The front verandah of the beautiful federation home that is The Birth House

Read Part 1 of this series here.

I started working with Bron in October, before I graduated. As a part of the structure of my job that we had agreed upon, I would be doing 6 hours a week of administration, helping Bron with the running of her business and learning the behind the scenes of being a private midwife. I was excited about this, because I knew it was setting me up for my future as a private midwife, and that I was lucky to have someone who had been doing it for years to learn from, rather than starting from scratch myself and making lots of mistakes. So, I started my admin hours straight away, started meeting Bron's clients as they came and went from the clinic while I was there, and waited for my registration to come through - hopefully before the baby that was due on Christmas Eve came.

I met the woman who was due at her 36 week birth plan appointment, as Bron and I had discussed I would, and I was introduced to her as the second midwife for her birth. We discussed her wishes for her birth, and she had a few requests for her birth which deviated from standard care. We discussed reasons for and against, provided her with evidence relating to her decisions, discussed when risk factors might present themselves which would suggest deviating from her choices, and gave her time to process the information and come to a decision. When we left the appointment, suspecting that I would find it a massive transition moving from hospital policy to a practice of informed consent led by the woman, Bron asked me how I felt about this. I was surprised to find that I was actually totally comfortable with the woman's decision. I asked Bron some questions about how we document her decisions to cover ourselves legally, and then said "I trust the process. I trust birth. I trust that the woman is making the decisions she feels are best for herself and her baby, and that she is taking ownership of her body and her birth in her decision-making. I trust that we have given her the information to make an informed decision, and I trust you. I trust that we will document her decision correctly to cover ourselves legally, and I trust that I will be well supported by you in her birth, and that if there are any indications that we should divert back to standard care, we will pick up on them in a timely manner, and have those discussions with her." Every word of it was true. I trusted birth. I trusted Bron, and I felt so well supported in practice by her, that I felt comfortable with honouring this woman's wishes for non-standard care. In fact, I felt like that was exactly why I was working in this model of care.

My registration came through late December and a couple of nights later I got my first midnight call out! The woman worked beautifully with her partner in her birth, calling us to come late in the piece, and being 45 minutes away, I missed it entirely! I got there in time to watch her have her first breastfeed and birth the placenta. I checked the placenta, cleaned up the birth space a bit, tucked the new family into bed and drove home. I was back in bed before the sun came up, smiling ear to ear.

Over the following weeks, I attended a few more births - all of them beautiful, natural and calm. Bron and I started to feel more in sync working together. I worked with another private midwife in the area, Libby, a bit and I really enjoy seeing the similarities and differences in her and Bron's practice.  I feel really at ease working with both of them, and I commented to them both one morning after a team meeting that I feel like I'm exactly where I'm meant to be. They both gave me beautiful feedback about my presence at a birth and my way of working. To begin with, I didn't really feel like a "real" midwife. I sort of still felt like a student, but I'm slowly gaining confidence in my practice and at least I've stopped having to correct my signature from SM to RM on documentation. I drove up to the Gold Coast for a birth at 2am one night, and was coming home just as the sun rose. It was so beautiful and peaceful. I was totally in awe of my own life! I wrote this on facebook later that morning:

I love waking up in the middle of the night to a phone call, rushing to the car and driving through the still of the night, the only car on the road, to a birth. I love pulling into the street to see the lone house with lights on; thinking that's the one! And being present when new life enters the world. Sitting quietly in the corner of the room, writing notes and observing the woman and her support people as they work together to bring baby down and out. Anticipating needs and providing reassurance and encouragement. Seeing a family grow in an instant, as they meet the baby, and then tucking them up into their own bed to sleep, before heading back home to my own. I watch the sun rise from the road, and climb back into bed to sleep as the rest of the world wakes, feeling contented.

Everything felt right in those first few weeks of working in this way. I was in a blissful, private midwife, normal birth bubble. Everything about it still feels right 3 months in, and I'm really appreciative of the gentle start I've had to life as a registered midwife thanks to the support of Bron and Libby. Taking the road less travelled isn't straightforward though. I've come across a few challenges, which I'll discuss in my next post.

Part 3 can be found here!

The Graduate Midwife Road Less Travelled Part 1 - Making the Decision

Photo by Matt Duncan on Unsplash

Wow. I really thought I'd blog a lot more than I have since I made this blog in November, but truth be told - I've struggled to find the creative energy as I transition into life as a Registered Midwife, juggling work, further study, skate commitments (which to be fair, are usually all I want to commit to), and home life. But here I am, tapping away at the keyboard in a tidy home, with the honey-cinnamon scent of home made granola wafting over to me from the kitchen, having just completed an assignment for the course I'm doing. *sigh* - a rare moment where I feel like I actually have my shit together!

