Midwifery
In midwifery, relationships matter
Continuity of care by well-trained and well-remunerated midwives in midwifery group practices leads to the best birthing experiences and health outcomes for women and babies, according to Hannah Dahlen AM, Professor of Midwifery at Western Sydney University.
Speaking to the Association’s annual conference, Professor Dahlen said New South Wales, with the lowest number of midwives per 100,000 head of the population in Australia – 104.3 midwives compared to average of 124.9 Australia wide – is struggling to keep up with other states and territories.
“So, if you think you’re tired, if you think you’re overworked, you are, ” Professor Dahlen said.
“In every country where midwifery as a profession is strong, the outcomes are better. They’re better for the babies, they’re better for the mothers. They’re better for costs and they’re better for quality.”
Professor Dahlen, who has been a midwife for 30 years, cited the World Health Organization’s push for investing in the midwifery workforce because a strong midwifery workforce leads to drastically reduced deaths and improved health outcomes across a range of measures.
A well-resourced midwifer y workforce is “a cost-effective investment, but there’s a startling lack of investment in midwifery, and now is the time to take collective action,” said Professor Dahlen.
“Midwives cannot give quality care when they’re running from woman to woman, room to room.”
NSW is also lagging behind most other states and territories on the model of care that leads to the best outcomes, the midwifery group practice (MGP). Research shows that women who have continuity of midwifery care are less likely to have caesareans, instrumental births and episiotomies, and are more likely to have a spontaneous, vaginal birth and a positive experience during labour and birth.
While the 14 per cent of births occur in MGPs Australia-wide, in New South Wales the figure is 10.9 per cent of midwifery care.
“The most common model of care in Australia is public maternity hospital care, which is fragmented care, followed by shared care with the GP, followed by midwifery group practice caseload care,” Professor Dahlen said.
To make matters worse, a 2019 study of the midwifery workforce found that 42.8 per cent of Australian midwives had considered leaving the profession, or intended to leave, in the previous six months.
“Early career midwives, which are the ones we really need to keep, were the ones most likely to want to leave the profession. And almost half the midwives who considered leaving the profession were most dissatisfied with their managers.”
WOMEN NEED ACCESS TO CONTINUITY OF CARE
It is not surprising the NSW Parliament recently conducted a birth trauma inquiry in NSW, with some 28 per cent of women in New South Wales giving birth experiencing trauma, Professor Dahlen said.
In her submission to the public inquiry – one of over 4000 submissions – Professor Dahlen told Parliament the hearings “were a #MeToo moment for mothers”.
She said the lowest rates of birth trauma, mistreatment and obstetric violence occur when mothers are cared for by “privately practicing midwives, followed by midwifery group practice, followed by private OB care, and then the fragmented care [of GPs and hospital care]”.
“What this shows is relationships matter, and midwife relationships matter the most. This is a huge endorsement for our care.”
Two of the top recommendations of the report that has come out of the New South Wales Parliament birth inquiry are ensuring that all women have access to continuity of care model, and expanding midwifery services, especially in regional, rural and remote New South Wales.
In addition, we must close the gap in outcomes for Aboriginal women, Professor Dahlen said. “If you look at the birthing on country services…where you had continuity of midwifery care, culturally appropriate services and culturally sensitive models, women were more likely to attend antenatal visits, were nearly 40 per cent less likely to have a preterm birth, and they were more likely to exclusively breastfeed on discharge.”
MIDWIVES LEAVING
Professor Dahlen cited recent work surveying 669 members of the MGP midwifery workforce, which found midwives are resigning because of poor work conditions and how the service was managed. Managers, meanwhile, resigned because of the role changes, conflict with their upper managers, limited support, heavy workloads, competing demands and burnout.
“Relationships with women in this survey were absolutely one of the major motivators for midwives. They loved the work. However, work- life imbalance is a deterrent, and it’s exacerbated when you have staffing shortages.”
“We’ve got to stop counting mothers and babies as one. We all know they’re one, but they are not one in workload.”
Better remuneration, improved orientation, and attracting new graduates and students to MGPs also need to be addressed.
We need to “imagine a maternity service where women were at the centre of every decision,” Professor Dahlen said. “A service where midwives would be the number one people, along with you wonderful nurses, that would be protected, promoted and supported.”