Ep 103 Christine Catling on choosing home births, workforce sustainability and interdisciplinary advantages

Ep 103  (http://ibit.ly/Re5V) Christine Catling on choosing home births, workforce sustainability and interdisciplinary advantages

@PhDMidwives #research #midwifery  #education #birthsetting #homebirth #UTS #ACM #workforce

research link - t.ly/XwoCO
https://australianmidwiferyhistory.org.au/

A purple-striped uniform, a corridor of hand-drawn portraits, and a decision that changed everything. That’s where Christine Catling starts—then she takes us through three decades of midwifery identity, home birth advocacy, and the quiet systems that make or break trust. We follow her move from UK nursing to Australian midwifery, the spark that led to a qualitative PhD on why women choose home birth, and the national consortium that helped publicly funded home birth services grow across Australia. The pattern is clear: when people feel seen and valued, services improve; when they don’t, the costs—human and financial—compound.

We dive into the workforce crunch with blunt honesty. Why are midwives leaving between years three and five? What does it cost to lose skills and continuity just as clinicians hit their stride? Christine shares promising findings from a cluster RCT on group clinical supervision and argues for cost analyses that count retention, recruitment, agency use, and the ripple effects on safety. The conversation also tackles freebirth and distrust of institutional care, not with judgment but with a hard look at what it takes to rebuild trust: first impressions that centre the person, informed consent that’s real, and models of care that let midwives do midwifery.

Along the way, you’ll hear how interdisciplinary work sharpens policy, why shared decision-making around induction and elective caesarean is a safeguard, and how compassion—eye contact, presence, a name—can change outcomes in seconds. We end with momentum: papers in the pipeline, global conversations with UK professional midwifery advocates, and a push to turn evidence into resourced policy that keeps midwives and families safer. If you care about midwifery, home birth, workforce sustainability, and humane care that actually works, this one’s for you.

Enjoyed the conversation? Follow, share with a colleague, and leave a quick review—what’s the one change you’d fund tomorrow to support midwives?

Transcript

SPEAKER_00 0:27

Thank you very much for joining me. As per usual, can you introduce yourself, please?

Hospital culture, art, and belonging

SPEAKER_02 0:32

Oh, yeah, sure. My name's Christine. Christine Catling. I've been a middle free academic for quite a while now. Midwife for well over 30 years. Come from the UK originally. Actually, I've been here for 30, 31 years now. God, that's ridiculous. That's the longest, longer than I've been in the UK for. So that's a bit bizarre. So came here with when I was 26 with a little one and a half year old, then had my son when I got here. Yeah, obviously started, um, did my education over in the UK. Um, trained as a registered general nurse, that's what it was called then, in the Norfolk and Norwich Hospital in the late 80s, which is a very, very beautiful old place. Um, it's now been made into bijou residences and nobody can afford to live there. Um, yeah, I was actually talked into nursing by a close friend. I never really knew what I wanted to do. Um, she's since had an amazing nursing career and is just about to retire. But um, yeah, so and also it was it was to um defy my parents as well because when I mentioned it to my mother, she thought that how are you gonna deal with all that blood, Christine? And so, of course, if your parents say one thing, you want to prove them wrong. Yes. So I went ahead and did that and um, you know, did nursing for probably about six-ish years, lived in this beautiful nurse's home, beautiful oak fittings, massive bathrooms, big claw foot baths. It was a really special hospital, is a is a blend of the old and the new. Um it, yeah, like I say, it's not there anymore, and it's moved to I think it's called the North and Norwich University Hospital, and it's now sort of outside the city of Norwich, which is a beautiful old city, it's one of my favourite cities in the world. Um, but the the unique thing about this, um, and my ex-husband, he came over to be with um me, obviously, and for a number of years he worked there as well. And um, there was this guy who was employed as an artist. So I'm just going off at tangents here. Yes, right, go. Um, he was employed as an artist, and I know lots of hospitals do have like their art collections and all this sort of thing, but this guy was special. His name was David Poole, and you can actually still buy his books of art. And he basically drew pictures, he went wild and drew pictures on the all the walls in the corridors. Um, he was quite gifted, well, very gifted, but quite a troubled man, um uh similar to many other geniuses in the world. Um, and he he he drew pictures of like cleaners and porters and just those people who've been around forever in hospitals that everybody knows, and sometimes you don't even know their name, but like once they're face and you see them on the wall every time you walk down this corridor, get to know them. Um, anyway, so not just nurses, midwife, doctors, but all of the people that make up the hospital. And you know what? It just did a really great thing in that hospital that everybody I don't know, it seemed to gel people a more a lot more. Um, because it really made people realise that, you know, that's that big chunky porter person that we see all the time, and he's got this big smile on his face, and we've got to know this guy, you know. We see his face on the wall. Anyway, he's named David Poole. Um, great guy. Um, the other thing about the hospital, I'm just gonna go on about the hospital now, um, it was very social. There's lots of interdisciplinary activities, like there was cocktails in the doctor's mess every Monday. And if anybody who I um was there with me at the time, they will just have the same memories as me, as me about Monday evenings in the doctor's mess. It was just crazy. Um, this I obviously don't I don't drink now, but like at that time, big drinking, you know, student nurses doing that sort of thing. Um yeah, so you just got to know all of the people, um, the doctors, junior doctors that you're working with. Um so yeah, about six or six or so years medical surgical neurocorinary care nursing, I think, which I love. Um, but honestly, never again will I be able to run around a 30-bed ward knowing all of the patients' names, all of the relative, yes, all the diagnoses. Do you remember that? Yes, I remember that. I don't have the cognitive ability to do that, the physical prowess to do that. Anyway, but come midwifery. Um, yeah, I just saw some friends do it, and I'm like, hmm, quite much specialise in that. So I just sort of did that 18-month midwifery certificate. I'm one of those old midwives who did the midwifery certificate. I I really, you know, nowadays the B Mid, it's just a fantastic degree, intense degree, but wow, it's just next level to what that midwifery certificate was. It was in the hospital, ton of community stuff, um, which was great. And you know, I just I went that, I just started that and I'm like, I am never going back to nursing. This is just this is me. Um, and also in the UK, you know, midwives wore the purple striped uniforms, and um, nurses wore the blue. So there was this separation of the disciplines. Um, and that's what I began my career with in the knowledge that midwifery was quite a different discipline. So when I came to Australia in '94, I realized there was a whole world of midwifery politics in that regard, which was quite interesting.

