The graduate Midwife Road Less Travelled Part 3 - The Road Is Not Always Straight and Flat

 Photo by Sergio R on Unsplash

If you haven't read them already, part 1 of this series can be found here and part 2 here.

In deciding to work in this model of care straight from university, I knew I was going to face some challenges.

The first challenge was going to be people's perception of my work, or my ability to work in private practice as a newly qualified midwife. The next challenge would be finding a structure which worked for Bron and I. Then, there was the financial challenge of not earning a salary. Finally, there was the challenge of trying to work towards endorsement as a Medicare eligible privately practicing midwife - my long-term role, which would enable me to continue working as a private midwife with my own caseload, and which involves a lot of jumping through hoops. I started the hoop jumping as soon as I started working with Bron, and thus begins 3 years minimum as AHPRA's circus animal.

I was really nervous to tell friends, family and my colleagues at the hospital I trained at about my decision to forgo the traditional grad position I was offered in Sydney to work at The Birth House. Most of my close circle of family and friends don't know a lot about home birth, haven't been exposed to it and I wasn't sure if they'd be supportive. While I got a few strange looks, and was asked a lot of questions about safety and what I'd do in emergencies, it was really clear to all my loved ones by the way  my eyes lit up when I spoke about it that I'd chosen a job I absolutely love, and over the past 6 months, they've all become a lot more accepting and supportive of my decision (I may have even converted a few into potential home birthers!) Not to mention the fact that taking this job kept me at home with my loved ones, rather than working fly in, fly out in Sydney.

My colleagues at the hospital I trained in were absolutely delighted for me when I told them. This job is my dream job, and I think that while some of them may have encouraged me to take a traditional grad job if I'd discussed it with them, they know I'm onto something really special here, and know how well supported I am by Bron. The first time I had to transfer in to the hospital with a client, I was shaking in the car on my way in. It was completely nerve wracking doing the transfer - were we making a good call? How would  be received by the midwives on duty? I wondered who was in birth suite and who was team leader the whole way in, and practiced my handover in the car. When I got to the hospital, the most lovely midwife was coming onto birth suite for the night shift - one I'd worked with a bit at the end of last year and got along with well. I was so, so happy to see her walk into our room, and she made the whole experience more like a homecoming than the scary transfer I'd built it up to in my mind. Over the following few days, I visited our client in hospital and ran into many of my old mentors, who were so beautiful, kind and helpful to us and our clients. I remembered why I had loved my midwifery training so much - the midwives at our local hospital are incredible, kind, intelligent and funny. most of all, they're great friends to work with.

Bron and I are still working out what structure works for us - my role is ever-evolving as our client load and needs change. Mostly, I do 6 hours of admin per week, Saturday morning antenatal classes, a few hours supervised clinic plus whatever birth plan meetings and births we have on. Sometimes I also mind Bron's daughter while she works, and more recently I've started liaising with the international student midwives we have coming to visit over the coming year, and I will be trying to fill their days between appointments while they are here. The days are fairly flexible, and I'm often back and forth to The Birth House and to our clients' homes  4 or 5 days in a week, despite my hours only being part time. When something isn't working, we just have a chat and try something else, and as the practice grows, so will my role within it, which is something Bron and I are both working hard for.

Not earning a salary is difficult at times. When we have a lot of births on, money is great! When we are quiet, my admin hours cover my rent and I'm thankful that I haven't been totally cut off from Centrelink yet, which tops up my pay when I'm having a bad week at work according to my fortnight's earnings, which I continue to report. I'm also thankful for an incredible landlord for our tiny little granny flat, and my partner who also subcontracts, but somehow always has work when I don't. I'm honestly very nervous for tax time, as my book keeping has been very lazy and I've got a lot of work to do to get my receipts and car log book in order if I don't want a massive tax bill. These are challenges I wouldn't face with a traditional grad role, but I gladly do because I love this job, and its flexible, part-time nature which gives me incredible work-life balance even while I pursue further study.

Which brings me to the next challenge - possibly the biggest one. To become endorsed by AHPRA, which will give me a medicare provider number, prescribing rights and make me able to get insurance for antenatal and postnatal care, and carry my own caseload, there are several hoops I need to jump through.

First, I need to do a Prescribing and Diagnostics course, which I begin as a part of my Masters in Primary Maternity Care through Griffith University in July. The postgraduate study, in my eyes, is the easy part.

