Ep 106 Olivia Tierney on regional practice, COCE learning, and national policy

Ep 106  (http://ibit.ly/Re5V) Olivia Tierney on regional practice, COCE learning, and national policy

#PhDMidwives #research #midwifery #regionalmidwifery #COCE #policy #governance

research link t.ly/qze7R

A nursing student drawn to babies and family care doesn’t always end up writing policy, but that’s exactly where Olivia Tierney’s path led. We sit down with the Senior Midwifery Advisor at the Commonwealth Chief Nursing and Midwifery Office to map a career that spans MGP caseloads, tertiary units, regional hospitals under flood and fire, and the long arc of a PhD that changed how she sees student learning and continuity of care.

Olivia takes us inside the contrasts that shaped her practice: the intimacy of continuity models versus the shock of high-acuity tertiary care, the autonomy and breadth of regional shifts, and the logistics of transfers when roads close and distance is daily reality. She explains why continuity of care experience (COCE) lights a spark in students, how following women through pregnancy, birth and postnatal periods turns theory into grounded judgement, reflection, and confidence. Her research journey is frank and relatable: withdrawing, restarting, choosing supervisors who fit, sitting with uncertainty until the work clicks, and then using that evidence to improve how students learn across varied placements.

We also explore what it means to lead from policy. Olivia argues for midwives at every decision table, translating lived practice into better guidelines, workforce planning and equitable access, especially for regional and remote communities. She shares how endorsed midwife pathways, prescribing shifts and smarter placement design can reduce attrition and keep midwives in roles that match their philosophy and scope. Through it all, she keeps a link to research, ensuring national decisions are tested against evidence and the realities of care.

If you care about continuity, education that actually works, and policies that respect both women and the profession, you’ll find both clarity and courage here. Subscribe, share with a colleague who mentors students, and leave a review with one change you want to see in maternity care—what would keep more midwives thriving?

Transcript

Meet Olivia And Early Career

SPEAKER_01 0:53

Thank you very much for joining me, as per usual. Can you introduce yourself, please?

SPEAKER_00 0:59

Yes. Hi Liz. My name is Olivia Tierney and I am the Senior Midwifery Advisor with the Commonwealth Chief Nursing and Midwifery Office. Woohoo! And that's a new role from this year, too, isn't it? Absolutely. Yes. It's uh just clicking over four months.

SPEAKER_01 1:15

Oh, so exciting. So you've taken over from Kelly in that role.

SPEAKER_00 1:19

Yeah, that's right. Yeah.

SPEAKER_01 1:21

I'm so excited. So exciting. Okay, let's go back to the very beginning.

SPEAKER_00 1:27

How did you get into midwifery? Um, I knew you were gonna ask me that question, so I had to think about it. Look, I think I I always was gonna go into some sort of healthcare profession, I think. Um, and when I put my you know uni preferences in as a good year 12 student, I um put in a few different options and midwifery wasn't one because you couldn't do it as a as a direct dentist then, but um nursing was one, um, and that's the one I got, wasn't my first preference, but that's the one I got, so that's what I did. Happily went along and did my nursing degree. I think I learned pretty sort of early on. We got to do so much clinical placement in my nursing degree, um, which I was so thankful for. But um, I think I learned pretty early on I was gonna do something around kids or babies, or you know, had that motherly type of interest, I guess. Um so did that, and then um yeah, in my new grad year, I was in this really great um program where they, you know, put you around a few different places, and then at three months they checked in with you about what your interests were, and then they redesigned the rest of the year. So I had this three-month type of you know, timeline when I was doing um my first year of nursing. And um yeah, pretty quickly went, you know what, I think I want to do something around like neonatal uh nursing, or um probably should go and do my MIDI first if I'm gonna do that. So that's sort of my interest. So then for the rest of my first year of my nursing degree, they put me in the maternity unit. Nice, which was like so great, but like just like consolidated, you know, you know, yeah, this is where I want to go, this is what I want to do. So, you know, you had to do your one year mandatory nursing, and then you could apply for your postgrad, um, which was super competitive where I was living at the time, but I got in, so I was very excited about that. Yeah, and then in that program, you got in your clinical aspect, you got six months with an MGP and six months in a tertiary center. Yeah, and I didn't really know much about MGP, I don't think, back then. And um that's what I got for my first six months. Yeah, so I was just so thankful to have that experience and um you know, worked with one midwife in that caseload model for six months. It was a brand new midwifery student, and like it was the most amazing introduction I could have asked for. So yeah, that sort of, yep, that was the beginning and kept it absolutely fueled my you know, midwifery passion from there on.

SPEAKER_01 4:17

How did you find the change then to the second six months when you then went into acute care or a hospital system, I should say?

First Placements And MGP Discovery

SPEAKER_00 4:24

Yeah, it was a real uh shock. It probably didn't help that, you know, we had quite a small group of students and we were all pretty close. And the ones, you know, you go to uni a couple of days a week, and those ones who were at the tertiary centre were listening to the stories of us who were in this level two birthing unit with the mentor that we were, and we were all really like nervous at going to that tertiary center, and they were like, could not wait to get to the MGP. So I was pretty nervous and went straight into the birthing um unit. Um, and then we, you know, did our rotations, but there was a bit of a culture back then around you know, the the midwives who worked in the birthing unit only worked in the birthing unit, and yes, you know, don't go through the door into the other areas, and so there's a bit of that going on, which um you had to navigate as a pretty young as well, and pretty early in my career. So I look back with fond memories, I can still remember the births that I attended in that year. Like I clearly can remember them more clearly than many other births I've ever been at. So they're really imprinted, I guess.