SPEAKER_00 5:48

But and we're still fighting that really, even though it's been now quite a few years. We're still fighting that pop the identity um politics and that discipline, identity of that separation. Because you ask a lot of people, what does a midwife do? And they'll kind of go, Oh, they'll look possibly look after babies. There's not, can you tell me the difference between a nurse and a midwife? And it's like, well, don't you have to be a nurse to be a midwife, even though we've had direct entry education in Australia for 25 years.

SPEAKER_02 6:18

Absolutely, yeah, yeah, yeah. I love asking people young people, or when they ask me what I do or something, I don't know. And there's a lot that just like, I don't know, especially young fellas, I find. Um, so I love educating them in that respect. We have a few um young blokes at UTS who come in and do these internships in the Sim Labs and stuff like that. And oh my god, do they get an education? Well, they would in the SIM labs. Yes, so they come out of um their um little secondment or whatever they do, um, with a whole heap of knowledge that they didn't think they were going to go in there and get, which is brilliant.

SPEAKER_00 6:56

So, where did you go if you then once you finished your 18-month course in midwifery, where did you work? Did you stay in the community or did you kind of stay in the hospital system?

SPEAKER_02 7:06

I did stay in the community a bit. I worked with a privately practicing midwife for a while. As soon as I was um finished my I had to call it training because it was training well, training slow gadget slash education, but it was it was different, shall we say? Um, so she said, Oh, you know, come out with me. And I'm like, okay, fine, I'll do that. Um, and I did for a while, and then it wasn't that long after that I, you know, started having babies and things, so things became a little part-time, and then because my husband was Australian, he was like, Ah, I need to see the wide open spaces again, and whatever it was. And um, yeah, we we migrated back. Um, well, here um, we were gonna do it for a couple of years and just see how it went, you know, 30 something years later. And um, yeah, yeah, yeah, yeah. So uh, and then when I got here, I think we had this little apartment in Cogra. Oh yeah, and that was that was the interesting thing because um because my husband was a nurse, my ex my husband at the time was a nurse, and um he was oh he went to see the people at St. George Hospital about working there, and they were just amazing in that we want you, we value you, please come and work with it. Like they were just really lovely, and we're like he was just sort of sold with their what's that smooth talking or just being valued. And I'm like, I wonder who goes into an interview nowadays and comes out feeling that way. I don't know if many people do. Anyway, so he started working at St. George's hospital, he still works there, actually. Um, and I did, I worked there for 15 years as well, about 15 years on lost track. But um yes, in all areas of military.

SPEAKER_00 8:42

Yeah, that's it about magnet hospitals and magnet employers, is people stay because they feel valued, because they feel kind of respected. And it's that's also the reason why people leave places is they don't feel valued, they don't feel respected. And quite often it's to do with how the management treat people, isn't it? And it's so many people change because of that. And it's so easy to value people, it's so easy to, and we had this conversation at work this morning, that gratitude is limitless. You can be happy and celebrate other people's, it doesn't take anything away from your own achievements, and we need to kind of do that more and more often.

SPEAKER_02 9:22

Yeah, yeah, and I think it's coming out as well. I mean, there's a lot of research about you know, um, what midwives value in their workplace, workplace culture, and that's been a topic of mine for a long time now, and um, it's just cut and dried, really. It's human, it's just you know, any job, if you're not valued, if you're not um treated correctly, uh, you haven't got that collegiality with your with your colleagues, you can't you don't feel safe to go to your manager to talk about anything you need to talk about. It's gonna be a limited time that you're gonna cope with that, really, and they're gonna leave. And that's what we're seeing a lot of times, sadly.

SPEAKER_00 9:58

And that kind of and we'll come back to that because that actually links in with some of your post-PHD studies and areas of research. Definitely let's kind of go back now. So you're kind of working with this private um midwife. How did you then when you kind of came here to Australia? You kind of got work at um St. George, how did you then get into because you've been at UTS for a while? You found a home there really early.

SPEAKER_02 10:25

I know. I'm not gonna change, am I? Um you have because you've changed countries. Yeah, I know that was hard enough. But um that seems like ancient history now. Um, how did I, what's the question? How did I where did I?

SPEAKER_00 10:38

How did you then get into kind of like education and research? Because that's where your area's kind of been for a while.

Discovering midwifery identity and politics

SPEAKER_02 10:43

Oh, yeah, yeah, yeah. No, that's uh yeah. Look, I think having toddlers at home, I just needed something with my brain. I need to do something with my brain. So I just did a part-time master's of midwifery. I just randomly chose some uh I don't know, course down at Wollongong. I was living down the square at the time. Yeah. Um, and so got a master's in midwifery, so that was quite helpful. Um, when there was an opportunity at St. George Hospital where I was working at the time, to apply to work as an associate um clinical midwifery consultant with Caroline Homer, who was there at the time. So this is way back in the 90s. Um so then I ended up working quite closely with Caroline for around 16 years, weirdly enough. So when she moved to UTS, I had opportunities to work as a research assistant at UTS. Um, and then my work spanned the uni in the clinical workplace quite a while until I became a full-time lecturer in 2011. I think I lingered on casually for a few years, but now I've fully transitioned into wikadia, which which is always a bit sad in some ways. You know, don't ask me to do anything crazy in the clinical workplace. I'll be rubbish at it now, sadly. Um, but I did get so interested in research. I love the creativity, the questions that were being asked, the wide variety of the ways that you um find the answers to those questions, the methodologies, the structures around, you know, exploring topics. Um so yeah, so I was sold. And as you know, um Caroline has that influence on many, many others. She certainly does.

SPEAKER_00 12:17

She certainly has. Mind you, she was she's also the benefit of Leslie Buckley, who had an influence on that whole generation of Silka Odair and kind of like Carolyn Homer, who have continued to roll down and roll on um that influence as well. And I think I worked out with as part of my PhD that I can clearly count at least five generations of Australian midwifery PhDs.

