A midwifery student's perspective - for the Maternity Services Review

Katrina Flora

I write as a student midwife who is a few weeks away from graduation and becoming a registered midwife. I am completing the Bachelor of Midwifery in Melbourne and as such have completed most of my clinical training in large urban tertiary hospitals.

The Bachelor of Midwifery is designed to prepare me and my peers for a midwifery career incorporating woman-centred care, continuity of care and evidence based autonomous practice. However our clinical experiences and the nature of the models of care available do not match that for which we have been trained.

The main maternity hospitals in Melbourne provide care which is fragmented and which serves the needs of the institution before that of the midwives who work and the women who birth in them. My experiences on clinical placement in these hospitals have, in many ways, been profoundly disappointing and I believe I have seen why there is such a high rate of burnout among midwives and why the profession struggles to keep midwives in the job.

Currently midwives have very little access to models of employment which would allow them to provide continuity of carer. Seeing a woman through her pregnancy, labour and birth, and into the postnatal period means the midwife can develop a trusting relationship, tailor the care to the individual needs of that woman, and truly be with woman - the real meaning of midwife. As a student I have experienced this continuity by following thirty women through their pregnancies, births and postnatal periods. The relationships I developed and learning I gained through each of those journeys has been incredibly enriching and satisfying for me.

Yet the employment models available to me on graduation and into the future are totally fragmented. Mostly midwives care for laboring women they have never met and know very little about. While many midwives do their best to develop rapport with the women they care for, it is very difficult to establish a relationship which might be helpful for the woman and satisfying for the midwife. Consequently I believe it is easy for midwives to become cynical and jaded in their care.

In addition I have been witness to an almost total domination of obstetric care in the maternity services I have seen in the past three years. When midwives are denied autonomy, and work under the narrow restrictions imposed by obstetric care which is often not evidence based, job satisfaction can plummet. In this type of model, midwives can feel like little more than a task-oriented robot that has very little capacity to engage in partnership with birthing women.

As a soon to be registered midwife I cannot foresee a long career in a fragmented model which offers no continuity and very little autonomy. In the absence of publicly funded caseload models I see myself in private practice. This in itself is not an unattractive option but poses other issues such as the lack of professional indemnity insurance and questions of income security. I am thrilled to see the discussion opening up around midwifery care and the possibility of widespread caseload models, autonomy and the provision of Medicare provider numbers and PI insurance. It is a long overdue and positive step for Australian women and midwives.

[Thankyou Katrina for this reflection on your career options. jj]