October 7, 2026

maternity

First steps taken to transform midwifery and maternity care

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Staffing ratios in public hospital postnatal maternity wards have been welcomed by the NSW Nurses and Midwives’ Association (NSWNMA), as part of key improvements to rebuilding the midwifery workforce.

Safe Staffing Levels (SSL) in dedicated postnatal wards will help to ensure safe care is delivered to women and babies, with staffing levels of one to every three women at seven dedicated postnatal wards including Royal Hospital for Women, Campbelltown, Liverpool, Nepean, John Hunter, Royal Prince Alfred and Westmead Hospitals.

Alongside SSL in those units, the NSW government has announced the appointment of the state’s first Chief Midwife, Donna Garland, who has dedicated more than 30 years to the midwifery profession.

NSWNMA General Secretary, Michael Whaites, said the union had long advocated for the crucial leadership position.

“We look forward to working constructively with Ms Garland in her new position as the inaugural Chief Midwife for NSW. This role was a key recommendation in the Birth Trauma Inquiry report, so we are thrilled to see it fulfilled,” said Mr Whaites.

“This pivotal role will help to strengthen and advocate for the profession at a time when it is facing significant workforce challenges.

“Midwives have been calling out for three systemic changes: improved leadership, improved workloads and improved pay. Today we can see we are making progress, bringing the change that is needed.

“We welcome the NSW government’s implementation of staffing ratios in public sector postnatal maternity wards. It is a key mechanism to rebuilding and transforming the midwifery workforce and maternity services.

“Safe staffing ratios will help improve workloads and reduce the high rates of burnout our members are experiencing because of understaffing and under-resourcing.

“It will allow members to practice in a safe and nurturing environment and provide the best possible care to women and newborns, which leads to a stronger healthcare system.

“Alongside ratios, increased pay and significant investment in midwifery and midwifery-led continuity of care models are critical to improving outcomes and fixing the staffing crisis in maternity.”

NSWNMA Assistant General Secretary, Katrina Bough, said this phase of the SSL rollout would build on the ratios already introduced in public emergency departments.

“The NSWNMA has been campaigning for ratios for more than a decade, so we are extremely pleased to see the next stage of this crucial reform taking shape,” said Ms Bough.

“It follows the implementation of nurse-to-patient ratios in the majority of Level 6 to 3 emergency departments across the state.

“We know maternity services, particularly in regional and remote areas, have been under enormous strain in recent years, with a lack of midwives and obstetricians available. We hope to see ratios extend to these areas in the future.

“We look forward to working collaboratively with the government to ensure the rollout in postnatal maternity wards is a smooth and successful process.”

Seeing the same midwife or doctor in pregnancy and labour reduces the risk of birth trauma

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Every pregnant woman wants to deliver a healthy baby. During labour and birth, women also want to feel listened to and respected, and to come out of the experience physically and emotionally well.

But around 28% of Australian women describe their most recent birth as traumatic.

Birth trauma can include fear for their life or their baby’s life, a loss of control, damage to the perineum or pelvic floor, disrespectful care, or mistreatment from health care providers.

Our new research paper examined birth outcomes and both physical and psychological experiences of women and babies who experienced five different types (or models) of care in Australia during the COVID pandemic.

We found that seeing the same midwife or team of midwives was associated with lower rates of intervention and birth trauma, compared with standard care.

And for some women, private obstetric care also led to lower rates of birth trauma than standard care in the public system. Let’s take a look.

Five main models of care

Most Australian women receive standard public care or GP shared care.

In standard public care, women see rotating hospital staff (midwives, obstetricians and at times, trainees) throughout pregnancy and often give birth with a midwife or doctor they’ve never met.

GP shared care is when there is an arrangement between a GP and hospital. Women see their GP most during pregnancy and hospital staff for some antenatal appointments. The GP doesn’t usually attend the birth, except in some rural, remote regions.

In continuity of care models, one or a small number of midwives and obstetricians deliver the majority of the care before, during and after birth. This includes continuity of:

  • midwifery care in the public system
  • private obstetric care
  • private midwifery care.

When given a choice, women favour continuity of care models.

What our study found

Our study looked at the experiences of 3,682 Australian women who gave birth in 2020 and 2021.

Compared to women who had standard care, we found that those who had continuity of midwifery care (through the public system or a private midwife) were:

  • less likely to be induced or have an oxytocin drip to speed up labour
  • much more likely to have a vaginal birth
  • more likely to have the midwife visit them at home after the birth
  • less likely to have a caesarean section
  • less likely to have their baby admitted to special or neonatal intensive care or receive formula in hospital when they had chosen to breastfeed
  • half as likely to describe their birth as traumatic.

These differences were seen even after adjusting for differences in the groups that could affect outcomes, such as women’s age, medical risk, education, employment status, country of birth, income and mental health.