SPEAKER_01 5:36

Why do you think that why why are they more memorable than the the MTP births?

SPEAKER_00 5:41

Yeah, I don't know. I haven't really thought about that before, but I think I think probably because it was so I was just learning every day, every moment. It was always something new. And like I said, it was a tertiary center, so you know, a lot of the women were quite complex because the women who weren't weren't were with the the MGP or the birthing, the birthing unit. So yeah, and I think the women when I think about it right now, the women really were really grateful for you. I felt that there was a lot of connection really quickly in the births um there. I don't really know why. I haven't really given that a lot of thought, but yeah, that's what I'm thinking right now.

SPEAKER_01 6:19

Cool, that's right. The first thing is quite often the the meaningful thing because it's kind of jumps to the surface first. So how long did you where did you go after you finished that 12 months?

SPEAKER_00 6:30

Yeah, so after I did my um my MIDI program, I stayed on at that at that facility in the tertiary center and got a new grab program. Um again felt felt very fortunate because not all of us, you know, the numbers dwindled and you know there was not as many places as there were students. And I did that sort of you know, rotating around the different areas for probably only like less than a year. And then I was offered a second into the MGP. I think about that now, and I think, gosh, I was only like, you know, maybe eight or twelve months into midwifery, and they, you know, asked me to be in the MGP model, and I just wonder about that now. Like, would that happen as easily? Because I know where I've come from, we've you know really had to advocate for that. But um, so I did that for a little while, um, maybe like a year, and then we moved out into the country. So um, so and then I've been um where I am now ever since in Port Macquarie.

SPEAKER_01 7:32

So that's uh for those that don't know, that's a regional area, population of about 30,000?

SPEAKER_00 7:41

Yeah, maybe a bit more with the local surrounding areas, yeah. Um yeah, so mid-north coast of New South Wales, Virupai Country. And we've been here ever since.

SPEAKER_01 7:52

And you guys have actually been hit with quite a lot of weather over the last 12 months, as in floods and storms.

SPEAKER_00 8:01

Yeah, and then yeah, and fires before.

SPEAKER_01 8:05

How's that all impacted?

SPEAKER_00 8:07

Yeah, it's really interesting, actually, that um when those natural disasters happen, we have had such a run of it over the last few years. And in the role I was doing um during that time, you know, I had to actually then I found myself working in the emergency ops center when like being the health representative. But yeah, just having to coordinate and ensure from um patients' perspective, but also, you know, they I always used to get asked around the women who were pregnant, and you know, making sure that they can get to care if they need to, like, and it's interesting when you come from a regional area and you know distance is like common practice to have to consider. Um, and then you throw in a flood or a fire that's that's affecting how you move from one facility to the other. Yeah, it just throws another element onto it. But I guess when you work in that space and you consider those things, if it works there, it'll work elsewhere. So, like, you know, when you go back to the city, yeah, it'll work if it works in the region. So yeah, it's interesting. The things you find yourself doing.

Tertiary Shock And Early Births

SPEAKER_01 9:19

Yeah, that's one of the things that a lot of midwives, especially city midwives, can forget because they don't have that exposure to those kind of critical and natural disasters. But midwives are primary health providers, and so part of that, whether you're regional, rural, remote, but it is how to deal with these emergencies. And in the city, we've got kind of the natural extremes of weather, cold, and and heat that can affect, but it is something that is unless you're experiencing it, it's not necessarily something on the forefront of your mind as a midwife. Absolutely. And I remember seeing a picture, and I I think I talk about it with my students, that there were some stories with some floods in the south of um of England a few years ago, and there's this classic picture of this midwife in an inflatable swan just kind of floating down to get to the other side or something like that because someone was birthing. It was like, well, I've got to go, and this is kind of how we're doing it. So you sit there and there's lots of different ways that people go through, but it is that whole kind of like, well, we need to be there, so how are we gonna do it?

SPEAKER_00 10:25

Yeah, well, that's awesome.

SPEAKER_01 10:27

Yeah, there's some fun ways that people kind of get around, but also, and there's I think there's a new breastfeeding thing that I was reading today on what are the supports and and in the preparation for natural disasters, what do we as midwives kind of are obliged to tell people that they need to stock up on, which is a little bit different than if they weren't pregnant or if they weren't postnatal and breastfeeding, and having an understanding of those resources is important too.

SPEAKER_00 10:55

Yeah, I hadn't really thought about that, but yeah.

SPEAKER_01 10:58

Yeah, it's an interesting area. My best friend's into water and sanitation, so kind of all of those things of how do you keep things clean if you don't have water? Sanitation and these issues are it's all interesting. Where did you what do you find most enjoyable about being well, obviously you've stayed in a regional area? What do you find as one of the attractions and also one of the barriers or one of the downsides to being a regional?

