clinical practice
Are you worried about the outcomes of children who were born during the pandemic , and mothers and their mental health ? We know that women who had a baby in 2020 , post-March , had a lot more stress and anxiety .
And we know that for many women , instead of having face to face care a lot of the care was on the phone . There was a whole lot of anxiety for women around the time their babies were being born : would their partners be allowed in , would their support people , their doula be allowed to come ?
And then also in that postnatal period and more importantly when women went home , a lot of women missed out on child and family health visits from nurses in those early days and weeks because services were shut down .
So we are worried about all of that . We ’ re certainly concerned about mental health and some of the surveys that have been done at the moment are showing higher mental concerns around women ’ s mental health and families . Whether they are longterm impacts we don ’ t quite know yet . There have been some reports from other countries about higher rates of stillbirth but lower rates of preterm birth .
The prevailing theory for preterm births was that lockdowns forced women to actually rest . Is that still the thinking ? It ’ s quite possible that women rested and didn ’ t run around so much . But they also weren ’ t exposed to other pathogens – less flu , less whooping cough . That ’ s perfectly feasible , but the increased stillbirth , we haven ’ t seen it in Australia across the board from what we know so far . They certainly have in other countries because women did not access care when they should have . But we do know that the mental health and social support issues have been hugely concerning . There have been some upsides . We know from the research and particularly in that postnatal period after women had their babies , things are very quiet in hospitals . There are not people rushing around , there ’ s no visitors ; it ’ s all very quiet and peaceful . And a lot of women really like that .
Partners stayed at home because everyone was working from home , so many women have told us that actually those early weeks and months were lovely because they were home together .
And we don ’ t know what the long-term impacts are of the negative or the positive side . What we want to do is to try and work out how to keep the positives and get rid of the negatives .
Give us a brief rundown of your career . I trained as a nurse at the Royal Brisbane Hospital in Queensland in the days where we were sort of apprentices – we worked on the wards .
I wore the big funny hat for first year , and at the end of that year we had a big protest about a parking lot that wasn ’ t going to be built and we wanted it built for safety . And so , we burned our hats . We were very rebellious , and we refused to wear them ever again .
It was a bit sad because the status at the time was you got a stripe on your hat the more senior you became and I ’ d just got my first stripe so I thought I was terribly special .
Then I came to Sydney and I worked as a nurse for five years , I guess , and then decided to do midwifery . And I did midwifery at the Royal Hospital for Women in Paddington and I really loved it .
Not long after that I went to Africa and worked in a mission hospital in Malawi . After I came back I worked at the Royal in the labour ward for a couple of years and then went into research .
So I ’ ve been doing research for about 20 years , but for almost all of that time , until about two years ago , I still provided clinical care to women , mostly through St George Hospital in Sydney .
When you ’ ve become a midwife or a nurse your capacity to make a difference to one person at a time is huge . You can make sure that a patient or in my case , a woman having a baby , has the best experience possible . But for me , ultimately , one woman at a time wasn ’ t enough . I needed to be able to influence the care for more women at once . So education and research enables you to start to change the service delivery , change the model of care , change the experience that women get at a broader level .
How have you seen the role of the nurse and the midwife evolve over your career ? The big shift in Australia over my career is the recognition that nursing and midwifery are separate professions . We ’ re happy to walk alongside together and some people like me came from nursing and went into midwifery . But the big shift , basically in the last 15 years , is to recognise the two disciplines and enable people to become midwives without already being nurses .
These days I ’ m not registered as a nurse , although I ’ m a very proud former nurse , because I can ’ t demonstrate competence as a nurse anymore . It ’ s been so long since I worked as a nurse , I just couldn ’ t , I wouldn ’ t know anything about anything .
So it ’ s safer for the public that people like me aren ’ t registered as nurses , but I ’ m safe to be registered as a midwife . I ’ m a perfectly capable midwife . But that ’ s been a big shift , that took national law changes a decade ago to understand the distinction .
The other big shift has been the recognition that midwives can be a welleducated profession who can look after women without having medical doctors telling them what to do .
Now we have midwifery models of care where , if they ’ re well and healthy , women can be cared for by midwives throughout their pregnancy , labour and birth and after they have their baby without needing to see a doctor .
And we ’ ve seen fantastic midwifery models of care across the country , in every state and territory , very innovative ways of delivering services in the city and in rural areas and in remote settings now in Aboriginal and Torres Strait Islander communities .
And I think the recognition that every woman needs a midwife and some women need a doctor too has become much clearer in the last decade . And that ’ s an important mantra , I think , that we ’ re not saying we ’ re better than doctors ; we ’ re not , we need doctors , we need to work with them to make things better for women .
What do you see as important areas for the profession ? I think in Australia it ’ s this notion of what do we take from COVID going forward ? How do we build maternity services to be better ? If women liked the peace and quiet in maternity wards and the quiet time at home , how do we make sure that ’ s normal ? I think more broadly across the profession we need more women to have access to midwifery continuity of care . We ’ ve now got really good evidence showing better outcomes if women have midwifery-led continuity of care , and it ’ s really time that every woman in the country had an opportunity to have that .
And we haven ’ t managed to make that happen . It ’ s probably somewhere between 10 to 20 per cent of women have that opportunity now – it needs to be 80 per cent or 90 per cent . ■
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