These findings line up with decades of evidence. A 2024 Cochrane review of 17 randomised controlled trials found midwifery continuity of care models reduce some birth interventions, including caesarean section, forceps and vacuum birth, and episiotomy (surgical cut to the perineum).

Our study also found that while women who had private obstetric care had higher rates of birth intervention, they had lower rates of birth trauma when compared to standard care. There was no difference in outcomes for the baby, such as admission to special care or neonatal intensive care.

This suggests when women’s choices align with their care provider’s philosophy, outcomes are better – even if intervention levels are higher. Some women seek, or are not concerned about, increased obstetric intervention. Continuity itself, regardless of who the lead health care professional is, reduces birth trauma.

What are the study’s limitations?

As with any study there are limitations. This study relied on women reporting their labour and birth outcomes, so there could be difficulties with recall that affected reporting of some health risks and other important information.

A high proportion of women responding (86%) were born in Australia and spoke English at home (92%) and only 2% were Aboriginal or Torres Strait Islander, meaning the diversity of the Australian population is not represented.

We did not examine stillbirth or neonatal deaths as all the women responding to the survey had a live baby. So people still could have had those experiences but they weren’t captured in our data.

Why does continuity of care make a difference?

Continuity gives women a stable, familiar guide who knows their story, understands their concerns and advocates for them when the system is under strain.

It also allows for the kind of personalised care women consistently say they want and which midwives wish they could deliver more often.

Nearly half of all models of care (49%) have a midwife as the designated carer, with 16% having midwifery continuity of care throughout the maternity period.

However, midwifery continuity of care models are more common in urban centres and can be harder to access in rural and remote areas. Even in urban centres, not everyone who wants to access them can. The popularity of these programs means they fill up fast and many women miss out if they don’t book in when they are first pregnant.

Private obstetric and private midwifery models of care come with out of pocket costs and are not available everywhere. There are few private midwives and many struggle to get admitting rights into hospitals like doctors have.

The recent New South Wales Birth Trauma Inquiry recommended expanding continuity of care models to help reduce the high rates of birth trauma in Australia. Our study shows that this could make a significant difference.The Conversation

Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University; Hazel Keedle, Associate Professor of Midwifery, Western Sydney University, and Kingsley Emwinyore Agho, Professor of Biostatistics and Global Health, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

‘I’m dreading birthing in such a system’: what Indigenous women globally think of birth care and what they’d like to see instead

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Pregnancy and having a baby can be a special time. And families want to feel safe and trust their maternity care.

But when we reviewed the evidence, we found many Indigenous families globally face unfair treatment during pregnancy and birth. This can include racism, neglecting cultural aspects of their care, or using health care poorly designed to accommodate their needs.

We found similar themes in research involving more than 1,400 Indigenous women, Elders, fathers, family members and health workers from locations including Australia, New Zealand, Canada, the United States, Greenland and Sápmi (parts of Norway, Sweden, Finland and Russia).

Many Indigenous families felt disrespected. They said hospital staff often didn’t understand their cultures or give them basic rights during their maternity care, such as being listened to, included in decision-making, or giving informed consent.

As a result, some families felt hesitant to seek care in mainstream hospitals. As one Indigenous woman told us during recent Australian research submitted for publication:

I’m dreading birthing in such a system.

But there are alternatives.

What can hospitals do?

There is a clear need to improve birthing services and cultural safety in mainstream hospitals with a focus on respecting the beliefs, practices and traditions of all families, including Indigenous ones.

For example, many Indigenous families view childbirth as a communal event with extended family support. But hospital policies that limit the number of support people often disregard these important cultural practices.

Indigenous families also need to get the type of health care they trust and feel comfortable with. Ideally this might involve staff with sound cultural knowledge and who can support families clinically in a culturally safe way.

Aboriginal patient liaison officers are sometimes available in hospitals or health services. But there are not often enough, they have to service entire facilities, and they provide cultural support not clinical patient care.

Indigenous families may also want to access a specific type of care. One example is “continuity of care”, where the same midwife or a small team of midwives, supports the family through the whole pregnancy. Ideally, these midwives should be Indigenous or, if not, be trained in supporting Indigenous families with respect and understanding.

What is ‘birthing on Country’?

For Indigenous women living in rural and remote areas, being sent away from home to give birth in a city hospital can be really hard.

Sometimes women and families are evacuated from their home communities and have to stay for weeks or months in temporary accommodation in the city, both before and after birth, or if their baby is born pre-term and needs extra care. This temporary accommodation can be far from the hospital.

All this takes place in unknown cities and towns, without family support, and sometimes away from their other children cared for by the community back home.

This makes it harder for mums who need extra support, and can get in the way of starting breastfeeding and bonding with their baby.