SPEAKER_00 11:23

I think one of the attractions is just the um, like when I was working with women, I think the attraction is just the exposure and experience you get in a regional setting. And like, you know, the the hospital I was working in wasn't even that tiny. Like they were smaller in our area, definitely. But as midwives, you really, you know, there's only a few of you on a shift. You really the working together is just necessary. And you, you know, I got exposure to working in all areas of midwifery. You know, we didn't really have the luxury of being able to say, or only want to specialise in one area or another. You really had to be across most areas of Midwifree if you could, for the benefit of the safety of how the service operates it. Definitely a benefit to be able to, you know, work quite autonomously and and to your full scope. There was, you know, I don't recall any barriers for us doing that. And we had such great relationships with all of the um obstetricians who used to come. And we also used to get, I just thought about the the we used to get the um training registrars used to come from Sydney to to the um hospital I was working in, and they were just like, they just loved it. Every single one of them used to love it because of the exposure and the experience they get working. So I definitely think that that's an advantage. Barriers, I think, you know, you always wonder what you're missing out on, not working in a tertiary centre. But I had a little taste of that, and I don't think it was anything I wanted, so that wasn't too much of a barrier, but I I remember sort of trying to explain it to others that it wasn't about like, you know, yeah, if you work here, you're actually going to do more clinical skills than you would if you're working in a big tertiary center. But I probably reflect on barriers probably were career advancement, I think, because there's less opportunities in terms of like the volume of opportunities, and it's you know, the opportunities have to be local. Well, they had to be for a period of time. I've had had some opportunities where you know they were not based in this area, but I could be supported to to work from this area. But I think because of the the number of opportunities, if you wanted to become an educator or a manager or move into those roles, they were a bit few and far between because there was only one of each. So I think, yeah, like I say, it was a barrier, it was for a period of time, but I also was really supported to get the exposure and experiences when I needed to.

SPEAKER_01 14:00

So the level of the of the um the centre that you're at now, can you deal with Premise or are they or complications, or are they the cluster of women who are transferred to the next level of care and therefore have to birth off country? And I know we use birthing on country in a in an indigenous form, but looking at regional remote women, they have to also then birth off of their country and go to cities. So is that what your level at, or are you a higher level?

SPEAKER_00 14:26

Yeah, so the facility I was working in, the hospital I was working in, it's it could um support planned birth from 34 weeks. Right. So anything less than that, if if able, we'd transfer. And then you know, the next sort of uh regional facility up the road, they were from 37 weeks. Um planned to the women that come to us from them um as well. And then there's another smaller facility up the road, and they would go northern. So, like in our footprint, there we moved, we were able to support women to stay within that sort of geographical footprint, still off-country for some. But yeah, a lot of women got transferred out to tertiary centres when we could.

Regional Life And Disasters

SPEAKER_01 15:09

And we've had unfortunately some of the centers closing down for a variety of reasons in regional areas, which we don't have as many obstetric um obstetric deserts as well as America has. And I saw a map of American obstetric deserts, and it was absolutely frightening when you saw how much of the area was red where they have to travel more than an hour to kind of get somewhere, um, or even two hours. So but we've got that issue on ourselves, and especially within the regional areas, that it's hard because of staffing levels, because of support levels to keep those um areas going.

SPEAKER_00 15:47

Yeah, it'd be interesting to do that in Australia, wouldn't it? To understand what that, you know, the what you described as the deserts where they are, because I think they're expanding here as well in our regional areas.

SPEAKER_01 16:00

Well, if anyone wants to do a PhD on an interesting area that's very topical and is very important, there we go. You can do one on midwifery and obstetric deserts in Australia. So then you were working in that area. You how did you get interested in research?

SPEAKER_00 16:17

Yeah, so I did a few different roles. I think I like the equivalents in in New South Wales. You know, I've I've worked as the CM, the clinical midwifery educator, I've worked as the midwifery unit manager, um, acted in lots of other roles. And then I moved into a role with the university. So we're uh in Port Macquarie University of Newcastle brought the map the Bachelor of Midwifery um to the satellite campus here in Port Macquarie. Like that was back in 2012 we started that, and I was really fortunate to get the role to be the midwifery educator where our responsibility was to coordinate the students from the Port Macquarie campus. So it involved a little bit of teaching as well as the actual, you know, clinical facilitation support and coordination of all their placements and then continuity care and that type of thing. So because I was working very closely with the university, I was strongly encouraged if I was considering that pathway, which I didn't even know if I was considering that pathway. I just loved working with students, but um yeah, to think about doing a PhD. So that's sort of where I first not sure I drove the interest rather than it was presented to me. Yeah, and that was like I've stopped and started my PhD a few times, and that was the first start. So that that was an interesting first start where I um did the did the work, had to come up with my topic and write the write the proposal and protocol, you know, had had an incredible um support mentor, midwifery academic that I worked with, Linny at the time. And you know, she was really supportive and uh encouraging, um, but also like gave me the reality check of what I was signing up for as well, which I appreciate. But I remember going in to have this meeting with another potential supervisor, and she's like, come meet this person, um, you know, potential supervisor. I didn't know what I was doing with, like, I just like okay, got this idea, you're telling me I should do it, I'll go. I had this chat, and then I walked out at the meeting, and I remember it took me a few hours, but I remember thinking, hang on a minute, I walked in with one idea, and I've walked out with a different project. Oh yeah, that happens project. I said it took me a little while to understand it wasn't really my idea, and did I really want to do that? So I'd I'd had enrolled and everything, and then yeah, just got brave and and withdrew from that and just said I need a little time to work this out. Um, because I didn't really felt like that experience wasn't quite right, but I didn't really know either. And then a little while later, bit more experienced, a bit more sort of understanding of what was you know involved in the research and committing to a PhD. I discovered what I truly wanted to do as my research, enrolled again with supervisors. Lynn was one, and Linda sweet, who I know you know, um, another supervisor from Flinders. And I enrolled in Flinders because that's where Linda was, and we'd met through other channels and she'd done a little bit of work on the same topic. So, you know, when you search your reference list to see who you possibly've supervisor, and I'd met her through I can't remember what we're doing, I think it was some work with the ACM or something. I thought, oh, she seemed really nice. Maybe I could email her that I did, and yeah, and so that was the second start to my PhD, and that's how I like that's when I properly got into it, you know, got cracking on the research to understand what I needed to do.

