In this blog I want to share my transition to working as a practising midwife in a totally different system from the NHS and independent midwifery roles in the UK. I had worked extensively both in the NHS and independently as a midwife. My passion is and always will be family centred primary focussed continuity of care. I love it, thrive on it, inspired and energised by that model of care. Long before all the evidence started stacking up in favour of continuity and primary birthing I was hooked, convinced and intuitively just knew it is how I must work.
After working at Queen Charlottes Hospital in West London with its massive rates of epidurals, feeling downtrodden by a system that continually frustrated me, I moved to a group practice with the newly established Chelsea & Westminster maternity services under the management of Paul Lewis in the mid 90s. The seminal moment at QCH came when I chose to follow a mother from the antenatal induction of labour area to the labour ward. She was scared and had come to trust me throughout my shift. I went upstairs and provided continuity until after her birth. I was reprimanded for leaving the AN ward despite getting a colleague to take my place for the shift. Going into a group practice at Chelsea and Westminsiter was super exciting. Changing childbirth was a real possibility for change. Yet I still craved the continuity 1:1 relationship. So I went independent in and
around London and Surrey. Loved it but didn’t like having to ask for payment. I then worked as a midwife in France (long story for another blog!). Returning to the UK I continued in a community Group Practice in south London before going to Cambridge to be the first consultant midwife at Addenbrookes. That was a whole adventure (I’ll save that for another blog!)
Then to NZ. In midwifery terms I had died and gone to heaven! I spent a short time locuming in a Auckland hospital. Then swiftly moved rurally and within weeks was booking women for full childbirth care. No need to speak about money, no need to speak about insurance, (New Zealand has a no fault compensation system called ACC), no need to speak about who is in charge of my days on or days off! I was self-employed booking as many women as I wanted and being paid for the midwifery work I did.
In NZ women ask around, look in papers, yellow pages, look on notice boards and ring around to find the midwife they want to work with. They can even find a midwife online:
For my part I advertised and got known. I was in the local press, interviewed on a local rural radio station and attended several women’s support groups in the area. In one month I was busy. One month I was dashing to three births in one night! That was very unusual. Most months I had 4-6 births due. After the first year word of mouth is the most powerful way to gain more mothers for care.
Once a woman has decided to book with me we both sign a contract. This contracts me to provide full midwifery services. This then gets sent to the Ministry of health (DoH in the UK). The ministry then pays me. Such a great system. In New Zealand about 50% of midwives work as self employed caseload midwives 50% as employed working mainly in facilities. All midwives from qualifying and being certified to practice choose which area she practices. Some midwives spend time in both areas in the course of their careers.
I was living pretty rurally at the time so needed to ensure I had back up and good networks. This is vital in rural caseload midwifery. I got to know everyone as you can imagine. Sometimes I could be super busy others more calm. But what is always beautiful is the depth of connection forged with women and their families from 1st trimester booking to 6 week postnatal discharge. The collaboration, working together and guardianship of that precious time is warming and ackowledging of the human capacity to be together in health care. I felt the childbirth process unfolded more safely due to that relationship, knowing women over time allowed for red flags to become easily visible.
Knowing women allows for the felt experience to be magnified. The spirit of childbirth over the extended rapport with women and families comes alive. I have been at births when 4 generations are present…magic. I am so often moved to tears and feel the hairs on the back of my neck stand up on end in the sheer joy of those Kairos moments. Yes I am tired at times but knowing woman when they call me in labour is far less exhausting and stressful than shift work and fragmented care. Being woken up at 3am to attend a birth of someone you know well is so different to waking for an early shift at the hospital.
As a Lead Maternity Carer (LMC as named in NZ) midwife I am able to get full access agreements with local hospitals to ensure continuity is safeguarded. At these times I honour and respect my hospital based core midwifery colleagues. With them higher risk women get the midwifery expertise required in addition to the primary focus I provide as the LMC. The interface of primary and secondary service misunderstandings and differences fades. Women are in the centre of care.
NZ midwifery is a truly integrated service. I said to a group of student midwives in the UK before I came to NZ how working in 1:1 ways with women over the childbearing year brings the felt experience of being a midwife to a whole different level. I now work with student midwives who have this embedded as the infrastructure of NZ maternity models of midwifery. Partnership, collaboration, protection and continuity lie at the centre of the philosophy of midwifery in NZ.
Watching a women grow into her breastfeeding confidence over 6 weeks knowing you have provided consistent advice from AN, immediate postnatal when she first meets her baby and then ongoing support…pure magic. To work with a woman who is terrified of labour and birth and to watch her roar with delight as her baby emerges in water at home and see the power and rawness of a new being unfold infront of me, to have the elder children that I helped into the world watch on as I return to the family each year to see a new sibling come join the party, magic. Yes sometimes things do not go to plan. But with well formed relationships so many things are possible, even when outcomes are not positive. The relationship helps, heals and restores.
I was invited to the funeral of a neonatal death due to fetal abnormalities. It was a traditional ceremony in a Maori Marae (meeting house), I was invited to speak and sing for the baby. The whole ceremony was nourishing and healing. The eye to eye contact, the hugs the authentic being together in human pain was healing and freeing. Relationships and partnership are key to midwifery; birth is always significant whatever the outcomes requiring tact and sensitivity – connectedness.
Continuity of care is evidenced based, many midwives experience working this way, we are learning how continuity is sustainable, how continuity can be the very aspect of midwifery that maintains passion and joy of practice. It is not a gold standard, it is a minimum standard for all mothers, regardless of risk, place of birth. Yet we all all need to ensure that a philosophy of childbirth and midwifery is deeply grounded in trust and appreciation of physiology, a way of attuning that honours the invisible qualities of childbirth, the spirit, heart and hold what is most sacred. Only then does continuity truly rise above the technocracy and fear surrounding childbirth. Fear can be moved to joy allowing all possibilities to arise!
Do you want to work in New Zealand? Working in NZ requires adjustment and further study. NZ midwives on qualifying are able to prescribe for childbirth related things (UTIs, mastitis, thrush for example). NZ midwives on qualifying need to be proficient in neonatal examinations and be confident providing care from early 1st trimester including miscarriage care, intepret scans, blood results and make referrals. I remember being professionally challenged ordering serial blood tests to measure HCG levels for a mother with threatened miscarriage shortly after arriving in NZ. With help from practice partners I learnt what I needed to do and say to provide support to this mother. Post natal care extends to 6 weeks; after my UK postnatal 28 days experience there was much to learn here also! The learning curve at the start can be steep and also includes gaining appreciation of a bi-cultural society and the history of colonisation on indigenous Maori. Transitioning from UK midwifery to New Zealand midwifery can be challenging yet that challenge depends on what you have done previously, what you want to do and how adaptable and open you are.
That is a taster of my own felt experience. Hope it adds to your thinking about the myriad potentials in midwifery.
Here is some useful links to explore more….