SPEAKER_02 12:45

I love that. I'm actually the chair of the Midwifery History Society. Um not a society, what am I saying? Group project anyway, uh project. And um, you know, we focused on the ACM history and we also focused on the history of midwifery practice throughout Australia and the website had a bit of an issue about a year ago. It's now fine now, so please go on and have a look at it. It's brilliant. And Beck, who's the like webmistress master person, she um has populated it fully with all sorts of things, which which we've all the group has all had a lot of input in. Um but we also get emails from random people saying, Oh, you know, my grandmother was this, she worked in Almadale, blah blah blah. So then we'll liaise with them, they'll give us some information photographs, we'll put those on as well. And it was just a wonderful way to honour midwives of the past. Um, but I'm just thinking with what you just said, we should have another section about these. We have got a lot about pivotal midwives, um, you know, and what they've done, especially the presidents of the over the past however long since EACM was formed. Um, but you know, just about that academic academic of the five generations, we'll have to you'll have to uh pass that on to me.

SPEAKER_00 13:55

Let me let me finish my PhD, hand up next year, and then I'll seriously sit and chat to you. So with your masters, it was a coursework masters then? Yep, coursework, yeah. So then obviously with Carolyn Home, there is being understanding and getting supervised for an a PhD is a kind of clear pathway. Was she your supervisor?

SPEAKER_02 14:18

Yeah, yeah. I mean, she was just in the office next door, which was quite handy, and um, and also had Hannah Darling, so that was quite lovely. Um, yeah, I did resist for a while, as many do. Um uh yeah, I uh I was broken down. But it just made sense, and also uh working full-time. Well, actually, I started in 2008, so I was quite part-time then. I mean, I just um a huge piece of work to undertake, isn't it? Um but once you find the topic, once you find something that you really love, I think it it sort of falls into place. So after a while, you're just like I could do this.

SPEAKER_00 14:59

So did you have the topic first and then approach them as supervisors?

SPEAKER_02 15:04

Um, I think it was like always like, oh, when are you gonna do your PhD? Blah blah blah. Um and then I I just got to thinking. So I did have Oliver at home. I I engaged a privately practicing midwife, Jan Robinson, who is no longer around, sadly. She was a wonderful midwife. Um, and she sort of opened up my eyes because I had him probably about a year after I got here, actually, in '95. Um she opened up my eyes to the politics of midwifery quite a lot. And I was sort of, you know, you have a lot to do with your privately practicing midwife who comes to you all the time and there with your baby, blah, blah, blah. So I got interested in home birth, I got interested in publicly funded home birth, um, and what led them to choose a home birth. Um, so that became the topic of my PhD. Um, and I know that now there's like a zillion uh zillion papers out there about why women choose to have a home birth. That's fine. But um, yeah, so that was that was my topic, and and home birth has been quite a um you know passion of mine since then, really. It's been one of my sort of main research programs, um, especially immediately post my PhD, which is which has been great. And the wonderful thing was that um I think Caroline um put it together the um National Publicly Funded Home Birth Consortium. So I led that for quite a few years. Um, and that's still going really strong uh with Deb Fox, Associate Professor Deb Fox, um running running that now. It's got all of the managers around the country attending um every couple of months. It's really pivotal to helping other services work out all of the hoops they have to jump through, all of that sorts of thing, that sort of thing. And um, yeah, so so that kept me going for a while. Also published together with that group as well. So all sorts of things have got have led from that that consortium and all from that PhD, I guess.

SPEAKER_00 16:59

So thinking back to your PhD and to your own research back then, what still sticks in your mind that maybe surprised you that still resonates today that was related to your PhD?

Moving to Australia and finding community

SPEAKER_02 17:15

Um, I guess because a lot of people get bogged down at certain points of time with their PhD. I think my point of difference is that I don't think I ever did. I don't think I ever let myself that happen to me. I'm quite protective of my, I don't know, well-being, I guess. Um, I didn't let it bud into my weekends unless I had some serious deadlines. Okay. I had young young kids at the time. I was not gonna let me uh be sitting in an office in the back room while they're running around wondering where their mum was. I mean, I know that's not possible with a lot of people. I mean, I was probably privileged in that I could actually do a bit of it at work because you know working in academia, so that made sense. But um, I think I was pleasantly surprised at how lovely it was. And I chose qualitative, I chose crowded theory. Yeah. So to have participants uh you go to their home, I talk to them. Well, I think all of my all of my interviews were done in women's homes, yeah. Um, and how wonderfully creative it was, and just you know, the writing, not of writing, but you know, that's just part and parcel. Um I think to that part of it that I don't think I ever found it, yeah. It was a big bit of work, and there were times where we're like, oh my god, you know, it's always hanging over your head, sort of thing. Yes. But it was it was okay. It was okay. I chose to do this, I owned it. It was just it's like you know, a PhD is not it's a what is it? Somebody calls it a degree in persistence or whatever it is, isn't it?

SPEAKER_00 18:44

Oh, it is, it's not intelligence, it's determination and stubbornness.

SPEAKER_02 18:48

Yes, persistence. So I'm quite persistent. I do like to finish where I start. So um I guess that was something that I didn't anticipate at the beginning, that how much I liked it, and um sort of move moved through it without too much drama, shall we say. Although saying that, you know, a lot of students, you know, they're around for a few years. There's always some big life thing that happens during like I did get divorced during my PhD. Oh, that's a slight stressor. That was quite stressful, but I mean, you know, the PhD was outside of that, and you know, that was just something that happens. It's just life, isn't it?

SPEAKER_00 19:23

It is, which kind of links into one of the other questions I usually ask people is how did you keep your sanity during those moments? You kind of sharpened out well.

SPEAKER_02 19:32

Yeah, yeah, quite well. Um, good people around me, good families around me, immersion in that qualitative work, um, balancing it with work and family, you know. They were early teens, my kids, when I did that. Um I've never really talked to them about it, how they actually talked to them. Um they're now in their 30s. Um, and my daughter lives in a tiny house just in my driveway. So I should talk to her about it, how how it was when I was doing my PhD and find out. Um, maybe it rubbed off to a certain extent, bit of role modelling. My son did end up doing a PhD, not in midwifery, but in physics for all things. Um and my ex also, he did a PhD in um in nursing, so there you go. Something like that. Rosie, Rosie's busy. My daughter is just she's a mother now, I've two little ones, so hasn't got time for time for her to kind of think about it then. Go and do a master's, and yeah, yeah. I think she'd just strangle me if I mentioned that. Yeah, no, it's um yeah, so no, I did I did um I did keep my sanity, I think. Uh probably luck more than anything, but like I say, I think people around you help you through, don't they? And um it's not all me. I'd say it was family, friends, situation, my work situation was ideal to do it. Yeah.