Advantages And Limits Of Regional Practice

SPEAKER_01 20:13

I think that's one of the key things is you need to have that underlying passion, and passion is such an overused word, but you need to have that really authentic drive to answer whatever question you're looking at, that it's a lot harder to do if you're looking at somebody else's question, because that internal motivation isn't as as strong as when it's you've got that burning desire, you're really you're really annoyed with the kind of the system the way it is, and therefore you really have a burning desire to change it because there are absolutely ups and downs to kind of do it because it's not something that you can take on lighthearted, it is quite an immense commitment.

SPEAKER_00 20:57

Absolutely, and I remember someone saying to me, I cannot remember who said to me, Oh, you have to love your topic. You're going to be with this topic for many years, and it wasn't many years in my case. Um, and you have to love it so you you you don't fall out of love with it during this, you know, research. And it's so true, and I've said that to others now, and I think there's no other word than passion. You have to have a passion for what you're doing, so you you know that motivation persists, and you you you know feel like you need to continue to make that difference.

SPEAKER_01 21:31

And it is quite uh an intuitive thing with if you have the opportunity to select your supervisors, because that relationship is so critical. And some people don't end up with good relationships, and that's detrimental to their mental health, whereas others are able to go, this isn't good enough, I need to make a change, and are supported to make that change, whereas others don't have the opportunity to change, and it costs them in the end, and it ends up being a negative experience as opposed to a positive growth experience.

SPEAKER_00 22:06

Absolutely, and I remember having that advice as well. You know, you've you've got to have a good relationship with your supervisors, you know, and and lots of people who you know tell you their stories, but they didn't have a good relationship for various reasons that occurs. And I just feel so fortunate. Like I've I've had two different sets of supervisors because I didn't continue with that first enrollment, and I've took me three enrolments if I finished. So there's another one to come in the story. So I had a few two different sort of sets of continuing supervisors, and I feel so grateful for every single one of those people. Like they each brought their own sort of experience and strengths to the work, but they were just like the relationships were perfectly effective. Yeah, like there was no, I not didn't have any issues at all. And I feel so grateful because you hear of other people who do have clashes or issues or whatever it might be for whatever reason, and I just feel so thankful. I didn't have to add that into the mix. Yeah.

SPEAKER_01 23:08

And that's also a reason one of the leading reasons why people stop it as well and don't continue. But yeah, is that kind of non-support environment? So, what's the third change? Was it the same topic kind of thing? Or you changed topic as well?

SPEAKER_00 23:22

No, no, same topic. I did I had done a couple of years, like I was part always part-time because I worked full-time. Had done maybe two or three years, um, and then that first few years I had um also spent a year living in Canada, and I wasn't working for a period of the time and I was living in Canada. So, really, my whole plan was I'm gonna go to Canada for a year and be a housewife and and do my PhD, and I was having way too much fun, so I didn't get a lot of my PhD done while I was good on you for having fun, yeah. Um, but I did get some of it done, and then when I returned from Canada, I stepped into a mid-wifery unit manager role. Like it is true that that is one of the most challenging, hardest, biggest learning curve, yeah, roles, commitments that's required. And I just didn't have space to do my PhD as well. So I let it go. I just thought I can't do this. So I actually unenrolled with no intentions of completing. And then about probably about 18 months, two years later, I moved into another uh role, um, which was more of a uh strategic leadership role, so not operational management. And it sort of gave me some thinking space and some space to be able to go, oh, maybe I should do this again. And I remember, I clearly remember when I decided I had um I'll just I'll just do some reading, see what's been done in my topic, you know, since in the last couple of years because a bit out of touch. Yeah. And I'd read a couple of papers that I was cited in a couple of those papers from my previous like publications from a few years ago. And I have no idea, like, and I was like, oh, oh, people think I'm doing this work. Oh, and I felt this enormous sense of responsibility to finish. Like, I just thought I've got to get it done now. Like people have cited Tiny et al. said blah blah blah, and they're going to do X, and I'm like, so I rang Linda, and um she's like, of course, yes, come do it, enrolled again in a different uni because Linda had changed unions, and then introduced me to another supervisor, and I actually have then a supervisor who was local in my own town, so that was the first time I had somebody around me as well, and so yeah, they're all very supportive, and on we went, and that actually finished that time.

SPEAKER_01 26:01

So, what was your focus on your PhD?

Transfers, Service Levels, And Deserts

SPEAKER_00 26:05

Yes, so my focus and my passion still um is around um mid-wifery students learning in the continuity of care experience model, yeah, and really, you know, understanding what's the objective of that learning as opposed to clinical placement that involves shift work and what how do they learn differently in that, and how can we define that learning to enhance that experience for everyone involved, so that learning is really of the most value it could be. And I think why I was always passionate about that is when I was working as the ed in the educator role with the students, I used to work with them clinically a lot, and um we set up a like for their continuity care experience, we set up like a little MGP for them to do their COCEs in and it was really cool because at that time there was no continuity models in the town we lived in either. So we thought, oh well, we can do this, and then the students can offer continuity for women in the community, so that's awesome. Nice. We didn't think we were we didn't think we were doing anything too out there, but apparently it, you know, it was pretty great what we were able to do. And when I used to work with the students when they were learning with their continuity of care, I could just see such a difference in their like engagement in their learning, their way they reflected on what they were doing, they you know linked linked learning something, like some theory to the woman that they were working with in there, and they it just made so much more sense for them and their growth while they were working in this way just stood out so much. And I thought we've got to do something to enhance this even more. Like we can't let this go away, it's gotta be the best it can for everybody, you know. So yeah, that was my that was my research, and I still think it's so critically important that we can optimize that experience for and for all students, you know, because again, how the students were learning now in the town I'm I lived in was different to the students up the road as well in a smaller town, which is different to their um student colleagues who were down in the tertiary centre as well. So, like, how do we ensure they all get this fantastic, valuable learning in this particular way? Um, and how can we sort of somewhat harmonize what they do so that they're all focus their learning in a particular way when they're engaged in that continuous care experience?

