Midwives lead the way


The success of midwife-led birthing services across the state is a mark of recognition by the NSW Government of the capabilities and competence of midwives. The Belmont Birthing Service provides a strong professional role for the midwives leading the unit and a secure and comfortable environment for the women who choose this option for their maternity care.

Hayley* wanted a secure and comfortable environment for her birth. She is young and healthy but she wanted to be cared for by a midwife she was familiar with during her pregnancy and birth. Hayley was an ideal candidate for the Belmont Birthing Service, a low-care birthing service where women are attended by a known midwife throughout their pregnancy, delivery and in the weeks following the birth.

Although attached to John Hunter Hospital in Newcastle, the Belmont Birthing Service is located 20 minutes away and is staffed by highly-competent midwives who are appropriately qualified to provide antenatal, labour and postnatal care on their own.

According to Midwifery Manager of the Belmont Birthing Service, Carolyn Hastie, normal, healthy women who have healthy pregnancies birth well with one-to-one midwifery care and do not need medical intervention or need to be under the care of an obstetrician. ‘This is for women who are sick or who have medical and obstetric complications. You wouldn’t have a cardiologist on stand by if you were healthy and wanted to do some exercise,’ she said.

‘Faced with an unknown attendant in a harsh, sterile environment with artificial lights and machines that inhibit their movements, many women become afraid and panic. Fear sets off the fight or flight pathway of hormonal response, leading to prolonged labour and increasing the chances of medical intervention,’ she said.

‘A birthing woman who knows her midwife and feels comfortable is going to labour more efficiently and the outcome is more likely to be a quicker, smoother birth.’

Hayley developed a personal relationship with her midwife Jacky Eales over the months of antenatal visits. When it came to the birth, she felt comfortable and trusted Jacqui.

Hayley gave birth to a healthy baby boy at 11am one Monday. She stayed at Belmont for four hours after the birth, celebrating with a ‘birthday’ cake with her partner and pa-rents. Around 3pm, Hayley felt ready to go home with her new-born son.

Midwife Jacky visited early that evening to see how things were going and to ensure Hayley was managing the breastfeeding, and continued visiting for the next three weeks.

‘An important aspect of the Belmont Service is exploring with women what to expect. Hayley knew all about the labour process and what to expect with her new baby,’ said Carolyn.

‘We also discuss with women and their partners ideas on how they can look after themselves so they recover quickly from the birth and survive those first few sleepless nights.

‘A drawback of more traditional maternity services and education is the emphasis on the birth as being the be-all and end-all. Women give birth and have little idea of what to expect from their newborn. They all too often have unrealistic expectations of what a baby in the home means.

‘I think that’s why women experience the post-natal “blues”. They’ve experienced the most emotional event of their lives, the birth … and then they are left alone with little idea of a typical newborn’s cycle and behaviour. That can be scary,’ she said.

Since opening its doors in July 2005, 126 women have given birth with the Belmont Birthing Service midwives. Statistics so far reveal that the one-to-one midwifery model is achieving safer outcomes than more traditional maternity services with higher levels of intervention, and that the mothers are happier with their birthing experience.

‘Giving birth is a normal, healthy, happy process. There is nothing in the sickness model that matches it,’ said Carolyn.

There are seven midwives, including a manager, working at the Belmont Birthing Service and each midwife books about 40 women a year. A midwife will see a woman in a schedule of antenatal visits – at the centre or at the woman’s home – over the months of her pregnancy, be on-call for the birth and then visit the woman at home in the three weeks after the birth.

No medical support is available at Belmont. If problems arise, the woman is transferred to the John Hunter hospital, along with her midwife.

‘The midwives are specially trained in neonatal care and resuscitation and we have great relationships with our medical and midwifery colleagues at the John Hunter Hospital,’ said Carolyn.

The NSW Midwives Association has developed guidelines about when consultation or a transfer should occur.

‘It’s a flexible, woman-centred service and the mothers love it. They feel very supported,’ said Carolyn. ‘One mother said to me, “I feel like a real person here. I feel better than when I arrived”.’

‘It’s also a flexible workplace for the midwives working here. They are part of a supportive team that enables them to juggle their families. Nearly all of us have older children.’

Consumer pressure is driving the expansion of midwife-led maternity services in NSW. The midwife-led maternity unit in Ryde celebrated two years of service in March and similar services are operating in Wollongong and Gosford and one will open shortly in Camden. St George Hospital also launched a publicly-funded home-birthing trial last September.

The enthusiastic uptake of these services is testament to the fact that women want maternity choices, and there is mounting evidence that choice and flexibility results in happier and healthier women and babies.

NSWNA Secretary Brett Holmes said it is important that midwives working in services like Belmont are covered by an agreement that considers their levels of responsibility and the unsociable working conditions.

‘These midwives have a caseload that requires them to be on-call for most of the week. They need to be appropriately compensated for this. The Association has worked closely with hospital management in each case to negotiate an agreement that provides an annualised salary that takes into account penalties that would be earned over a year and on-call allowances.’

As The Lamp went to print the NSWNA was signing an agreement with Camden Hospital management covering midwives who will be working at the new birthing service set to open in April.

*Name changed for privacy reasons.