Born into our family

Our family, late 1980

Today I would like to share with readers one of my own birth stories, written in 1981, a few months after the birth of my fourth child.  

This account reminds me of who I was then, and who we were as a family.   Although I had graduated as a midwife in 1973, the only serious experience I had had in midwifery was as a mother.  I had maintained my registration by paying the renewal fee each year.  I had done a little teaching as a childbirth educator for the Diamond Valley Childbirth Education Association.   Considering this long period of not practising as a midwife, and my lack of experience after graduation, I feel very blessed to have now, 30+years later, had a satisfying career in midwifery. 

I had forgotten about this account.  It was tucked away in a folder in the filing cabinet, and I discovered it just a couple of days ago.


Born into our family
We arrived at the [Women's Hospital] Birth Centre at about 11 o'clock on that sunny spring Friday morning.  We came complete with books, toys, and food; and proceeded to make ourselves comfortable.

My labour had commenced at 3:30 am, with mild contractions every 10 minutes, and a show.  Although this was my fourth child I felt sure that the labour would progress in much the same way as the others - very slowly.  I went back to sleep until breakfast time.

By lunch time the contractions were still coming every 10 minutes, and only increasing in intensity very gradually.  We were in high spirits, as we knew that our long time of waiting was almost over.  We decided to go out for lunch, this being a pleasant way of passing the time.  We walked along Lygon Street, and chose a little Health Food shop, where we purchased a variety of concoctions packed with super-nutritious foods.  We all felt satisfied and well fed as we followed the meal with frozen yoghurt.

I continued to make progress slowly.  The midwife and her student made occasional assessments of my condition, used abdominal palpation to check the position and progress of the baby's head, and listened to the foetal heart sounds.  Time slipped by easily for me, as I relaxed and enjoyed the feeling of being "at home" away from home.

The afternoon passed slowly for the children [aged 6,5, and 3, and Patti, our American exchange student and special friend], as they found their books and games rather dull after a while.  Their grandparents came to the rescue and took them to a nearby park to play, then gave them tea at the hospital cafeteria.  Noel and I had ordered a salad for tea, and although I ate some I knew I had other work to do very soon.  With each contraction I had to relax my body and concentrate on slow, deep breaths.  By 6:30pm I had had a shower and gladly went to bed.  The position which I found most comfortable was 'on all fours'. with a bean bag on the bed to support me between contractions.   The baby's head was posterior, so the combined effect of taking the weight off my sacrum, and good firm sacral massage which Noel administered with great proficiency, kept the sensations within my range of 'bearability'.  I spoke very little at this time - Noel was working in beautiful harmony with me, and was able to sense my needs from a single word or gesture.  Between contractions I rested completely. I closed my eyes to rest, but was not sleepy.  As each contraction came I concentrated on relaxing with the routine of the rhythmical breathing.  I kept to the slow breathing as long as I could, as I found this the most relaxing, and only built up to the quicker breaths when I needed to .  The children came quietly into the room at times, but did nothing to disturb us.  They showed no anxiety, and a reassuring smile or nod from us sent them happily back to their own amusements.

This intense labour had gone on for about an hour when I began to feel the changes which I knew to be transition.  Sometimes I wasn't sure if I had a contraction or not.  I got the shakes for a while, and I could not find a comfortable position.  This must have lasted for a few contractions - to me it meant progress, and I was glad.

I don't think the midwife really believed Noel when he said I was almost ready.  I had been there all day, and my progress had been so slow - why the sudden change?  Upon abdominal palpation she confirmed that the head really was 'all in'.  While the delivery trolley was being prepared I was sprinting the last lap of the race.  Although I was detached from the surroundings, I was listening closely to my body.  When I felt the urge to push I did my utmost to relax the muscles of my pelvis.  I was comfortably supported by the bean bag in a sitting position, and Noel continued to assist me and control all that went on around me.  There was no heavy breathing or strenuous pushing; just the rhythmical, light, upper chest breathing, with pauses to assist the baby's progress whenever the urge was present.  It was during one of these pauses that I felt the forewaters burst.  That felt good!  I felt the stretching of my old [perineal] scar.  The words 'olive oil' passed my lips, and Noel quickly obtained it from the midwife and was rubbing it on my perineum to help it stretch.  Another of my little pushes, and he was supporting our baby's head.