SPEAKER_01 28:51

And that equity is one of the biggest issues we have as educators because over 80% of women are giving birth in non-continuity of care models within Australia. Some states are doing better than others. Queensland is leading, which is not unexpected when you think about how much regional and rural area is in Queensland versus kind of what they're on the coastline, their urban cities are. Um, South Australia, I think, is second in midwifery continuity of care and the latest results. But yeah, it is very hard and student-led kind of continuity models is that we can develop because every midwifery educator is a registered midwife, they're qualified, um, and they've always got a mix of people there. So it is when we're looking at expanding opportunities, even if it's not continuity through all three stages, if it's continuity antinatally and postnatally and intrapartum, they go into different areas. But oh, wouldn't it be a dream to have independent birth centers all over the place, kind of like run with student-driven and staff?

SPEAKER_00 30:02

Absolutely. I mean, they're part of our workforce, and the more engaged and you know, we can support them to be, you know, the more likely they're going to complete and continue as well. And we know that. But yeah, there's so many opportunities uh around, like you said, just being a bit creative with engaging the midwifery students into the workforce and sort of designing how can we enhance this model and and make it work so that more women are getting continuity in whatever area might be. Because, yeah, like you said, that all the students are placed so differently, as we know, like some rural, regional, remote, tertiary, but then also the difference between learning between being, you know, in your first year as a in your bachelor of midwifery or doing the postgraduate program, you know, your learning focus is different. Different as well, and it evolves over time. So, how do we ensure that each and every one of those students, regardless of where they are located or in their journey of learning, that they still get the most out of that learning experience with continuity?

Stepping Into Education

SPEAKER_01 31:08

There is a mind change that needs to occur, especially and in particular for those who are registered nurses and doing their midwifery afterwards. Because in the in as a registered nurse, it is the sick patient. It is very much the patient, the sick patient, and helping them to get back to a level of independence they were behind before. Whereas the direct entry, they only they start off with this is a well woman or a woman with comorbidities, but this is a natural process. It is changing that mindset from sick patient to this is a woman, birthing person doing something completely natural, and they may or may not have some comorbidities. And that mind change can take a while because you're completely changing philosophy from someone sick to this is a normal process, and there are variations of normal that we can deal with within our scope that are not deemed to be complications, but we need to accept them as variations of normal.

SPEAKER_00 32:11

Absolutely. And I always wonder like I feel like the learning, like that, you know, process of learning for someone going straight into a bachelor of midwifery versus somebody who's who's been a nurse either for a short or a long time and doing the postgrad, that process of learning is so different between the two because of what they bring, but also like the people involved as well, like whether if you're you know 20 years' life experience doing something else, and then go into midwifery as well. Your learning process is very different to your 18-year-old student colleague as well, and how you support each other in that too. You know, everybody just has such a variation of their learning as well as where they're placed in all that learning. Exactly. And then the support that they have and who's around them, and you know, level of reactivity, level of resilience.

SPEAKER_01 33:01

There's so much that is individualized, and yet we're trying to teach a generic principle-based course that we're trying to tweak so that it does become a little bit individualized, but there's only so much we can do for the reality of it, and so yeah, that's the challenge of how do you make something that's generic principle-based, but then can still be tweaked enough that individual people can learn it through whatever mechanism they do and adapt in different ways.

SPEAKER_00 33:32

Yeah, it's a challenge. It is a challenge, and I think we've still got a long way to go to well, there's a lot of opportunity, I guess, to enhance it. So we've got that opportunity to enhance learning for um our midwifery students, and we know we know, and we need to know more, but we know what supports them to complete their education and what supports them to transition well as a registered midwife, and then what then we need to, you know, then move into that early career. What supports them to stay engaged and to maintain their self-care and want to continue? And yeah, there's a lot of opportunity to do better.

SPEAKER_01 34:15

Thinking back to your PhD, what is something that surprised you from either the process of it or the results of it?

SPEAKER_00 34:25

I think what surprised me is that you can't, which frustrated me, but now that surprised me, but the surprising of this is what the frustration came from. You can't go into it knowing exactly what you're gonna do step by step and what the outcome is gonna be. Yes, yes. I was like, oh what? I have to sit in this space of unknown and like just let it, you know, organically unfold and go take it stage by stage, and at that same time I'll my maturity and my knowledge will grow and I'll get clarity. Oh, okay, that surprised me. I was reminded a lot that you had to just sit with it and you can't always know exactly you know where you're going and what you're doing. And I think that surprised me because I just thought there was a bit more of a formula to it and a bit more of a step-by-step step. I spent many years not knowing what the heck I was doing. Yep. Many years, but then you know, at one point, for whatever reason, after a conversation or just a you know, moment to think about it, it all clicked into place. Yeah, and you know, the path becomes clearer, you get a bit more confidence, and you sort of then can start, you know, directing your supervisors rather than them coaching you. So yeah, it does sort of I had a moment of it when it did click over, but it took a few years for me.

