Being a midwife in NSW sucks!

Guest post

A heartfelt guest post today, from a midwife who wants to remain anonymous. Please show her your support with a comment at the end of her story. We have to look after our midwives or they will all leave.

“I dreamed of becoming a mdwife for a long time. What could be better than helping a woman become a mother? And yes, it is rewarding! I love the work of midwifery, the relationships you form with women and their families, that magic moment when they finally meet their baby, then seeing them blossoming into mothers. There is no better task in the world.

BUT IT SUCKS! It really, truly sucks to be a midwife in NSW right now. I heard a colleague use the term ‘love the work, hate the job,’ and this is so, so accurate. It's not a single, simple thing that makes it suck, but a host of systemic problems that demoralise you, burn you out, eat away at your soul until you just can't do it anymore.

The elephant in the room is of course the poor pay and terrible conditions - and the government's absolute refusal to give us a pay rise, despite many other public sector professions receiving generous ones. However, there are so many more problems than just pay.

It started when I chose the postgraduate pathway. There was no direct-entry midwifery where I lived so, like many before me, I became a nurse first. I was warned that the midwifery year was the hardest of your life, and it was. I got lumped with a horrible educator who basically sat me in a corner and bombarded me with theory for hours on end. I assume she was trying to prove her superiority in knowledge. Any question I had was either blatantly ignored or hushed with a click of the tongue and roll of the eyes. I had books and guidelines thrown at me if I didn't know something, and told “it's in there, you should know that” (clearly she missed the ‘student’ part of my job title). I was then excluded from anything hands-on until I could recite things to her satisfaction. I fell so far behind in my practical work that I almost gave up then and there. I truly wish I had. I really felt the ‘nurses eat their young’ adage with that educator. The system is full of these types, who just keep on getting promoted no matter how many people complain.

I work in a big hospital. You would think that a large city would have plenty of midwives. We don't. If I’m in birth suite, I might have three labouring women to care for at the same time. If I’m on the ward, I will probably have eight to ten, depending on the shift. It's a mixed antenatal and postnatal ward, so if you include the babies I might actually be responsible for the lives of sixteen, even twenty, humans at one time. None of whom I have met before. Some may be well and have straightforward care, but usually they have complications or complexities that require skilled and attentive care. I can't provide this care, no matter how hard I try. Women are sent home as soon as we can get them out, unprepared and unsupported. Many of these women are from diverse backgrounds and often have limited English (or none at all) which makes everything so much more difficult. I can only imagine how hard it would be for them, trying to navigate a system they can't even understand. On top of my load, I am often in-charge as well. This means that I am responsible for the care of everyone else in the unit. I have to sort out transfers to other hospitals, decide who gets a bed and who doesn't need to come in yet, manage emergencies, handle complaints, support newly graduated midwives and students, do all the admin tasks, all while trying to provide optimal care for those allocated to me. I am somehow supposed to be superwoman. I don't remember the last time I had a meal break. I don't even know where a staff toilet is because we don't get the chance to even pee. I am exhausted.

I'm a midwife. But the system is so medically focused that I feel like an obstetric nurse. I want to provide woman-centred care but I am so confined by policies and guidelines that I cannot. If I miss a single thing on the production line of care I can be disciplined for it. A midwife is defined as an autonomous practitioner but I cannot be autonomous in this system. I am surveilled at every turn. The system controls my practice. I am a robot, doing the bidding of faceless bureaucrats too afraid of being sued to allow women the freedom to choose. Research shows that continuity of midwifery care provides the best outcomes. But the bureaucracy doesn't see that. The medical stranglehold will not let me be a midwife. It will not let women step off the production line. Sometimes it dangles a carrot like MGP or even home birth, but only if the obstetrician says so. Only if the woman fits in the rules. I want to care for them, lead them into motherhood, not tick boxes and tell them what they must do to qualify for what we call ‘care’ in this state. I am an invisible number on someone's computer. I am not a human being. Women are just a number too, soulless automatons who must do what they're told, follow the path, unwavering.

I am highly trained in many skills, but if I go to a new place I must retrain and reaccredit in every skill all over again. I must not perform the skills which I have done hundreds, thousands of times, until the system says I am competent. I must be signed off by an educator who usually has less experience than I do, and a superiority complex. Why did I bother going to uni and struggling through that highly stressful year if nobody recognises what I learned? Why do I have to prove myself time and time again? Basic skills that every midwife has, must be retaught and reexamined so that a box can be ticked by some bureaucrat sitting in an office. If I miss the tiniest thing, or dare to use my clinical judgement, I am ordered into an office with at least three managers to explain myself. I can be placed on an improvement plan without even a chance to give my perspective or rationale. Procedural fairness? Ha! I am a drone, I must comply.

The most demoralising part of all, for me, is obstetric violence. This system keeps women passive, as bystanders in their own lives, while things are done to them that they do not want and do not need. I see harm caused every day, justified by the misguided excuses of ‘woman/baby would have died’ or ‘there was no time to discuss it, we had to act.’ Birth trauma is dismissed with the old chestnut of ‘you got a healthy baby.’ Culturally diverse women are especially vulnerable to harm. If I speak up, or try to step in, I am disciplined. I must be complicit in this trauma with good grace or I am labelled a troublemaker and given a ‘punishment roster’ or moved elsewhere. I must be a sheep.

The government would have you believe that we have an excellent maternity care system. The truth is that we don't. This system is toxic, harmful, dangerous and downright shameful. Women deserve better. Midwives deserve better.

How can you work in a system that pits your morals against it every single day? How can we 'possibly claim to ‘do no harm’ when it's there before our eyes every single day? The policies of the workplace are incongruent with the code of ethics and code of conduct that we must abide by to keep our registration and thus our livelihood. Human decency and morality are thrown out the window. How do you endure the cognitive dissonance of every single day? None of us escape unharmed. None of us.”