The rest of the delivery proceeded normally.  The cord was around the baby's neck, so it was clamped and cut.[:-(] The baby was delivered straight onto my abdomen, and we joyfully caressed the beautiful moist little body as he made his first little squawks and gurgles.  The children wanted to know: "Is it a boy or a girl?"  But we didn't know yet - our hearts were too full of thanks and wonder, and we let the minutes stretch out. 

We went home the next day.  Our baby's alert mind, and strong, growing body, have not ceased to enthrall us.  I gladly give as I am able to nourish and care for this little gift from God.

Thinking globally; acting locally

I am struggling with my emotions as I clear the shelves of this room which has been my professional office since I began private practice in 1993.

I am looking at thick, heavy reports, conference papers, sequential journals and newsletters, printouts, folders with copies of significant documents - all with a thin film of dust - and most destined for the recycle bin.  Midwifery, lactation, College of Midwives, Nurses Board of Victoria, and lots more.  I can't possibly transplant the contents of this room to my new home.  Retirement means down-sizing. 

I tell myself it's silly to grieve about throwing out material that has no relevance.  I remind myself that I haven't opened or looked at most of these documents in years - and I'm not likely to, in the next decade.  But I am grieving.  

Think globally, act locally (click to enlarge)

Today I would like to record a little more of what I have learnt and experienced in the past 20 years.


Thinking globally, acting locally
The global terrain of midwifery knowledge in the 1990s nurtured my hungry mind.  I was fortunate to be able to integrate theory and evidence, and apply it from first principles to childbirth and breastfeeding in my own community.

The information age took us from paper to digital communication.  I learnt 'mail merge' to produce addresses printed out on sticky-labels.  Documents and letters were photo-copied and physically mailed out; faxes and overhead transparencies were the mainstay for teaching and disseminating information within professional circles.  These were quickly replaced with email, websites, data projectors, and much much more.

This is my thumbnail sketch of significant midwifery moments from my perspective.  (Readers can use search engines to check details and fill many of the gaps that my imperfect memory will undoubtedly produce!)

World Health Organisation had, in 1985, published the Fortelesa Declaration on appropriate use of technology in birth, followed in the 1990s by Safe Motherhood publications, such as Care in Normal Birth, a practical guide (1996).  Parallel was the WHO-Unicef Innocenti Declaration leading to the Baby Friendly Hospital Initiative, placing emphasis on the protection, promotion and support of breastfeeding as a priority for all babies.

Coming as I did at the time from my own childbearing and breastfeeding years, I was ready to integrate the science (global) with the practice (local).  My husband, Noel, had researched the protective effect of colostrum on the newborn calf and been awarded Masters and PhD degrees for his research in the 1970s.  The literature review included current scientific knowledge on human colostrum and breastfeeding, and the emerging devastating impact of the loss of reliance on breastfeeding, particularly in poorer communities.  My understanding of the finely tuned natural phenomena in childbearing and nurture heightened my commitment to working in harmony with natural processes. 

In those days, many mothers received repeated doses of the synthetic narcotic Pethidine (also known as meperidine or Demarol) in labour, and their babies were born unable to achieve the most basic of physical challenges - effective breastfeeding - and often ingested little or no colostrum.  Babies were separated from their mothers, given dummies (pacifiers) to keep them quiet, nursery care, sterile water, and 'white water' (code for formula - administered with bottle and teat, of course) to give the mother a good night's sleep (with the aid of a sleeping pill).  Nipples were often severely damaged.  Breast engorgement followed: painful, hard and unproductive breasts that quickly progressed to mastitis.