SPEAKER_01 35:55

I think that's something that is the unexpected, is the fact that the level of vulnerability that you need to be comfortable with, especially in the early days when all you feel like you're doing is reading and talking, you don't feel like you're making any progress, and then you do kind of like lots of reading, and then you do lit review, and then you kind of do this, and then it's like everything, all the feedback comes back with red pen. And then eventually it's kind of like actually, no, I disagree with this, and I can actually make it, I can I can discuss it and I can justify why I disagree with this, or no, that changes what I'm thinking of, and then it's like suddenly you go from down here to kind of level, and then it's like, oh, actually, no, you're the expert, and your supervisors are kind of just pushing you that extra bit so that you can articulate what you already know, but it is the and especially if you're coming from a position of power and responsibility, of then going back into a vulnerable position in that relationship, and that's why that free relationship is so important.

Choosing And Restarting A PhD

SPEAKER_00 36:57

Oh, 100%. You just described that so well, and often too, like your supervisors are often those people who are like what I describe as the midwifery rock stars, right? Like they're the people who are at the conferences that you've always looked up to and you knew them in name but have never met them before, and they've written all these incredible things, and now you're getting a relationship with them. You don't I was in no position to tell them. I think the other vulnerability shift that I was thinking about when you were describing that then was like in my workplace, I weren't I was in positions of leadership, you know, people were looking to me, and I was in in that that role of knowing and being confident and having you know being the one providing the advice to others, and then you know, slip into a supervise supervisor's meeting and having to sit there going, Oh my gosh, I have no idea what I'm doing.

SPEAKER_01 37:57

It's a rushing personality, isn't it? It feels like a very split personality of in your day-to-day work, yes, yes. And then you come and suddenly it's like I feel like an imposter, and I don't really belong here and I'm wasting their time, and it's but it's not, but it is that, yeah.

SPEAKER_00 38:15

Yeah, totally. And then I had like this other sense of like, because I work in health, I don't work in academia. The people around me knew I was doing my PhD and they just thought, God, you mustn't you know know what you're doing. And that's like I could never do that.

SPEAKER_02 38:31

And you know, you get all those comments, and you think, no, I don't know what I'm doing. I'm trying to figure it out. I've got no one to talk to about it.

SPEAKER_01 38:42

Which leads me to my next question.

SPEAKER_00 38:45

How did you think sanity? It's I think a combination of things. I think I like I said, I had wonderful supervisors who were available, you know. I could call them, I could check in with them, I could be, you know, crying on the phone and they talk me through. So that helped. And I felt okay to do that after a period of time. So that helped with my sanity, but I was part-time too, so it was a really long, and I had just accepted the fact that this was gonna take me a while. Um, so I didn't really have the time pressures. I mean, there's an ultimate time pressure, but I didn't have to spend many hours every week working on my PhD because I was part-time. Um, so you know, I still I don't feel like I it was all consuming either. But what I did realize after I submitted was that it felt like this weight, just like something had gone. Like this lip. And I didn't realize, I truly like if you you'd ask me why I was doing it, I'd be like, yeah, it's fine, just do it when you can, blah blah blah. I did not realize for eight years that I had been constantly thinking about it. Yep, like it's just hanging there and you're thinking about it, and you're wondering, and you're curious, and you're like, oh, I must remember to look that up, or I've got that new idea. And so you are always thinking about it, and I just didn't realize that until I didn't have to think about it. Well, I couldn't think about it anymore because it was dumb. Brain never stops. Yeah, I think um sanity was it was okay. Like, yeah, it was a learning and once I just settled into you know, I don't know what I'm doing, and I am learning, and then confidence kicks in as time goes on, it was fine.

SPEAKER_01 40:43

How did you balance your work and your family with your study? Well, I shouldn't say balance. How did you manage your work, your family, and your study?

SPEAKER_00 40:51

Again, I feel like it was it was really okay for me, and I don't I think it was because I was full-time at work and part-time study. So that sort of lifts a bit of the I didn't have to work like if I was a full-time student, I know some full-time students have to squeeze the work in so they can live, right? I didn't I work was my first priority, so I, you know, income-wise, that was fine. And then I knew I was part-time and I had this long time frame, so I just sort of did it when I could. And my kids were a bit older, they were sort of teenagers most of the time, a lot of waiting around at you know, sports and other extracurricular activities are good opportunities for doing. But I think the thing that um also was some advice I was given, I can't remember, by some very wise person very early on was also if your topic aligns with your work in some way, shape, or form, then it won't feel like this added burden or this extra thing, like it sort of all melds together a little bit, which I had on and off, but had it for most of the last sort of couple of years very strongly aligned. And I think that's where I was like got the motivation and the movement going because I was taking what I was doing in my PhD and injecting it into some of my work, and it just all aligned really nicely and made sense. And yeah, so that sort of helped balance it. So I think I wonder how you'd do it if you had two completely like if your job was something completely different to what you were doing in your PhD um topic, that would be really hard to get that synergy.

SPEAKER_01 42:37

And it's the energy to keep going because mentally, if you compartmentalize it, it's easier if you've got two different different topics, but you want double the bang for your buck. If you're doing something that's part of your work, then it's easy to okay. So you can, as you said, integrate it. You can make some of those changes early instead of waiting. We're looking at still 15 plus years to kind of like integrate an implementation of change. So if you can make little, because it only takes a little stone to change the direction. And so if you make a little bump here, ultimately that can end up in a completely different pathway. So yeah, chewing something that's very similar is I think a lot easier because your head stays in that same space, you're not reading completely different topics.

