Australian Birth and Post-natal Services Conference lists a number of speakers who will offer their experience from the business and political worlds in an effort to explore new ways of promoting midwifery, implementing better services and surviving the struggle. I will be there, to speak and meet people and perhaps I will some of my readers?

Posted by andrea at April 04, 2007 02:13 PM