Again, there is an alternative. For many Indigenous families, giving birth is not just about having a baby. It’s also a spiritual and cultural event that strengthens their identity and connection to Country. A “birthing on Country” model of care, which respects Indigenous traditions and knowledge, reinforces that.

This is midwife-led care designed for and with Indigenous communities. It doesn’t mean you have to birth in rural and remote spaces, but it is a model of care that focuses on culture, and can also be implemented in the city.

Ideally, families would see the same midwife or team of midwives and use the “birthing on Country” model.

What else can we do?

Maternity services can be led by Indigenous people, which many women prefer. But Indigenous staff make up about 3.1% of the Australian health workforce.

So it is crucial to engage non-Indigenous staff in building relationships and to support Indigenous families in their right to receive culturally safe care.

This can start with better training for staff, not only to understand and respond to an Indigenous person’s individual needs, but to know when and how to speak up, call out or report racist or disrespectful behaviour.

This is everyone’s problem

A health system you can trust should be safe for everyone. If some people feel unsafe or face discrimination when getting care, this not only affects them, it affects everyone.

For instance, when Indigenous women avoid or delay going to the hospital because of past bad experiences or discrimination, it can lead to health problems that could have been prevented.

This not only harms the women, it puts more pressure on the public health system, which affects us all.

By talking about these issues, we hope all Australians begin to care about the safety of all women during pregnancy and birth.The Conversation

Nina Sivertsen, Associate Professor, College of Nursing and Health Sciences, Flinders University; Susan Elizabeth Smith, Researcher in Aboriginal and Torres Strait Islander maternal health and wellbeing, Flinders University, and Tahlia Johnson, Lecturer and researcher, College of Nursing and Health Sciences, Flinders University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Urgent action needed following Birth Trauma report

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The NSW Government has failed to recognise the urgency of the midwifery workforce crisis, after releasing its response to the recommendations of the state’s first Birth Trauma Inquiry.

The NSW Nurses and Midwives Association (NSWNMA) welcomed the state government’s support of 42 of the 43 recommendations but was disappointed by the lack of immediate and proactive measures to improve workforce challenges and maternity care.

NSWNMA Assistant General Secretary, and midwife, Michael Whaites, said the state government needed to focus on fixing the midwifery staffing crisis.

“Midwives strive to deliver the best possible care to women and babies in a system that has been chronically understaffed, under-resourced and neglected for far too long. This cannot continue any longer,” said Mr Whaites.

“The government must recognise poor pay and conditions are driving the severe staffing shortages and as a result, there’s an inability for midwives to intervene.

“The government is refusing to acknowledge the pivotal role of midwives and the centrality of midwives to the solutions. There needs to be significant investment into the midwifery workforce, because if the government doesn’t act to address these staffing shortages, the ambition of the Maternity Care Blueprint will not be recognised.

“We need to see competitive rates of pay and a staffing model with the appropriate skill-mix. We continue to advocate for safe staffing ratios in maternity with one midwife to every three women in postnatal wards.

“It’s pleasing to see the government recognises the importance of midwifery-led continuity of care models and is committed to increasing access to these care models, as well as improving support for women with postnatal debriefings.

“It’s evident that the government cannot sit on its hands any longer. It must urgently act to stem the loss of midwives, if it is serious about improving maternity care for women and babies in this state.”

First Nations women are at greater risk of stillbirth. Here’s why – and what we can do about it

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Australian national data show First Nations women face almost twice the risk of stillbirth or “sorry business babies” compared to non-First Nations women.

To address this inequity, Australia’s national stillbirth action plan focuses on ensuring culturally safe stillbirth prevention and care for First Nations women.

But first, we must understand the underlying reasons for the ongoing disparities in stillbirth rates and other pregnancy-related outcomes.

We argue much of the inequity can be linked to the ongoing impact of colonisation on First Nations women and birthing. Here’s why.

Ongoing intergenerational trauma

First Nations people have lived in Australia for at least 65,000 years. Prior to European invasion and settlement in 1788, more than 2,000 generations of First Nations people lived in connection to family, community, Country and their ancestors.

Colonisation saw First Nations women stripped of their traditional pregnancy and birthing practices, including use of medicinal plants, techniques for active labour and pain control, and songs for labour.

From the mid-1800s to the 1970s, First Nations babies and children were forcibly removed from their communities and placed with non-First Nations families.

Loss of land, violence and abuse, medical experimentation, cultural suppression and other systemic injustices have led to widespread intergenerational trauma that contributes to poorer health outcomes today.

Intergenerational trauma described in four minutes (The Healing Foundation)

Maternity services aren’t designed for First Nations women

Historical violence and exclusion have led to an intergenerational distrust of colonial systems, services and spaces among First Nations people. First Nations people have been expected to adapt to a Western health service, rather than these services adapting to First Nations people’s ways of knowing, being and doing.