COCE Focus And Student Equity

SPEAKER_00 43:24

That's right, you're not flipping from one thing to the other. Like, and even I remember at work, I was doing this piece of work supporting students like that across the state. And I was like, I've got all that literature, bang, here it is. Like, you know, I know exactly what I'm talking about here because you've, you know, just been in that world for so long. So yeah, that was easy. Yeah. And I think, you know, we asked about family balance as well. Like, I got like an incredible supportive husband and just sort of held me accountable as well and was like, you're gonna get this thing done. You bet you know, you wanna do it. I know you want to do it, but you never do it. Like he didn't really understand what I was doing, but like knew that I wanted it so much, and you know, did what they you know could to support me. So that's just wonderful.

SPEAKER_01 44:16

Family and friends don't need to believe in the topic, they just need to believe in you. I was very fortunate in that case. So something good and something happy, how did you celebrate?

SPEAKER_00 44:25

Um, I had a few celebrations. Good, good. Yeah, I don't mind the celebration. So I had a holiday book strategically, like uh in the month after I was meant to submit. So I knew that I had to submit because I did not want to go on that holiday without like having it out of my life. So that was good, and so then when I was on holidays, every night was a celebration because I'd submitted. Uh so that was well timed. We did um we do this thing, like there was a group of students who we shared supervisors and um like we we some of us hadn't even met in real life, but we were because we're all scattered across the country, so we did this thing where every time we um actually you know hit the submit button, we're always probably sitting at home by ourselves. So we all started this. I can't remember who started the trend of the glass of champagne photo as you're pressing the button. Uh so that was another celebration, sending it around to them all and sharing that. And then there was another celebration when um I actually went to my graduation, which I'm so glad I'd I made the effort to go because it was in Melbourne, and that was just so great. My daughter and my um husband came, and I remember walking across the stage and I was sitting in the second um balcony, like in the big, big auditorium. I was so loud, screaming out for me. I was thinking, it's supposed to be all proper here. Like I just hear them screaming from the balcony. So that was really lovely, and we had a lovely weekend in Melbourne and went out for dinners, and yeah, so that felt like a real, you know, ceremony and celebration.

SPEAKER_01 46:03

So we know that midwives, majority of midwives will work in a clinical focused role. We've talked about midwives who work in education first role and management and governance role, and one of the other important ones that we don't talk about a lot, but is just as critically important because it affects all of them. And this is where you've kind of gone into is in the policy role. So, what made you make? I know you've done some management roles there, what made you take that extra leap into kind of purely into the policy-focused roles? Because we need midwives at every table where decisions are made about women's health. Absolutely.

SPEAKER_00 46:47

I'm not sure it was like a planned sort of approach, but uh, you know, as I've moved through different roles and into sort of roles that sort of somewhat step away from the the um where the care is provided and more into supporting a workforce or supporting like maybe supporting more of improving the clinical practice and the governance of what we do. And then I had an experience where I got to work do a project, uh a state-based project. Um, so that really again stepped me out of the district I was in and into a state-based role. And that really was just, I mean, such an incredible opportunity, but also just I guess the exposure I got from that was the impact you could have at a policy level, which I really hadn't, I mean, and I sort of I knew it was there and I knew people did it, but I didn't really have the lived experience. And I think once I had that exposure and that experience of you know what you can achieve and impact and influence at a policy level and what that difference means for the midwife and the woman who are you know working alongside each other. I thought, oh, this is I like this, this is good. I I can see this. And I've had a lot of people say to me, Oh, don't you miss the clinical? Yep. Like I I get that question now, and I don't think I have you know been in a clinical environment working for probably I don't know, I don't want to admit how many years, it's a number of years. And I say, Oh, you know, like I don't, I don't miss the hands-on, I miss what I miss is talking to women, yeah, but I don't miss the hands-on. And then I think, well, maybe this is what I was sort of like, I guess I get that, like that joy or satisfaction from the impact you can have in a different way to support those who are working with women and and the future workforce. And yeah, I don't know, I might be sounding a bit sort of idealistic at the moment.

SPEAKER_01 49:00

We have it, and it's happened on, I've seen it on a couple of social media platforms, is that there's still that thinking within the profession that you can only really call yourself a midwife if you are on the floor working clinically, kind of teaching babies, bad term, I know. But there's that if you're not doing that and if there's not some clinical involvement, it's like you're not a real midwife. There's that demoralizing is not the right word, but that just sweeping away the fact that there are other rules like education and management and governance and policy that have the direct impact that are equally as important because if you don't have good policy, if you don't have good education, is that you don't, then you're not able to provide evidence-based care. So you need the researchers, you need the people who are writing the policies and the procedures so that they do the updating and the changing. So if that is your choice to be a clinical midwife, fantastic. But we want midwives in all the other areas as well. And thankfully, that was reinforced with the State of the World Midwifery Report in 2021, that they're the four main areas that we need to have that equal attention on.

Shifting Mindsets In Midwifery Training

SPEAKER_00 50:14

Yeah, absolutely. And it's like you said before, it's important to have midwives at the table, and it is so critically important. Like I've had that exposure over the last few years, and then most recently in um my current role, having the opportunity to be able to share the lived experience of a midwife or reflect back on how might that impact the midwives and the women back in my community or anyone else's community, and be able to have an opportunity to influence how something is designed or or you know, developed or implemented with that opportunity to contribute in that way. But also, too, I've had the experience of others who I've been working with so thankful that you're there, you know, so thankful that oh, we can reach out to Olivia, let me wipe and ask her, would this work? Yeah, is this like like can you help me understand how this might intersect with this or work here? Or, you know, and they're really willing to have those conversations and really grateful that you're there. And I wonder if you weren't there, what the results might be sometimes. It's it's really important, but it's really like I still feel like a midwife. Yeah, yeah, I feel like I'm doing midwifery work, yeah, 100%. Yeah.