I'm almost 3 months deep as a Registered Midwife, and the past 3 months have been filled with absolutely wonderful experiences and learning opportunities, so I thought now would be a good time to share a little bit about my work, and why I have shunned a traditional graduate position in a hospital to work in private practice fresh out of university.

I haven't always wanted to be a midwife, but from my first day of university there has been no doubt in my mind that it is what I've been called to do with my life. 

I haven't always wanted to be a midwife, but from my first day of university there has been no doubt in my mind that it is what I've been called to do with my life. Furthermore, it became clear very early on in my practice that I wanted to be a private midwife. All throughout my degree, on placements in the hospital, I was continually let down by the public health system, which I felt undervalued the role of the midwife, and treated birthing women like a product on a factory conveyor belt, with designated stops for diagnostics, testing and delivery. *shudder*  (I hate the word delivery being used in birth, but that's a whole other blog post!)

Don't get me wrong, we are incredibly lucky to have a free at point of contact public healthcare system here in Australia, with the option for not a single medical bill for your entire pregnancy and birth, however I just didn't feel like I fit with that model of care as a midwife. It leaves no room for individuality in practice, with policies and guidelines dictating your every move as a midwife, and it leaves little room for respecting the woman's individual birthing experience, either. I hated not having time to spend with women to listen to them (they tell you all you need to know and more if you just give them the space to do so), or to provide adequate information to facilitate informed decision making, and sometimes I felt unable to provide evidence-based care, due to policy, time constraints or the wishes of the medical staff who oversee the women's care in the hospital. My goal from the start was to learn as much as I could in the hospital in my time there, learn even more outside the hospital in my own study, and just get the three years' full time experience I needed to be endorsed and get out!

In my third year of university, I went through all the paces of the student midwife looking for a grad job. I had a resume and cover letter written by week 2 of semester 1. I had multiple appointments with the careers advisers at the university. I had my selection criteria written and reviewed by the careers adviser and 3 separate midwives a month before it was due. I networked with the hospital staff at the hospital I wanted to work in, and applied for grad positions in 4 separate states of Australia. I practiced for interviews by myself, with other students, with the careers adviser and with practically anyone who could stand listening to me rabbit on about NSW Health CORE values for longer than 5 minutes. Through my networking, I got a job as an assistant in midwifery at my first choice hospital, and I worked as many shifts as I could in the hopes of showing the interviewers what a fantastic midwife I would be.

I ticked all the boxes on paper, and then I went for my interview.

There were 12 of us interviewing for the two positions at my first choice hospital. We all went to the same university. We nearly all had the same experience in the same hospital. We all had our resumes, selection criteria and practice interviews with the same careers adviser.

I went blank on one question, missed some key information and was a knot of anxiety for 4 weeks after the interview as I awaited the first round of job offers for NSW Health.

I didn't get the job. I cried all day at the prospect of moving away from my family, of doing fly in, fly out midwifery in a capital city, of leaving my boyfriend and my dog here on the North Coast and going at it alone in my first "adult" job in a strange city somewhere.

I was offered a job in the western suburbs of Sydney, and I was miserable at the prospect of taking it. I messaged Bron, a local private midwife and mentor of mine (she had facilitated my clinical supervision meetings for the best part of a year, and offered me many opportunities to experience what antenatal and postnatal care looks like in a private setting as a student, despite me never being placed with her through uni or being allowed to attend homebirths as a student at my uni). I knew I wanted to work in private practice as soon as I could, and she had mentioned the possibility of a bit of work as a second midwife at births to me a while back, but mostly I just wanted to chat with her about forging a pathway back to private practice from what I was certain would be a very high-intervention, high-risk graduate job in Sydney.

Throughout my whole degree I'd been told by midwives and other health professionals that I needed to consolidate my practice in a big, busy hospital for a few years before turning to caseload or private practice...
You do not build trust in the birthing process from working in a tertiary hospital, you build it from observing normal births.

Throughout my whole degree I'd been told by midwives and other health professionals that I needed to consolidate my practice in a big, busy hospital for a few years before turning to caseload or private practice. All of these health professionals worked in those same big, busy hospitals. But when I sat down with Bron in her office, which smelled sweetly of the jars of plant matter she uses in herbal medicine, she turned to me and said "You do not need to work in a big hospital to be a good private midwife. You do not build trust in the birthing process from working in a tertiary hospital, you build it from observing normal births." She offered me work on the spot as a second midwife for births. It wasn't full time, it wouldn't pay as well as a traditional grad position, I'd be limited in practice by the tight constraints of insurance on private midwives, but it was local, it was private practice, and it was with Bron, who I knew would be an amazing mentor. I told Bron I needed to go home and talk to Jake about our options. I messaged her within a couple of hours to say that I'd accept the job!

Part 2 of this blog series can be found here and part 3 here.

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