SPEAKER_00 20:53

Was there anything from the participants' stories of their experiences from home birth that surprised you or still resonates with you now? Oh gosh, it was so long ago, Liz. Yeah, that's okay. But sometimes there's one person who sticks in your mind when you think back to it, or one comment that they made, or kind of something that was a bit shocking for you, or this it doesn't have to, but sometimes, and once again, time does make a difference.

SPEAKER_02 21:27

No, I can't recall anything that was out there. It's funny though, when you mentioned that, and and you know, in the same sentence, home birth, but my very first birth was a home birth, and I arrived before the midwife. So, you know, newbie midwifery student, not knowing her ass from an elbow, sort of thing, and um turning up at this woman's home, she's just lying on the bed, breathing really deeply, and that's basically how she gave birth, just lying on the bed, breathing deeply. And I'm like, wow, wow, that's quite funny. Yeah, this is good. Luckily, um, the midwife turned up just before she started pushing, which was great. Um, but yeah, I my head went to her. I've always got that vision of her just beautifully, and it was like a second or third, I can't remember now. Certainly wasn't her first baby, but it was just such a I don't know, she just she just handled that the way she yeah, it was just beautiful to see. You know, there's some women's births that never leave you. Um yeah, but sorry, I can't I can't recall anything major or shocking or rememorable. I think it was all um, but it was at the same time beautiful to interview those women and ask them about why they chose home birth, because most of them I recall, most of them might have been multips, but there were a few primeps who um, you know, that's an unknown, that's quite something to do that. Um, and they I think friend friends and family were again a big influence. Like, you know, we think we have great influence as health professionals, but when it comes down to it, especially friends and family.

SPEAKER_00 23:00

Oh, that can very much change people's behaviours, absolutely. Do you think having been involved with so much to do with home birth since then, and from a kind of slightly distant area now than being involved, do you see things have changed a lot? Because our statistics are still very similar in home birth accessibility, um, and there's been some changes that we've been fighting for, but we're still fighting to get that recognition, even though theoretically every person in Australia could have access to a home birth if they've got the money and if they're in the right geographical location. But how much change have you seen from when you did it to what you're seeing now, as opposed to where you think we might be moving?

SPEAKER_02 23:54

Look, I think it has changed. I think the publicly funded home birth, the spread of services is getting bigger and bigger. So I I make a few of those meetings for the consortium, and I'm listening to midwives of in LHDs and areas far and wide around the country. Um, and some of them put together services and they really just like everyone's on board, everyone's, you know, this is it, da-da-da. It's done. And then some of some are um tackling clinicians and and you know, they have to look at the wider interdisciplinary. So, you know, obviously, you know, they've got to get be all on board, um, pediatricians, ostricians, ambos, everybody. Um, and they've got a few hurdles and people's attitudes that block blah blah blah block. And sometimes that's that's the executive, the executive of the hospital as well, because there's a lack of understanding and experience and knowledge and um, you know, all of those things. So, but I I'm seeing more and more services being set up. Like there's certainly where more are more now. I it's difficult because I'm in my midwifery bubble. Um, I would love to, you know, and I I I I know more and more people who are a little bit more accepting of home birth. But I think it's I think it's never going to suddenly have this massive uptick. It's just going to be a slow slog. Um, because because of the price, we have a big private system here.

SPEAKER_01 25:25

Yeah.

SPEAKER_02 25:26

Um, you know, the obstetric colleagues are very influential and you know, they work in a different way. They work with midwives, but you know, they're there there is there's a there's agreements, there's policies, position statements, and all sorts of things, but like really it's it's I think it will continue that way. Um I think we just have to keep keep fighting the fight and and not and you know enlightening people, putting it out there, talking about it, normalizing it. Um, it's not going to be a quick thing. I don't think ever it will. But I am seeing some breakthroughs in some services that are just got everybody aligned. And it's like, oh well, it got set up in four months or whatever. There are some people still going after two, three years, um, trying to get through to the people that aren't listening or keep blocking and all that sort of stuff. So, but I mean, you know, hats off to those wonderful managers and midwives out there who are who are doing that, believing in it and absolutely trying to jump through all those hoops that they have to. Um, and that's what the consortium is wonderful for because you know, we share all our resources, you know, funny little weird questions come on into the group sometimes and somebody knows the answer to it. Yes. It's so helpful because that's that's where the supportive part of it is is just brilliant. So, so yeah, um, a few changes, but not not as many as I'd like to see, shall we say?

SPEAKER_00 26:50

So then let's look at a potentially controversial topic. Um, how do we get the women who are free birthing back into a system that has the support there that is encouraging them to actually have a supportive home birth?

SPEAKER_02 27:12

Tricky. Very, very, very, very tricky. After talking with a colleague up in um Byron service up there, um it's it's it's almost as though it's not hate to say the word, it's cultish in a way.

SPEAKER_01 27:27

Yep.

SPEAKER_02 27:28

There is a there is a free birthing group, and they do not want to know anything about um healthcare professionals, and that's where they stick. And and there could be ri there's lots of reasons why they're in that group. Um and how do we get them out of that group? That's a it's a billion-dollar question.

SPEAKER_00 27:48

Um it comes back to the influences of other people.

SPEAKER_02 27:51

Absolutely. So so they're you know, they they've they they believe it's a belief system in some ways, and and you know, it's like the Marga crew can't can't change somebody who is is is in that cult. Um so I think I think changing people's or it's a lack of trust, they do not trust the system. And wow, when the trust is gone for whatever reason that is, it tars every health professional and every hospital and everybody who who is working for the right reasons, you know. But if you get one bad apple and and you've had a really traumatic experience, you can completely understand why.

SPEAKER_00 28:28

Oh, totally.