There is also a shortage of First Nations health-care workers. This further limits First Nations people’s access to culturally responsive care.

Recognition of the importance of Birthing on Country has led to services like Waminda and Birthing In Our Community.

But there aren’t enough of these services for all First Nations women. And barriers to setting up the services persist.

Resources aren’t designed for First Nations women

Pregnancy information resources have historically been designed for a colonial audience. These resources do not speak to First Nations women and have rarely been developed by and with First Nations people.

More contemporary initiatives have better engaged First Nations people in, or have them lead, resource development.

The Centre of Research Excellence in Stillbirth’s Indigenous Advisory Group recently led the development of the Stronger Bubba Born pregnancy information website and resources for First Nations women. The information is the same as that given to non-First Nations women, as part of the Safer Baby Bundle, but it has been culturally adapted for its target audience.

Stronger Bubba Born introductory video (The Stillbirth Centre of Research Excellence)

Racism and discrimination in maternity services

While some First Nations women face overt racism in maternity services, many more are discriminated against through implicit biases. This is where care providers’ unconsciously held beliefs about First Nations people influence their judgements of and interactions with pregnant First Nations women.

Active stereotypes that are commonly applied to pregnant First Nations women include assuming drug and alcohol use and a perceived unsuitability for motherhood. This stems from the historical marginalisation of First Nations people.

But implicit bias isn’t the only source. Institutional racism also contributes to worse health outcomes among First Nations women. It occurs because of embedded structures or policies that perpetuate racial disparities, and it often goes unnoticed by non-First Nations midwives. Institutional racism plays out in various ways, including restrictions on the numbers of family/support people able to visit.

All of this leads to power imbalances and First Nations women being less likely to attend antenatal appointments.

Providers don’t understand First Nations health

The Australian First Nations view of health differs from the Western view. Connection to family, Country and community defines First Nations people’s health, rather than illness, disease, and notions of “risk”.

Physical, spiritual, cultural, social, emotional and mental health are interconnected, and land is a source of strength, identity and healing.

These concepts form the foundation of Birthing on Country and underscore the importance of self-determination in providing culturally responsive maternity care.

Yet maternity care providers have limited knowledge of First Nations women’s cultural needs and little education and training on this.

Where to from here?

To eliminate racial disparities in stillbirth rates in Australia, our health system and broader society needs to recognise the effects of colonisation and the structural forces that continue to influence First Nations people’s health.

This requires acknowledging and sitting in discomfort with Australia’s history.

The Healthy Yarning Guide is a workshop based on two-way learning and yarning for non-First Nations maternity care providers and maternity service administrations.

The workshop aims to empower people to sensitively discuss stillbirth prevention with First Nations women. Participants learn about Australia’s history and the effects of colonisation in First Nations women and birthing, as well as what culturally responsive care looks like for First Nations families.

We have a long way to go in ensuring First Nations women and families receive high-quality, culturally responsive maternity care. But formal education within maternity services is a crucial place to start.

In this article, we use the term “First Nations” to refer Aboriginal and Torres Strait Islander people in Australia. We acknowledge there is variation in preferences for the terms “First Nations”, “Indigenous” and “Aboriginal and Torres Strait Islander”.The Conversation

Deanna Stuart-Butler, Indigenous Research Officer, The University of Queensland; Aleena Wojcieszek, Clinical Perinatal Epidemiologist, The University of Queensland; Sarah Graham, Epidemiologist, Mater Research Institute, The University of Queensland; Valerie Ah Chee, Indigenous Research Midwife, Stillbirth Centre of Research Excellence, The University of Queensland, and Vicki Flenady, Professor, Mater Research Institute; Director, Centre of Research Excellence in Stillbirth, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Women want to see the same health provider during pregnancy, birth and beyond

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In theory, pregnant women in Australia can choose the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs.

While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:

  • GP shared care, where the woman sees her GP for some appointments (15% of births)
  • midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
  • private obstetrician care (10.6%)
  • private midwifery care (1.9%).

Given the choice, which model would women prefer?

New research, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.

Surveying 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.

The survey analysed comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.

Overall, they found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths.

What women thought of standard maternity care in hospitals

Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care.

Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system.

The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days.

Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:

The experience was very impersonal, their focus was my cervix, not preparing me for birth.

Why women favoured continuity of care

Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals.

Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.

The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:

“Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).”

However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the cost and the small numbers working in Australia, particularly in regional, rural and remote areas, among other barriers.

Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments.

This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.

However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor.

What about shared care with a GP?

While shared care between the GP and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care.

Considering there is strong evidence about the benefits of midwifery continuity of care, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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