Rachel Reed is a mother, midwife and educator who moved to Australia from the UK in 2004 and now lives on the Sunshine Coast, Queensland, Australia with her husband. Having qualified as a midwife in 2001, Rachel has worked as a midwife in many environments and now works as an independent homebirth midwife. Finally she also lectures at the University of Sunshine Coast and is a PhD candidate for which her research is an exploration of women’s experience of birth and midwifery practice during birth.
Q: Why did you pursue a career in childbirth?
As a child I mostly hung out with boys and climbed trees, however I did play at helping my girlfriends have their babies (dolls). This involved them being ‘in labour’ and me assisting a doll to emerge from under their skirt. As I grew up I developed an interest in health, culture, society, politics and women’s issues (although I successfully avoided learning anything at school). When I was pregnant with my son I became fascinated with the childbearing process and also learned a lot about my own vulnerabilities. A few years later I gave birth to my daughter at home. It was an empowering and transformative experience and I wanted other women to enter motherhood feeling as strong and powerful as I felt after her birth. Midwifery encompasses all of my interests, has allowed me to indulge my fascination for birth, and has enabled me to assist other women to realise their own power. So in retrospect becoming a midwife made perfect sense.
Q: In a nutshell, what do you do?
I teach midwifery at the University of the Sunshine Coast. I provide midwifery care for women planning a homebirth, and support new midwives in their homebirth practice. I also write about birth in journals, books and on my blog site midwifethinking. I present at conferences and facilitate workshops, and I am currently writing my PhD thesis ‘an exploration of midwifery practice during birth: rites of passage and rites of protection’.
Q: Why do you feel that the only way you can work to your full scope of practice and provide the care you believe women deserve is as an independent homebirth midwife?
As an independent homebirth midwife I work directly for the woman in her home. I do not have to meet the needs of an institution or please colleagues and can truly be ‘with woman’. I am also able to provide care throughout the childbearing journey rather than being restricted to providing a few hours of care for a ‘stranger’ during a small part of the process. I think every woman deserves to choose who will be with her during her childbearing journey and know that they will be there throughout and regardless of how the journey unfolds.
Q: What does being an independent homebirth midwife involve?
Planning care in partnership with the woman, centered around her unique needs. Therefore, the mother-midwife relationship is different for each woman and each situation. In general it involves regular visits during pregnancy to build a relationship and address any needs the woman has along the way. I am officially ‘on call’ from around 37 weeks until the baby arrives. I attend the birth and visit in the postnatal period to nurture the new mother. The work of a homebirth midwifes involves everything from chatting about life over a cup of tea, to managing an emergency during birth. It is whatever the woman needs at that time.
Q: You qualified as a midwife in the UK, in your opinion which country provides the better maternity care? Why?
That is a difficult question. In the UK midwives are more autonomous and culturally accepted as the main care provider for pregnant women. Each woman has a named midwife and care is based in the community regardless of planned birth place. UK Obstetricians concentrate on the care of ‘high risk’ women and complications, and they collaborate with midwives in this care. There is no financial incentive for obstetricians to become involved in ‘low risk’ maternity care as there is generally no private maternity care. In addition, women have the right to birth at home, and the midwife has a duty of care to attend. Even if the woman is categorised as ‘high risk’ care is not withdrawn if she declines transfer to hospital. This is a good system in many ways. However, maternity care is still very medicalised and you only need to watch ‘One Born Every Minute’ to realise that midwives are perfectly capable of disempowering women without the help of obstetricians. UK midwives are also working with little resources and chronic understaffing which compromises their ability to provide good quality care.
The Australian maternity system is a hybrid of the UK and the US systems. There is a lot of money in private obstetrics which results in a turf war and resistance to change. In addition, midwifery is considered a branch of nursing and many women don’t even know what a midwife is, or that homebirth is an option. Lots of women also have private health insurance and want to get their ‘money’s worth’ by choosing expensive obstetric care. Midwives are unable to work autonomously in the system because even in the public system obstetricians control the care of ‘low risk’ women. Australian midwives are currently fighting to gain power and respect within the maternity system, but my concern is that they are leaving women behind in their attempt to gain acceptance from the medical profession.