SPEAKER_02 28:29

Yeah, yeah. Um, so I do not have the answer for that, and I think I think that would be well, it would take a lot of sitting down working out, um, because because there are women and and probably babies who aren't, you know, getting the best outcomes because of it. So um, but it's again, it's a woman's choice, you know. Yeah, but it I am worried about the the sort of negative influences that do push people into that. But the lack of trust thing, I think. Well, we've got a lot of that anyway. You look at the birth trauma stats. So um it does have to be tackled, um, absolutely. Um, so we have our work cut out. Um we do, but it it's multifactorial as well. It's not just about the bad apples, and they're all bad apples all over the world. Um, it's systemic, it's it's the lack of midwives, it's the midwifery crisis, which flows onto the whole um, you know, not getting enough, not getting the work done, not getting the care women need because of those systems and problems that we've got that we've we're facing right now that that will take creative thinking and lateral thinking and out-of-the-box thinking to to fix, you know, so it's not easy.

SPEAKER_00 29:46

And the healthcare system is increasingly costing, so that's the the business sense of it as well, with governments and and accountants and where do they get to, and I think I read a uh a United Nations or World Health report a while ago that stated that when they looked at the year 2030, which seemed a long way away, but is now no longer as far away, the highest percentage of GDP in internationally would be healthcare. And it's from modifiable lifestyle conditions. So and when you look at the the mortality. For um maternal mortality rates, then the non-direct cause is cardiovascular. But the direct cause in the first 12 months is still suicide. So those it's like there's so much work, but as you said, it's multidisciplinary, it's multifactorial, and gotta come. But when you're talking with governments who deal in election cycles, and we're talking intergenerational change, but also rapid change, yeah, there's really big problems.

PhD spark: why women choose home birth

SPEAKER_02 30:58

That's right. That's right. I mean, but the thing is though, if we don't start taking it seriously and trying to unpick all these wicked problems that are leading to these really serious issues, you know, we're gonna be spending millions of dollars on it. Um but we have to because the flip side is if it doesn't happen, we'll be spending billions of dollars in loose lawsuits or or um, you know, uh the UK I know currently has about three billion owing in negligence costs, you know. That's um we're gonna we're ours as has rose in here in Australia quite significantly over the years. And I'm just I'd love to know why um, you know, what percentage of that is related to workplace, workforce insufficiencies, all that you know, I mean they're all different, but um yeah, I think it someone needs to do the costing. If we don't look after our midwives, if we don't, if we don't do this, then it's gonna bite us on the bum. And I think it probably is starting to do that already.

SPEAKER_00 31:59

Oh, I think it has. And I think that's where kind of another reason why anyone doing research is important, because it is gathering those evidence, it's gathering those benchmarking, it's saying, here's what's happening now, here are some of the contributing factors. And yes, we need the quantitative, yes, we need the dollar signs, but you're talking about a healthcare system and a society that has humans in. So you need to have both of those kind of points of views in, because you go back to the old statistical significance versus clinical significance versus the personal. Um yeah, and it's like there's so many things that still need looking at and still need researching and exploring because it could be part of the answer, and we won't know until we find out all this information and then put it together.

SPEAKER_02 32:43

Yeah, absolutely. I agree. This it's just it is a lot of things to think about. But I think the humanity of healthcare and and midwifery, like that, you have to go back to that, don't you?

SPEAKER_01 32:53

Yeah.

SPEAKER_02 32:53

And I know you know, we do teach that, we teach communication, we teach you know, you can teach empathy, but you know, hopefully you'd have a good deal of that anyway. Compassion, all of those sorts of things, and then midwives get in the workplace, and it's all it's crazy out there. Um, and there's a ton of technology you've got to get over, you've got to get um um familiar with a zillion platforms, um, and then um some of the humanity can can be lost as well. So, you know, oh well, I have to do this, I'm gonna get disciplined if I don't document this in five different places. Um, and then that you know, they leaves very little time to sit and sit with a mum, new mum is desperately trying to breastfeed.

SPEAKER_00 33:37

So, yeah, priorities. Hey, Diane Minaj, when I was chatting to her, and she did hers on I know, and I'm I've just read one chapter of the new book, Love and Midwifery, and I'm just I've got a pile of books I want to read when I finish my PhD because I've got to be focused. Um when I was chatting to her, she said one of the things that came out of her interviews on what is compassionate midwifery, and she didn't define compassionate, she just put out her flyers. Have you had compassionate midwifery care or maternal care? Come and talk to me. And she's and it's stuck in my mind, and I tell my students, I've continued to tell my students this ever since the interview, is she said that one of the women she was talking about, they can tell within kind of like 10 seconds of you walking in the room if you are there for them or if you are actually still outside. Because if you walk in, you've got eye contact. Hi, I'm Liz, I'm here to look after you. How are you feeling? You're actually treating them as a person, as an individual. If you walk in, you're still on the phone, you're still reading the notes, you're not engaged, you go to looking at the computer, then they're gonna go, you're not treating me as an individual. And that is so powerful, isn't it?

SPEAKER_02 34:48

Isn't it? Oh, the eye contact thing is is quite something. Like, you know, I've had a bit of a horrible health history, but I remember when I had one of them, the breast cancer one, um, but that was many years ago now. Um, but I did see an oncologist, um, and they didn't even look me in the eye, they just looked at this computer program, and they were tapping things in this computer program, and she was she was like, Oh, well, if we do this, uh, you'll have a 10% chance of dying in five years. If we do this, you'll have a five percent, you know. She's looking at this computer and spelling out these um statistics at me, and I'm like, wow. Um, yeah, didn't go back to her. Yeah. But yeah, so I I understand what you're saying. It is the eye contact, the smiling, it's those simple things. Um, yeah, so I've I've had a bit of experience personally, uh, where that's been pretty bad. But I've had the flip side as well. I've had the other side of beautiful, caring nurses who've looked after me in horrible situations. But um, yeah, it's so important. It's interesting. She said that was it the first 10 seconds you can find.