Embedded in the maternity reform agenda of the late 1990s was the development of women's rights in childbirth.  Midwifery, as a profession, could not insist that mothers accept an ideal of umnedicated, natural labour, and the constant commitment of exclusive breastfeeding for six months, with continuing breastfeeding to the age of two years and beyond - unless women, MOTHERS, agreed that this was indeed the best pathway for them and their babies.

The notion of women's rights in childbirth has simmered away without, in my mind, reaching any major breakthroughs.  A competent adult does have the right to refuse any medical treatment.  This ought to be a real winner for women in maternity care, because the fact is that for most women, pregnancy, birth, and the baby's establishment of breastfeeding are able to happen without any outside intervention or assistance.  On the contrary, the principle of non-intervention in such normal physiological processes is actually established as the optimal. 

'Unassisted' childbirth is usually good. From a midwife's point of view it's the gold standard for unmedicated, spontaneous birth. When a midwife completes the statistics form for a birth we check 'unassisted' if the mother pushed the baby out herself.
 
The professional midwife who is in attendance does not necessarily assist. I think it's Michel Odent who said (I don't have the reference) that "One cannot actively help a woman to give birth. The goal is to avoid disturbing her unnecessarily."

Yet too many women today, and 10 years ago, and 20 years ago, will tell you they experienced bullying and coercion in maternity care; that they were told "You must have an induction of labour  ..."  "You must have a caesarean ...."  "Your baby must have this artificial formula milk ..."  It is, and always has been, rare if not unheard of in mainstream maternity services for women to be presented with information and support to make the decision they believe is best for them.  Maternity professionals have learnt, often without consciously recognising it, how to leave a woman no alternative.  "Your baby will die if we don't ..."

Having considered women's rights in childbirth from many perspectives, research, and practice, the only way I can see to reduce the incidence of birth trauma is through expert midwifery practice, together with effective support of women in decision making.  A woman who is working within a reciprocal partnership with a known midwife; a woman who understands the unique and awesome natural processes in the whole birthing-bonding continuum; this woman and her midwife will do all she can to stick with 'Plan A'.  Plans B and even Plan C are available, because medicine and surgery have advanced to the point where there are very few unpredictable situations in which the woman's life, or her baby's life, are truly at risk.

In the past decade I have witnessed the growth of intentionally unattended childbirth, also known as freebirth.  We don't know how many babies are born this way, because some are recorded as 'BBA' (born before arrival).  Some 'freebirths' happen under the watchful eye of unqualified people, including doulas, who probably do not have the knowledge or skill to intervene when even the most common complications arise.   I think this is a tragic development, because I see the role of the midwife as being so basic.

I say this with deep respect for those who have experienced unwanted interference in their birthing processes.  I am horrified that women are giving up the fight too early, and not exercising their right to decline treatment. Others are being swept into an idealism about unassisted, undisturbed birth that they will probably regret later.
 
Women and babies will die in free birthing.  This is unacceptable. Our bodies are wonderfully made, and science as well as experience have taught us about oxytocin and bonding. If that were the end of the story there would be no need for the professional midwife or anyone else. We could just hide in our undisturbed cave and birth our babies in blissful ignorance.
 
Women's rights in birth must come down to principles of safety and access to appropriate interventions in a timely manner.   

The principle that I follow is that there must be a valid reason to interfere with the natural process (WHO Care in Normal Birth 1996) We cannot know ahead of time if a complication (ie valid reason) may arise, even in the least risky situation. If a woman is giving birth unattended she has no idea if she is progressing normally, or not. She needs to minimise neocortical activity as the labour progresses, which means she must stop analysing and assessing what's happening. 

That's the midwife's job.

what have we done, and what's yet to be done?