Q: Why did you set up ‘midwifethinking’?
Initially I set up the site to make my life easier. I found myself repeating the same information and accessing and sharing the same resources multiple times for mothers and midwifery students. Midwifethinking enabled me to put all the information on a topic in one place and gather experiences and opinions from women and birth workers via comments. I had no idea that the site would become what it has. I think one of the most valuable aspects of the site is the sharing of experiences and debate that occurs in the comments.
Q: You are a mother, what did you find hardest amount the transition into motherhood?
I became a mother when I was 18, and in many ways I think this made the transition easier for me. We had never experienced the kind of lifestyle that many have to adjust in order accommodate a child. We didn’t have money, a car, holidays, etc. so didn’t miss them. I think the hardest thing about motherhood is the relentless nature of it. Everything you do, and every decision you make must take into account another person’s needs for many years. It can be difficult not to lose yourself along the way. I am extremely grateful to have a husband who has been equally responsible and involved in the raising of our children. I have great respect for women who raise their children without this support.
Q: What do you know now that you wish you had known before your babies were born?
Sometimes I wish I’d had the knowledge and experience I have now… or that I could do it all again to do it ‘perfectly’. However, learning is part of the journey and the lessons I learned through birthing and mothering have been invaluable. There is no ‘perfect’ and we can often learn more through imperfection. I do wish I’d known more about nutrition and not followed the mainstream advice about what is ‘healthy’. My children may have benefited long term if I’d eaten a genuinely healthy diet when they were babies.
Q: What was the best advice you were given as an expectant mother and as a new mother?
When my children were babies I had a poem by Kahil Gibran pinned to my kitchen wall which describes a mothering philosophy I have found helpful:
You may give them your love but not your thoughts,
I also like the simple advice of a colleague who advocates that all a good mother needs to do is ‘keep them alive til they’re 25’ – this is especially helpful for those difficult times when it is all too hard!
Q: What is you key piece of advice to an expectant mother and to a new mother?
You are the expert in your body and your baby. You can listen to all the advice in the world but only you know what is right for you and your baby. Listen to yourself above all others. Also, that no child needs a perfect parent – they need to know your imperfection and humanity.
Q: What is the best thing about being a mother?
My children are adults now and the best thing about being their mother is watching them making their own way in the world and become who they are - although it can be difficult to accept that they need to make their own mistakes and experience their own hardships to grow. I also love that we share the same sense of humour, cynicism, and love of deeply depressing movies.
Q: Does maternity care in Australia need revolutionising? If so how?
YES! The focus needs to switch from perpetuating cultural norms and protecting professionals and institutions. Instead, maternity care needs to focus on what women want and on evidence based, humane practice. Midwives need to embrace their core purpose which is to be ‘with woman’ and stop trying to gain status through aligning themselves with medicine. We need to rebuild our own body of knowledge based on women’s experiences, and underpinned by a deep understanding of birth physiology.
Australian politicians need to stop prioritising obstetrician’s demands over women’s requests when designing and implementing services. We have had numerous government reports and reviews stating that maternity care needs to community based and provide access to continuity of care by midwives. However, any attempts to implement this are blocked by the powerful medical organisations at every turn. We are currently in a situation where women can only access medicare funding for midwifery care by getting a signed agreement by a medical professional… a medical professional who will then lose the client and her medicare money to the midwife. Needless to say it is not working.
Midwives need to carefully consider proposed changes in relation to their impact on women rather than on midwives. There is a regulatory push for independent midwives to become ‘eligible’ for medicare rebates. The process of becoming eligible has nothing to do with quality care and everything to do with paying lots of money to various organisations and jumping through hoops. For example, undertaking a course in prescribing medications – midwives are not medical practitioners and if a woman requires medicine she should see a medical practitioner. Many midwives are choosing not to do this and to continue caring for women without eligibility and the medicare rebates which rely on medical collaboration and are only available for ‘low risk’ women. These midwives will most likely be regulated out of existence by the end of 2013. Some midwives are turning in their registration because of the increasing regulation and shift away from women-centred care. It is becoming increasingly difficult to provide ‘with woman’ care as a registered midwife.