SPEAKER_00 35:55

Yeah, I think she said the first six seconds. Six or ten seconds, but it's just right. You walk in the door, it's like, where is your head? If you need, and I've kind of when I teach it now, it's like before you go in the room, and it's something that I used to do as well when I was kind of like back pre-midwifery when I was in the nursing days, is you sit and you read the notes beforehand, you get your key information of what you need to do. And when you walk in the room, you eyeball the patient straight away, you're kind of talking to them, and then even if you're doing your bait checks, it's like, hi, I'm Liz, I'm here to look after you. Are you okay? I need to do some checking, or do you need something first? And it's that prioritizing of them, yep, they're important. I can do something for you. I just need to do these checks to start. Okay, no worries, and then I'll be back with you unless you need something. And it's that that flipping that makes all the difference, especially if they don't know you. And suddenly that's like, well, I've got to trust you. I've got to, you're kind of my life's in your hands sometimes, and especially when I was coronary care and I see you. Um, free as well. It was that kind of important. So hearing Diane do that, kind of say that from her research was just powerful.

SPEAKER_02 36:58

Yeah. Well, good on you for reading the first chapter. I haven't even read the first part.

SPEAKER_00 37:03

I've read the chapter on Liz Newman's chapter because we were we were teaching it today, or teaching it yesterday to our students. So I had to do a read on it. Um let's go back to something very human, very joyous. How did you celebrate your PhD?

SPEAKER_02 37:20

Okay. Uh well that was that was quite funny actually. My Rosie, my darling daughter, was going through her quite alternative stage at that point. Um, or whatever it was. Uh, don't think she realized that people usually scrubbed up a bit for graduation ceremonies. So I have these great photographs of us all with her looking completely trash following an all-nighter or something. Good on her. She has apologised a million times, which is totally unnecessary. But at the time I thought it was so funny. I mean, I and interestingly enough, I often think that that speaks to my wider parenting abilities because you know, my kids just get brought home by the police by doing some dodgy teenager thing down at the posh area where we live. And I would just be trying not to laugh because it's like, oh, this is it speaks to my way with behaviour of my upbringing in Suffolk because when I was growing up, I was like, Oh, this is normal behaviour. Whereas my ex was like seething and like really cross and anyway. We did, I think we went out for dinner, just went out for dinner, um, which was lovely. I mean, it's a recognized that whole graduation thing is a recognition of your of your hard work, but also your you know the pride in what you've done. Um, like I've got some very accomplished brothers, and I always felt I could never complete compete with them until now. So, you know, I leveled it up a bit, but um anyway, no, it's it is lovely because when you do hand in your PhD, first of all, it's just like a bit of an anticlimax. Yes. As many people said to say, because it's like usually a a click on a PDF dilute to the research office. Yeah.

SPEAKER_00 38:52

It's just a submission online. Whereas kind of I remember with my master's, it was a printed document, three copies, and then you actually went to the faculty desk and there was at least somebody there that went, Oh, is it is it that time? And so you you got that joyous kind of like celebration from someone, and then when they kind of yanked to pick it up, occasionally they'd have balloons there or something like that, if especially if you knew them. But now it's sitting at home and you see so many photos of people taking photos of the submission screen or sitting there with a glass of champagne, kind of like at home, and it's just kind of like going, Oh, we've lost some of the ceremony of it all.

Publicly funded home birth and the consortium

SPEAKER_02 39:28

Yeah, yeah. And you get it back when you have the graduate graduation, but I think at the time of you finishing it, you're like, because it's hard to finish sometimes, you don't know when to finish it sometimes. It's like, oh, have I really done everything I need to do? So, you know, to get to that point is it needs to be celebrated a bit more. Yeah, we need to some creatively put something in place, don't we? I quite quite quite like what you suggest suggested, just I don't know, just somebody acknowledging that. But yeah, no, it is just a PDF now, isn't it? On an eye PDF, but a PDF. Yeah. Oh well.

SPEAKER_00 40:02

One of the things now, when did you start working in now sphere, which is a Sydney Partnership of Health, Education, Research and Enterprise sphere, maternal and women's clinical academic group? Because one of the things I've noticed is we have different definitions of what a clinical academic is in Australia, in the UK, in midwifery, and in medicine. So in medicine, where I think it started, a clinical academic is a practitioner who works clinically but is expected to do some research and occasionally teach in midwifery. And I think in nursing, in a lot of the areas, if you talk to people on the floor, a clinical academic is a teacher who comes in to supervise students. There's no research component to it, or very rarely there's a research component to it. In the UK, it's a lot more acknowledged that there's a research component to it, but trying to get that recognized by the venues. And it's one of the discussion points that's kind of very important to post-PHD pathways. What is your definition in this group of a clinical academic?

SPEAKER_02 41:14

I think they were just called that, basically. Um, but I think your description of uh, you know, an academic that is still working clinically is is probably a very loose, um, but more correct um definition. Um, so in SPHEA, fantastic organization still happening. Um when I was co-leading that, I think I did that for four years from 2019. Um, maternal newborn and women's CAG, as they called it. Um that was fantastic. That was just lovely. It was a gorgeous um opportunity to have a bunch of really high achieving academics in a group that you'd meet with and progress projects. Uh, we did a really wonderful um timing of birth project um about you know elective cesarean sections and inductions of labor, which led on to shared decision making, the importance of shared decision making. I know that's called different things, and some people balk at that term, shared decision making. But um, you know, that's what that's what that led on to, the importance of how women need to be given in proper informed consent and you know, have this conversation with clinicians before their treatment options, and they have the last say about what happens to them, you know, especially in relation to induction of labor, elective insection, all those sort of things. So we did a number of projects we put out, um, we had used to get funding, we'd be able to put out um funding opportunities for sphere members. Um it it was uh yeah, I met a lot of people through that. Um I think they're called different, they're called they're not called um clinical academic groups anymore in sphere. I think they're called something different. And again, Deb Fox is leading that now. So um, so yeah, I did four years, I've met a lot of people, learnt a lot. It was it was uh it was a lovely leadership um opportunity that I had there. Yeah. I've had some wonderful opportunities actually throughout my my time. I think pretty much the first or second year after I finished my PhD, I was um given the opportunity to do um a fellowship with the World Health Organization Collaborating Centre at UTS. So that was wonderful. Um I did um I did have the opportunity to go to Papua New Guinea, be part of the first ever midwifery conference. Um there was a wonderful maternal and child health initiative on at the time, which was funded um to put senior midwives and obstetricians in hospitals in PNG to help build capacity. Sadly that's now over, but that was um wonderful. Um worked closely with Michelle Rumsey and of course Caroline was a big part of that, and Pat Brody as well. Um, so you know, following that I've sort of immersed myself in doing lots of teaching, bits and pieces of research along the way, um, being part of larger studies. But yeah, the sphere um came along. Um again, Caroline was started that up uh 2016, I believe. Yeah, excellent, excellent um uh NHMRC funded um um group. Um there's only a few of them in Australia, I think seven or eight of them in Australia. So that was that was wonderful.