With a 'for sale' sign in front of my home, and the last new baby in my homebirth caseload safely at her (equally new) mummy's breast, it's time for me to sort through folders and files in my office in preparation for a move.  Brochures, letters, and pictures from those busy days of maternity activism in the 1990s and early noughties have already surfaced, and triggered memories.


Today I would like to present snapshots of a few moments in the past 20+ years.  My story will link to the stories of others who saw the vision for maternity reform across this country.  Dear reader, if you are able, please continue with this vision.  There is as much need today as there was 20 years ago for maternity reform.

Working night shifts at the Women's, 1983

1983 - Snapshot #1

I am a mother with four children, aged 9, 8, 6, and 3.  My time is sucked up by the demands of the children for school, music lessons and practice, sport, Church, community groups, household chores, and the squeakiest wheel that grabbed my attention.  

I am working night shifts - permanent part time, two nights a week - at the Women's in Carlton.

In the mind-fog of tiredness I often spoke to colleagues of my dream that one day I would work with just a few mothers, and be the midwife through the birth and postnatal care at home.  I didn't know the phrase 'continuity of care' back then.  I felt as though I was having one night stands with women, and I wanted something better.

1993 - Snapshot #2

After 12 years of hospital night shifts I have resigned from the hospital, and (aged in my 40s) feel strong and ready for anything now that I am able to go to bed (almost) every night.  I have commenced private practice, joined Midwives in Private Practice (MiPP),  attended my first homebirth, subscribed to MIDIRS, read everything I could put my hands on by authors like Sheila Kitzinger, Michel Odent, certified as a lactation consultant, joined the Victorian branch executive of the College of Midwives, joined and chaired the Victorian Baby Friendly Hospital Initiative, and become a birth activist.

1993 - a midwife with her own private practice!

My children are growing up: the oldest at Uni and the youngest had started secondary school.  They don't need much from me these days.

Through MiPP I have met the women who had become active a few years earlier during the Victorian Birthing Services Review: Irene Shaw, Kerreen Reiger, Karen Lane, Rhea Dempsey, midwives Jenny Parratt, Annie Sprague, Robyn Thompson, Ali Page, Mary McKenzie McHarg, Chris Shanahan, Patrice Hickey, Clare Lane, and others.   I see a role for myself in the College of Midwives, and start writing responses to government reviews.

Victoria had the Midwives Regulations 1985, which said all sorts of things such as a midwife must have a doctor's permission to perform a vaginal examination (one might ask whose vagina?) and that a midwife must wear clean clothes of a washable material! The new Nurses Act came in in 1993, and we thought the Regulations would be set aside - even the lawyers at the time told us that they were unenforceable. But on the night before the new Act was voted on in the Vic parliament, the Health Minister Marie Teehan received a fax from RANZCOG (Vic) insisting that it was not safe for midwives to work without medical supervision. The solution was to retain the Regulations, which is what happened. All Regulations sunset after 10 years, so in 1996 we were released from them (only to be effectively re-regulated under medical supervision with the 2009 Report of the Maternity Services Review). 

In the early 1990s the Nurses Board of Victoria published a very nice Code of Practice for Midwives, based on the International Confederation of Midwives' Definition of the Midwife, which stated clearly that the wellbeing and safety of mother and child were central to all midwifery care, that the midwife was competent to provide midwifery services on her own authority, that midwifery was woman centred, that midwives collaborated with doctors when indicated ...  

Maternity Coalition and ACM ran the Midwifery Campaign, "To achieve for all women the right to choose a midwife as their primary caregiver during pregnancy and birth within the health system (public and private) whether in the community or hospital."

Our vision for maternity reform was inspired by stories from New Zealand: that midwives were able to be recognised as the primary maternity care giver (lead maternity carer or LMC); and that NZ midwives and doctors received equal pay from the public purse for equal work.  At the same time the news of Changing Childbirth reforms in the UK inspired us: that women wanted the 3C's: Continuity, Control, and Choice. 

At that time I dared to dream that Australian maternity care could also be reformed.