SPEAKER_01 51:35

If you're if you are on the register, you are a midwife. It doesn't matter where you're working, and if you're off the register, you probably are still a midwife because you don't change your thinking. Your first thinking is always going to be as a as a midwife. So within your role now, that is kind of a national role, which is brilliant, um, we are slowly getting our chief midwife roles. So hopefully that'll kind of change within the next few years to all the states having a chief uh midwifery officer and then hopefully a national one kind of in the near future. Are you able to be directly involved in research now in that role, or are you more a collector and implementation of research?

SPEAKER_00 52:21

It's such a great question because I never thought I would be in the position where I was worried that I wouldn't be part of research. I was like, ooh, I'm a bit worried that I may not be able to keep my finger in a little bit of research. I never thought I would be that person, but here I am. So, you know, very early on in my um new role now, I had that conversation with Alison McMillan, who's our chief and bigger free officer. And she was really like so supportive. She's like, Yes, like we'll work that out. Like it's okay. Because I actually was like, oh, do I want to do this if I can't? Like that's that was a big like, oh, I didn't realize I felt like that. But anyway, she gave me some reassurance. So I think it's both at the moment. I think absolutely right now I'm very much in a space of using my skills I've learnt and knowledge I've learned doing my PhD in my everyday work, um, having that lens of understanding what evidence has contributed to something and how then might we then evaluate and understand the impact of what we're doing. That's certainly very present in what I do. Um, and I think in terms of actually the doing of research, at the moment, I'd probably say it's a bit of a hobby rather than part of my work. I've got a couple of little projects that I'd still sort of ones um that I was part of, you know, a couple of years ago that are still moving along that I am sort of just on the parameters of at the moment, and I'm trying to cling on to some element of that, even if it's just providing advice or tapping into the group's meetings. And I have um come on as an adjunct with UTS as well to sort of and at the moment I've been able to join um their conversations around their research. And at the moment that's just been wonderful to keep myself engaged in conversations around research, and I hope to maybe in the future then I do some more, um do some more of the project because I actually want to do a little bit more for my PhD project. I still really want to like, or maybe um support somebody else to do that.

SPEAKER_01 54:42

Yeah. So what's next? What's kind of like on the horizon that excites you?

SPEAKER_00 54:47

Oh, that's a great question. I think like I'm very fortunate with the role I've just started in. Like, I'm still like, really? Did I, you know, is that me? Do I get to do that job? Like I feel it's not lost on me. Wonderful it is that I have that opportunity. So I think, you know, what's right now on the horizon is really just doing that well and understanding how I can do that well and to have an impact and influence in that. And but that excites me. I love that. I've got a lot to learn. I'm learning so much, and yeah, I'm very happy doing that.

SPEAKER_01 55:21

When you look at your role as senior midwifery advisor to the chief nurse and midwifery officer, then technically you are Australia's chief midwife by default in that position because you're the midwifery advisor to the chief. So you're the national role, and I know that could be kind of controversial, and I'm saying that, not you. But when you're looking at that, you get to work with the future chief midwives of each state, but you then your your governance is national. It's not just kind of New South Wales, it's actually looking at, and so each state has such different healthcare systems when we're looking at um midwifery.

What Sustains Students And Graduates

SPEAKER_00 56:02

Yeah, and look, that's part of my current learning is is understanding, you know, what each of the jurisdictions, how they they, you know, how they lead and and how they operate in terms of midwifery and and maternity care, but also then what's the role of the Commonwealth in that as a jurisdiction in itself, and how how do they all you know collaborate and work alongside each other? Um, and it is so critically important to understand those relationships too. And the leadership that I've been exposed to in the last few months and the you know incredible midwives I've got to meet and and nursing leaders has just been wonderful. Like, yeah, it's just incredible. I feel so grateful.

SPEAKER_01 56:46

I think we're in a really exciting space for midwifery as a profession in Australia. When we look at some of the changes that have occurred over the last couple of years, we look at the Midwifery Workforce Report, we look at the scoping for endorsed midwifes and looking at possible changes for that, we look at the um prescribing changes. I think that we're in this fabulous kind of like type flux that is just going to continue to drive midwifery as a profession in the future, which is going to be really exciting for those students that are graduating now and those new ones, because we still have a big problem with attrition in three to five years because of people not being satisfied with this with the healthcare system and what they're being asked to do versus what they want to do. Um, and so how do you see that challenge kind of playing out over the next few years?

SPEAKER_00 57:43

Yeah, and look, it's something that I've definitely had that exposure to, you know, over like in previous roles, but now that you know different perspective again. And I think I think there's a lot of possibility, like we said, there's there's a lot of opportunity to support enhancements and and and you know understand how we might do things in a different way that you know supports the engagement in the profession. Um, and I just see it as opportunity. Um, but how it might play out over the next few years is I think what's really unknown, but I think that they're we're in a position to be able to discover what that could be. Like you said, with all of the recent changes that are that have come about, um, in particular for for endorsed midwives and and really supporting their enhancement of the work that they you know can engage with. Um, and then looking at the pipeline of our workforce and and where do we need to focus on to be able to support them. Like, yeah, I think I think that we're in a position to be able to discover what that can be. There is lots of opportunity for us to focus on.

SPEAKER_01 58:53

It's an exciting future.

SPEAKER_00 58:55

It's so exciting. Like I really am excited, and um, yeah, I just think if I can be part of that, like how wonderful is that?

SPEAKER_01 59:06

Are you in prime position to be part of it and to help drive it, which is even better.

SPEAKER_00 59:10

Yeah.

SPEAKER_01 59:11

Thank you so much for your time.

SPEAKER_00 59:13

Thank you. It's been wonderful.