SPEAKER_00 44:30

What's some of the things that you found valuable working interdisciplinary?

SPEAKER_01 44:37

And yeah.

SPEAKER_00 44:39

What what kind what things would you recommend when people get the opportunity to be invited into some of these groups that are your maybe the only midwife in the room and at the table? What type of things can you learn? What type of things can you can you also then give?

Doing a PhD with boundaries and wellbeing

SPEAKER_02 44:58

Yeah. Well, your midwifery spec perspective. I think midwives just do midwifery and they just sort of see it as it's like when people say, Oh, I'm just a mum. You're not just a mum. Oh my god, you're most doing the most important job in the world. Um, and midwives can be a bit like that as well. It's just midwifery. Oh, what do I know? I don't want to, I can't sit around a table and be with these other people in these disciplines that you know. Um, but you certainly can because you have a unique perspective, and often it's more of a human bringing it down to the woman's level perspective, which is vital and and could be missing. Um, so I think there definitely needs to be more midwives around tables everywhere. It's like it's like when you go to conferences, you can go to mid-bofery conferences, fantastic. But when you go to interdisciplinary conference like Byzance or some or something different, um, you get a wider perspective, you see what these other researchers are doing, the way they do it, they're just people doing things in a different way, thinking of it in a, you know, they're looking at their from obviously from their perspective of their discipline. But that's important because you can get stuck in your own bubble. Um, and sure, you work with obstetricians, pediatricians, physios, all the people, but when you um are working with them in a different capacity, not necessarily just running around the ward working with them clinically, but when you're working with them in a sort of trying to create something, or even on a policy committee or something like that, where you do have to have everybody's heads into the into the policy to make sure that everybody's happy with what you're coming out with at the end, um, you know, those perspectives aren't necessarily yours. So you do you do gain a wider view of of healthcare, it is really important, and um and I think it's good to try to get midwife to see that importance as well and widen their confidence perhaps to to join those. Because I think when I, you know, I've been thrown, I'm quite good at jumping in the deep end, not knowing really what I'm jumping into, and then working out later. Um I don't know where that came from, and I've probably got a bit more risk averse as I've got older, but like I still will do that. But I think I've been around long enough now to sort of not worry about it so much. I still will say yes to a few things where I'm like, hmm, what don't I just say yes to? And then you know, you try and find the people who can help you along with that, and then you you find it's just it's just illuminating. You have to stretch yourself if you're in a comfort zone and you don't stretch yourself, then you're never gonna really you're gonna just be stuck in your own little little world and not never step outside of it and and sort of grow. So I think that's important, but you know, it does take a bit of effort to do and a bit of um, you know, you're going to be anxious, and that's okay. That's okay.

SPEAKER_00 47:43

But that's good stress, it's not just bad stress, it's good stress is growth, and it's like good sailors are not made in the harbour. That's right. I should have just said that instead of all the rubbish I just said. Yeah, what you said was really cool. So let's take that one step further then. In have you supervised non-midwifery students, or what can non-midwives bring to the supervision uh table? Okay. Um flip side to the same coin.

SPEAKER_02 48:17

Yeah, I guess my head goes to one that has just um graduated. Um, she was a psychologist from Brazil. Wonderful woman, yeah. So she came, she actually came by the sphere pathway. Um and I ended up being primary supervisor for her who looked, she looked at social support. So I think because she was a psychologist, I learned actually quite a lot from her, from her perspective about um oh she was she was just one of those students who just did it without really much guidance, you know, she was perfect. Um, yeah, uh in her second language as well.

SPEAKER_00 48:53

I'm amazed, absolutely amazed at people who used the second language.

SPEAKER_02 48:57

Yeah, yeah, yeah. So yeah, I her psychology background was perfect for that topic. She looked at all different types of social support in the perinatal period. Um, I guess what did I, yeah, just just that ability to think through things, I think. Um who else? Uh a number of nurses. I've got a nurse at the moment who's working quite closely with me in a PhD, um, extending my um my group clinical supervision work, looking at implementation science and the enablers and barriers and using various frameworks. And she's um sort of quite reasonably early on in her in her PhD. Um so she's a she's a qual she's a trained clinical supervisor. Um so that's where we link up. Um she has a nursing background. Um yeah, I I just I I you know it's lovely working with all I mean. I think, yeah, tons of midwives are students, um, but I do love to have different, like you know, the different disciplines. I think you you have to bit work with all disciplines now. It's just it's crazy not to, um, and everybody benefits. It's just as simple as that, really.

SPEAKER_00 50:15

So what's coming up next? What are you excited about next? Because he's still doing the COVID study, or that's finished? COVID. Or am I reading? No, there was something that you're doing a longitudinal five-year research project.

SPEAKER_02 50:29

Yeah, sadly, that's coming to an end. I got some wonderful um NHMRC funding for a fellowship, an investigator grant. Um so, yes, I have till December. Um, so I'm busy writing up all my results, getting the papers out. Um so I'd love to, once I've really crystallized the results, do the next obvious thing, which is to get policymakers to take this seriously. Um, you know, given the workforce crisis right now, the midwives are trying crying out for support, um, whether it's clinical supervision or it's a different type of support. Um, but I think all need to be on the table. Because, like I say, if we don't spend millions on this because it's a serious issue, they're not supported, they will leave. It's absolutely as simple as that. Oh, yeah. It doesn't want to be complicated. Um, so we did a cluster RCT. Uh um, just writing up the results now, but the clinical supervision was beneficial in the um in the intervention sites, which is wonderful. I can't give too many details. No, no, no, that's okay. But it does need to be invested in, like, you know, so perhaps a cost analysis, because I think cost is such a big part of you know what you have to think about now in um health workplaces.

