The core attractions of midwifery – professional independence, the joy of birth and long-term patient relationships – can make it a compelling career shift for registered nurses.

NSW Health’s MidStart program allows RNs to retrain as registered midwives while maintaining paid employment.

The RN is employed as a student midwife in a public hospital – usually on a 12-month contract, typically working 32 hours per week.

At the same time, the RN enrols in a postgraduate midwifery programme (usually a graduate diploma or masters).

The RN is supported on the job by educators and mentors and gets one day off a week to focus on university studies.

Coffs Harbour Hospital Branch Secretary Amanda Bailey-Derrett worked as a RN for about nine years before moving to midwifery. It was always her intended career, and she pursued nursing as a stepping stone until MidStart became available at Coffs Harbour Hospital in 2020.

“MidStart was an excellent program, and we were really well supported,” she said.

“Overall, I think MidStart has been a success. We’ve always got a few MidStarts coming through at our hospital.”

Amanda said midwifery can offer a broader scope of independent practice compared to nursing. “Nursing is largely driven by medical directives whereas midwifery is more autonomous.

“Midwives consult and refer if necessary based on set guidelines and only need to escalate to the medical obstetric staff if there’s a problem.

“That increased scope and independence of the role can be really rewarding. Also, nursing often involves caring for patients during their darkest times, whereas midwifery generally centres on one of life’s happiest times.”

Amanda pointed to another rewarding aspect of midwifery: its ability to enable continuity of relationships, with some mothers returning for second and third pregnancies.

“This continuity is especially rewarding in continuity-of-care models, where a midwife supports a woman throughout her pregnancy journey.

“Midwifery is not confined to a hospital setting and has a strong presence in community-based care.

“In the Coffs Harbour area, for instance, opportunities include private practice midwives helping with home births, women’s health clinics, antenatal clinics, and postnatal home visiting services.

“Some other areas also run publicly funded home-birth programmes”.

Amanda said career advancement in midwifery follows a trajectory comparable to nursing, with roles in education, clinical midwifery specialist positions, endorsed midwife status (similar to nurse practitioner level), and management roles.

She said some MidStarts “have not always had the best experience because the amount of support they get can depend on the service and it can be really varied”.

She explained that MidStart nurses are supernumerary when working in the birthing unit and antenatal clinics – the areas most critical to their learning.

“When staffing shortages arise, they are often pulled to the postnatal ward or the special care nursery, where they are not supernumerary.

“This can disrupt their ability to gain the necessary clinical experience and really highlights the need for a consistent approach to the program across the state.”