Revolution will come when women take control and responsibility for their own ‘maternity system’. There are plenty of women who decide what they want in terms of care – midwife, doula, obstetrician, no one - and go ahead and do it. More women need to know that they have the right to birth however they want and with who ever they want.
Q: What is your opinion on the rising caesarean and intervention rates across the world?
Birth has always been a rite of passage that involves an element of danger. Humans have historically attempted to minimise this danger and the methods they use to do this reflect their culture – whether that is the use of sacred words, herbs or the presence of a particular person. In our current culture medicine and technology are perceived as the best way to minimise danger during childbirth. Rather than confining the use of these interventions to births that are dangerous, routine intervention is seen as a way to avoid danger. The impact of such prophylactic intervention on the physiology of birth and on the long term health of the mother and baby are only just being explored and understood.
Unfortunately the medicalisation of birth has been exported around the world in an attempt to improve global outcomes for women and babies. The result is that many women are now subjected to the worst of both worlds – dangerous traditional practices and imported inhumane medical practices (eg. routine lithotomy, episiotomy, separation from their baby). Whilst the intent is to minimise danger, the method is short sighted. In order to improve outcomes there needs to be improvements to women’s social status and living conditions, and the development of humane maternity care with access to appropriate intervention when needed. At the moment the focus is only on the last element – medical intervention.
Q: Is normal birth endangered?
In Australian hospitals nearly 80% of women have their labour induced or augmented and over a third of women have caesarean sections. Therefore intervention is the ‘norm’ and many women who experience intervention consider their birth to be ‘normal’. I prefer to use the term ‘physiological’ – ‘being in accord with, or characteristic of the normal functioning organism’ - to describe an undisturbed, healthy birth. ‘Natural’ is also a useful term but sometimes nature becomes pathological and requires intervention to ensure a healthy outcome. Back to the question… Physiological birth is almost extinct in Australia.
Q: Do you agree with the argument that women are losing confidence in their ability to give birth naturally?
I think generally women have lost confidence in themselves as women and mothers. This is a result of a culture that considers the female body to be ‘weak’, and fosters the notion that expertise is located outside of the individual. Women have been dissuaded from taking responsibility for their births and encouraged to hand over the responsibility to professionals. In addition, the hidden nature of physiological birth and the public nature of medicalised birth sustains the cultural fear of birth.
However, I think the tide is turning. Physiological birth is becoming more visible as women share their experiences with each other, and information and support is increasingly accessible (eg. this website). Also people are beginning to question the dominance of medicine in all areas of health care and are becoming more open to other ways of understanding wellness.
Q: Who do you admire in the world of childbirth?
There really are too many to mention and they are most likely the usual suspects. However, I really admire midwives who work in the system and strive to be ‘with woman’ against all the pressures to conform to the institution. They make such a difference to the experiences of individual women yet their efforts often go unnoticed or are ridiculed by their colleagues. I admire the homebirth midwives who lay their hearts, family life and reputations on the line to be with women in the current political birth climate. There are some amazing local homebirth midwives here on the Sunshine Coast who I love and admire. I admire all of the women who trust themselves and take responsibility for their birth and baby - in particular those women who have previously had a c-section and look their fears in the face, turn their back on external assessments of ‘risk’ and surrender to their body’s ability to birth. It is impossible to watch a woman birth and not admire her.
Q: What is the one thing that never fails to amaze you about childbirth?
Women’s innate power and resilience.
Finally, is there anything else you would like to add or tell our readers?
Our aim should be that all women emerge from their birth experience strong and confident mothers. A society full of such mothers and their children will benefit all.
Rachel's blog is fantastically good and I urge you to visit - http://midwifethinking.com