Midwife is an old English word that means ‘with woman’ and this sums up the essence of what is recognised as one of the oldest professions in the world. Despite this ancient heritage people are often unaware of what midwives actually do and the pivotal role they play in the provision of maternity care.
Australian Midwives
The earliest midwives in Australia were of course Aboriginals and these wise and respected grandmothers in the tribes passed their knowledge on for thousands of years. During the first years of colonisation midwives arrived as convicts and as free women. Wonderful stories exist of their bravery and dedication. None perhaps was more glamorous than Mary Jane Bennet who was said to wear exotic Spanish clothing and ride a black stallion with great skill in all weathers to assist women give birth. She tied her instruments in a calico nightgown and slung them over her back.
Things have changed somewhat for midwives in the last 100 years. All midwifery education is now conducted at University with midwives obtaining their practical experience by working in a hospital and the community. They have to achieve a certain level of theoretical knowledge and practical skill before they are allowed to register as midwives. Until 2002 you could only train to be a midwife once you had qualified as a registered nurse. Now Australia is coming into line with other countries by offering a three-year Bachelor of Midwifery course, which will enable midwives to enter straight into the profession of their choosing.
Do midwives provide safe care?
The countries where midwives provide the majority of maternity care and have the greatest autonomy as professionals have the best outcomes for mothers and babies in the world (Scandinavia and the Netherlands). In the Netherlands for example 30% of babies are born under midwifery care at home and they have one of the lowest intervention rates in birth in the western world as well as excellent outcomes for mothers and babies. The World Health Organization (1996) has publicly stated that Midwives are “the most appropriate and cost effective type of health care provider to be assigned to the care of normal pregnancy and normal birth including risk assessment and recognition of complications.”
The recently release Systematic Review of Midwife-led care versus other models for childbearing women (Hatem, Sandal, Devane, Soltani & Gates 2008) examined 11 randomised controlled trials that included 12,276 women. The authors concluded that evidence from controlled trials show that women who received continuity of midwifery care were less likely to have a:
• Antenatal hospital admission
• Epidural or any need any pain relief
• Episiotomy
• Forceps and vacuum birth
• Baby dying before 24 weeks of pregnancy.
Women in the midwife-led care were more likely to have a:
• Normal vaginal birth
• Feel in control during labour and birth
• Breastfeed
• Shorter hospital stay for the baby.
Overall there was no difference in the numbers of babies dying after 24 weeks and none of the other major complications of pregnancy and birth showed any difference between the two groups. The author’s conclusions were that ‘all women should be offered midwife-led models of care and women should be encouraged to ask for this option.’ Access to continuity of midwifery care has been confirmed to deliver significant health benefits to mothers and babies, while remaining as safe as standard maternity care systems.
Where do midwives work?
Midwives work in hospitals and the community. They provide care for women during pregnancy, labour, birth and postnatally. Midwives can work as employees of a hospital or as privately practicing midwives. Midwives also pursue many different career paths, employed as: clinical midwives; managers; educators; consultants; researchers and university lecturers. Midwives work in both the private and public health sector.
Midwives Clinics
Most major public hospitals now have ‘midwives clinics’ run by a midwife or group of midwives. They provide complete antenatal care for women who are ‘low risk’. If any problems develop then the midwives ask a doctor to see the woman. Women generally enjoy their antenatal care in a midwives clinic because midwives focus on more than just the physical aspects of pregnancy but on the many important emotional and psychological needs of women. Women also develop special bonds with their midwives during their pregnancy and generally feel comfortable to ask them anything.
Caseload and Team Midwifery
Women have been telling us for years now that what they really value in maternity care is ‘continuity of care’. They like to receive consistent information and care from someone they know and trust. Particularly they want to know the person who will be with them ‘catching’ their baby when it comes. In response to these expressed needs programs like caseload and team midwifery are increasingly being set up. These involve small groups of midwives that work together to provide antenatal, labour, birth, and postnatal care to women. The outcomes from these programs have been excellent and women appear more satisfied with team midwifery than most other maternity care options. Many of the larger metropolitan hospitals now run team midwife programs or continuity of care programs similar to team midwifery. They tend to be very popular so you need to book in early if you are interested in this model of care.
Labour wards
Midwives care for all women in labour and conduct most normal births in public hospitals. It is interesting to note that a study of 170, 000 low risk women in NSW showed that when women were cared for in a public hospital (mostly by midwives) compared to a private hospital (cared for by obstetricians) they had half as many caesarean sections, half as many forceps and vacuum births, fewer interventions such as inductions and speeding the labour up with artificial hormones and much less chance of having a cut to the perineum during birth. Unnecessary interventions into birth potentially carry serious complications for women and their babies so midwives work hard to help women avoid these where possible.
Postnatal care
Postnatal wards are staffed and run by midwives. Due to the fact that women are staying in hospital for shorter and shorter periods many hospitals have set up ‘early discharge programs.’ This enables women who choose to go home in the first 48 hours after a normal birth or within 72 hours after a caesarean to have a midwife visit them at home for up to week after the birth. This program suits women who are well and feel they will be more comfortable and rested at home. All hospitals have slightly different ways of running these programs.
Birth Centres
Birth Centres are now mostly located in hospitals and are staffed and run by midwives. Midwives in Birth Centres try to provide a home like environment and work to support women through pregnancy as well as assisting them to give birth as actively and naturally as possible. If there are any complications during the pregnancy or birth then the women can access other specialist services in the hospital. Women attending Birth Centres are generally very satisfied and achieve a high rate of normal birth.
Private Midwifery and Home Birth
Several hundred women each year in Australia choose to give birth at home. These women are generally cared for by privately practising midwives. These midwives are qualified midwives who work for themselves rather than a hospital. They provide antenatal care, either in the midwives own home or in the woman’s home. They provide labour and birthing care at home, in birth centres or in hospital. They also provide postnatal care for at least ten days and often up to six weeks after the birth. The cost of accessing an independent midwife varies.
Hannah Dahlen Associate Professor of Midwifery at the University of Western Sydney
Tags: Birth Centres, midwives, Team Midwifery
This is why a women’s first port of call when they find out they are pregnant should be a midwife!
I can never understand why healthy low risk women wanting a natural birth, run off and make appointments with private obgyns. They then spend half their pregnancy sitting in their waiting rooms and end up having the birth they didn’t want!
If you live on the Coast and you want a great birth experience, go to Wyong. The midwives don’t keep you waiting and they believe in your ability to birth your baby. Plus you can have a water birth.
Belmont Birthing Service has been incredible for my 3 pregnancies. The water births are fantastic and their care has been beyond expectation. I would recommend them to anyone wanting a natural and safe birth experience.
If you want a natural and happy birthing experience stay well away from Gosford Hospital… they are stuck in the dark ages!