Next, I need to get 5000 hours of experience across all settings - antenatal, birth and postnatal care. Now, working part time as a second midwife for births, this is the truly challenging part! I'm not insured for antenatal and postnatal care, so have to be under supervision, and I have absolutely no control over how long a birth takes! Often, I'm only there 4 or so hours, including clean up. To top it off, the 5000 hours needs to be completed within 6 years, which means I need to supplement my hours with casual work at the local hospital. BUT, the local hospital won't give me casual work without postgraduate experience. Hmm..... I can see your brain ticking over, and this is not adding up, is it? No. Sadly, it is not.

I've been working part-time for 6 months now. I've completed a certificate in immunisation for health practitioners, and I'm enrolled in my Masters degree, so a week ago, I emailed the Midwifery Unit Manager to ask about potential casual work at the hospital, but so far I've heard nothing back. I've asked a few times how much experience I need, and I've not yet been given an answer. I'm eager to get my foot in the door - not for money's sake, and not just for the hours, but also because there are many valuable midwifery skills that you use often in the hospital that are rarely used at home that I would like to maintain, and there are opportunities for continued professional development in the public health setting that aren't available privately. I"m trying very hard to be patient, and to enjoy the slow build that my grad year has given me - the nurturing, supportive environment and beautiful foundation to practice of normal, non-medicated, vaginal births that I have been so privileged to attend over the past 6 months. As a very driven, goal oriented person, it is difficult to be patient though. I want to get my hours done as quick as possible so that I can fully immerse myself in private practice and work to my full scope and full potential as a midwife. It's also difficult thinking that my fellow graduates in bigger hospitals are getting their hours towards eligibility so much faster than I am, as full-time midwives despite not getting the hands on home birth experience, and business experience that I'm getting with Bron. I have to remind myself every day of how blessed I am, that it's not a race, and that the experience I'm getting right now, and the job I'm doing, which I love so much, is worth more than the full time hours I'd get in a hospital. Even if I can't work in the hospital until the end of the year, my time there will come and my hours will build. In the meantime, I need to just enjoy the ride.

The fact that my scope of practice is so limited after 3 years of university education, and registering as a midwife is very frustrating. The fact that this restriction is at the hands of the only insurance company in Australia that will cover a private midwife appalls me. The challenges I'm facing in pursuing this career pathway are unjust and uncalled for. They are designed and implemented by the medical patriarchy, which is more concerned with reigning in autonomous midwifery practice, which threatens its livelihood, than with creating positive outcomes for women and babies.

Continuity of care with a known midwife is the absolute gold standard of care, and leaving the comfort and safety of your home is the first intervention in birth. Graduate midwives having access to working in continuity models of care is absolutely integral to midwifery thriving as an autonomous profession, and to women having access to the safest model of care there is. As we learn more and more about the long-term impacts of birth on maternal and neonatal health, and uncover the mysteries of the microbiome, and epigenetics and birth, its importance is highlighted. As women have more access to information highlighting the benefits of continuity of care with a known midwife through the internet, it is also growing ever more popular.

It's so important that new graduates like myself are supported to pursue this line of work. A study in Queensland reported that up to 85% of midwives in both public and private hospitals have fear around childbirth. Midwives working in continuity of care models did not report the same level of fear. The road is not always straight and flat, but I know I'm doing important work in paving it for future graduates, and making continuity of care more accessible to women. If you're a private midwife, consider how you can open your practice to a new graduate and show them what it truly is to be 'with woman'. If you're a graduate, seek out this kind of work, and if you're a pregnant woman looking for the best care you could possibly have, and a positive, empowering experience, step outside the system - hire a private midwife and support an autonomous midwifery profession. Consumers are the voice of change, and by demanding this service, you create opportunities for more women to access it.

Despite all the challenges of choosing a non-traditional graduate job,  if I was offered full-time work in my first choice hospital from my graduate application last year right now, I wouldn't take it. I love my job so much. It's so worth every instance of stress, because working in continuity of care, in partnership with women who are making informed and empowered decisions about their births is the most amazing job in the world, and tucking a new family into their own bed after a home birth, leaving their house in the wee hours of the morning with the warm fuzzies inside me is a feeling I will never tire from.