2003 - Snapshot #3

the journal of Maternity Coalition

'Push for better birth' 2003 - with the Melbourne skyline in the background.

I am confident in my professional identity as a midwife.  I love being with woman, and writing my stories, and have published The Midwife's Journal on my website.  I love being a leader in Maternity Coalition, and in the College of Midwives, and I have had a 3-year Ministerial appointment to the Nurses Board of Victoria, learning a great deal about statutory regulation and legislation.

In 2002 we published the National Maternity Action Plan in which we dared to dream

that Australian maternity care would recognise the midwife as “the most appropriate and cost effective type of health care provider to be assigned to the care of women in normal pregnancy and birth, including the risk assessment and the recognition of complications"(WHO 1996)

We continue working towards that goal.

laying down the Pinnard

It usually stands, proud and ready, on the bookshelf of my office.  Easy to see, easy to use.

Today it is lying on its side, resting on the soft pink rug that I use on my legs in the evenings as I vegetate in front of the tele, passively resting to the tune of whatever strikes me as the best offering at the time.  Not something to tell the world about.  A picture of ageing and inactivity.


The Pinnard stethoscope - that symbol of midwifery.

This one beautifully crafted on a lathe, in some dark hardwood.  I love its feel, its proportions.  I love the physics of its action: the principle of the sound waves being picked up at its open trumpet-like mouth, and being condensed to make them more audible at the other end.  The connection is made between the little one within its mother's swollen belly, and my ear drum; my brain.  The sounds pulse clearly when the sound waves travel straight from fetus to midwife.

The Pinnard has been laid down.  I have finished using it.  I am reaching the end of my midwifery career, and it's time for me to leave attending births to the younger, stronger midwives.

The Pinnard will now continue to hold memories of my life's work as a midwife: with woman in her transition to motherhood, and guardian of the new generation.


I was woken by the phone call late at night, moments after falling asleep.  The young mother was now in strong labour, and her husband asked me to attend.

Labour had become established earlier in the day.  This young woman was innocently determined to do it herself, yet unprepared for the demands of whatever 'it' was.  Her strong man stood by her, assisting and supporting to the best of his ability.  They were both becoming weary, despite their youth.   She cried and writhed in the birth pool as each contraction mounted.  She looked up at me - "I'm so tired.  Why is it taking so long?"

My assurances and attempts to encourage were altogether inadequate, and it wasn't long before I was arranging transfer to hospital.   Perhaps the Nitrous Oxide gas will take the edge off for long enough for this wee one to progress to that point of no return?

I don't see this as any sort of failure, the change of plan from home birth to hospital birth.  When hospital is needed, I accept and embrace the change.  The time taken in the car as we travel to hospital, and in the routine hospital admission processes, is all time for the labour to progress.

The change of setting was good.  We moved to a large birth suite room.  The calm, fresh presence of the midwife at the hospital gave me strength too.   A couple of hours later a strong, healthy baby is born.

I am content.

Flowers that arrived today.  Thankyou, my dears.

When I finally make my way home I am surrounded by a thick fog.  Driving along familiar streets takes on an unreal status.   The road ahead is invisible: could it be a great unknown chasm in front of me?  My thoughts have taken their own direction under the intoxicating mixture of wonder at the birth of a baby, awe at the processes that produced a mother, and sleep deprivation that my ageing body finds increasingly difficult to accommodate.

Sleep.  Deep, dreamless sleep.

Up and at it again, a bit weary, and still traveling under the influence of that birth.  In the afternoon the late winter sun is shining, and the day is beautifully warm.  We have a walk down to the creek, and home again.

My memories take me to the day our fourth, and last, child was born.   I woke up that morning and looked out the window, and breathed in the warming Spring air.  "This feels like a good day for our baby to be born," I announced.  There was a lot of work ahead.  My babies were big strong babies, and they didn't just slip out.  But that night I went to bed with a sweet new child beside me, and a heart overflowing with joy.