SPEAKER_00 51:41

So there's huge costs in training someone, then you kind of you keep them for a little bit. Maybe I think the biggest turnover we have currently with graduates and new staff is that three to five year period where they're they're leaving. So we're having this massive skill set because the still the average age of a midwife in Australia is still sitting in the mid to high 40s. And as all of us kind of like Gen X's and the baby boomers are going, yeah, no, we're out of here, we're gonna have this knowledge gap that is missing. So that is unrecognized costs that we can't necessarily put a value to. But it's like you train, you give them all up and then they disappear. Where does that, how does that cost come into it in a cost analysis?

SPEAKER_02 52:28

Yeah, yeah. I got to talk to the special people who know about doing that and find out what we can do there because um uh it just seems sensible to me that we are losing what what we're not doing to support our midwives is causing everybody to lose, not just midwives themselves, the women and their families they care for, the health services. And if you take all of those things into account, what's the cost of that? That's huge. Just the human cost, but the actual financial cost. Um, so if we don't support these midwives to enjoy their jobs, can you imagine if you've got like this fully staffed workplace, everyone's motivated and engaged, loving their work, loving being there? I mean, you know, honestly, it'd be a total game changer. You talked about magnet hospitals earlier. I mean, you would get people knocking down the door to work there. So, you know, why why is that so hard to think that that like we laugh and smile, oh, that's never gonna happen. Why shouldn't it happen? Why can't we have workplaces where people are fully supported and everybody is just, you know, because if you're feeling that way, you've got high morale, um, you are going to do your best work, you know, um, you're gonna be engaged, da-da-da-da-da. So uh maybe I'm just living in a utopian world, but I think I think we do need to do a lot more work in that space um to convince people that this is what we need to do. Um, you know, it's it's horribly short-sighted for institutions not to take it seriously. Um and we've got to throw money at it, we've got to get it right. Um, and if we don't, we are foolish. So so I think I think that I would love to be able to get more funding to to be able to show more nuanced information about the importance of supporting midwives. Um they they can't keep leaving the way they do. It's just it's tragic. It's tragic for them.

unknown 54:29

Yes.

SPEAKER_02 54:29

Because if you see how much you invest in that three-year B mid or that grad dip, um, you know, they may go back to nursing if they have nursing as a background, and that's that's fine. Um, but we're losing them in the midward-free space, and that's where we're seeing the awful deficits, especially in those rural regional areas, while they're suffering out there.

SPEAKER_00 54:50

And it's also students too, because we've got, and I don't know what the percentage is, and that maybe someone's doing research on it, but we're losing students who are already getting towards the end of their course and already having the moral distress and already going, I can't go back into that, I can't, I can't go back into that placement, I can't finish this course. And so, yeah, if you've got places where they feel valued, if they've got that environment that they're able to give, and that's the big thing, is to give the quality of care that they want to give, even in a public healthcare secting or in a private secting that's not MGP, then we will we'll keep more, we'll have a better, kind of happier workforce, which means we'll have better care, less obstetric violence, less birth trauma for the people who are using the healthcare system.

SPEAKER_02 55:38

Absolutely. Yeah, we can we can put the worlds to rights so easily, can't we? About what needs to be done. Um, so but it is but it is a bit disappointing that the you know, I because I think I think they do tinker around the edges. Like I think a lot of health districts do try to support their staff in the ways that they they know how to.

SPEAKER_00 55:58

Yeah, within their constraints.

SPEAKER_02 56:00

Yeah, but I think not not every single person wants a certain type of support. They need all different, they need to have people to go to to say this is what I really need. Yeah. Um, or work out what they need with that person, and then it needs to be funded, they need to actually have time off to go to those, not not outside of work time, within work time. And and it needs to be, it needs to work, like it needs to be reviewed, evaluated. If it's not working, this midwife needs something else. Um, yeah, and it's not just EAP. EAP is great, some people, um, but not for everybody. Um, clinical supervision is great for a lot of people, not for everybody. Um but the support is needs to be there. But it's not just that, it's actually the change of the models as well. That's the bigger, harder um uh wicked problem as well. So, you know, we we we midwives aren't doing midwifery a lot of the time, and that's what gets them down. Um so we need to change that. We know what to do. Just getting other people to listen to us. Since 1989, the Shearman Report. Oh my gosh, you know, what was that? How many years ago is that? I'm not really good.

SPEAKER_00 57:15

Long time, long time, 2036.

SPEAKER_02 57:22

Yeah, yeah.

SPEAKER_00 57:23

36 years.

SPEAKER_02 57:24

It was it was it was black and white then. Continuity of midwifery care. Let's do it, it's great. Yeah, so yeah.

SPEAKER_00 57:32

It's slowly happening, it just needs to roll out a little bit faster. Yeah, just a bit. That's kind of a little bit the negative. What's an exciting positive thing that you've got coming up?

SPEAKER_02 57:42

What's exciting? Oh gosh, that's exciting. Exciting for me is to actually get my results out there, get my papers out there. That is exciting. Like um very close to um getting one out soon, and then the rest can follow. Um, presenting a zillion conferences this year. I've got about three left. I've got to go to the UK, meeting with colleagues over there. They do some wonderful clinical supervision type stuff over there. Um, professional midwifery advocates, going to meet with a few of those um and see what they're getting up to. So that's exciting. I always love to meet people from far and wide, and um, you know, if you're interested in the same sort of thing.

SPEAKER_00 58:22

So ICM next year on your diary.

SPEAKER_02 58:25

Oh gosh, yes, ICM. Hopefully the abstract will be accepted.

SPEAKER_00 58:28

Um they've got huge amount. Yeah, how much? 3,000 or something?

SPEAKER_02 58:34

Some of abstracts. Submissions. Oh gosh, yeah, that's a bit terrifying, isn't it?

SPEAKER_00 58:40

I I kind of I take my hats off to the committee that's gonna be kind of ranking them all.

SPEAKER_02 58:46

Yeah. But I think I think uh my colleagues at work have said the ICN is the same. The um the nursing con uh yeah, is is huge like that. So, you know, we always think ICM is just so big, but I think in nursing it's like that's just what they do. Um, yes, Portugal sounds good, doesn't it? Yeah, I'm looking forward to that. I haven't um any moves to go to organizing that yet, but I should do.

SPEAKER_00 59:13

Thank you so much for your time.

SPEAKER_02 59:16

Thank you, Liz. It's been lovely talking to you, really nice.