Midwives have protected women and their rights throughout history, says Professor Hannah Dahlen.
A couple of years ago Hannah Dahlen, a Professor of Midwifery at the University of Western Sydney, visited the red brick building in East London that was the inspiration for Nonnatus House, the fictional nursing convent home in Call the Midwife. Professor Dahlen’s mother lived and worked in the building, St Frideswide’s Mission House, during the 1950s with Jennifer Worth the author of Call the Midwife. “I grew up on stories of midwifery in the East End of London. It was probably one of the main reasons I became a midwife,” she says.
Professor Dahlen’s mother had passed away before she could revisit St Frideswide’s, but she was accompanied instead by her mother’s best friend, Fiona Haines. Born in India during colonial rule and the daughter of a British army officer, Professor Dahlen says Fiona’s resemblance “to the Call the Midwife character Chummy is uncanny”.
Professor Dahlen is passionate about midwifery’s extraordinary history and she spoke last month at the NSWNMA’s professional day, about midwives reclaiming their heritage. “Midwifery is one of the oldest professions in the world,” says Professor Dahlen, who is also a privately practising midwife. “Midwives have been highly regarded throughout history and there are great examples of midwives protecting women’s rights.”
She cites the Old Testament story of the midwives Shifra and Puah. When the Pharaoh of Egypt asked them to kill boys born to Jewish mothers they came up with a clever plan. “When he called them back they told him ‘Jewish women aren’t like other women: they give birth very quickly, and so we don’t have a chance to get there before they are born’. Throughout history midwives have worked hard to protect women.”
Midwives were burnt at the stake during the years of the witch hunts. “There is a line in one of the witch hunter books that says ‘No one does more harm to the Catholic Church than midwives’. They were the ones that carried out abortions, concealed babies and passed them off to other families and subverted the moral expectations of the day.
“In the 1600s and 1700s the barber surgeons started to get into childbirth. The Chamberlen brothers, who developed the forceps, kept them under wraps, and women would be blindfolded and they’d use them, often with terrible results.
“Slowly, as modern medicine started to arrive, the doctors realised the only way to have a monopoly on childbirth was to get women into hospital. They started to very aggressively campaign to get women into hospital, offering them money, scaring them about ‘illiterate’ and ‘dirty midwives’. What happened then was that medicine grew and nursing grew and the midwife got absorbed into nursing.
“The fully autonomous midwife was wiped out. For years we’ve had the nursing and midwifery professions entwined, even though they’re very different professions.”
When she entered the profession in the late 1980s, she first trained as a nurse at Hornsby Hospital. “I was one of the last groups to go through the hospital system.” After a short post-graduate stint in the paediatric and maternity unit, she went to UK to do her midwifery training, returning to Australia in 1991.
Now with the introduction of a standalone Bachelor of Midwifery, Professor Dahlen sees a return to a recognition of midwifery’s specific traditions and skills. “It is fantastic that we have many pathways to midwifery. Midwives now are very much about reclaiming their autonomy and heritage; midwives are not better than nurses, they are just different.”
Australia’s high rate of caesereans
This shift has huge benefits for mothers and babies, she notes. Recently the Cochrane review of research on continuity of midwifery care found that midwife-led care resulted in lower intervention rates during birth, higher maternal satisfaction, lower costs and lower baby morbidity and mortality rates.
Australia has one of the highest caesarean section rates in the world at 33 per cent. “We are one of the worst in the world now for caesareans. We’ve got countries in the world with half our caesarean rate and they lose fewer babies.”
Professor Dahlen’s research on the 25 per cent of women giving birth through private obstetric care shows poorer outcomes. “Those women have double the intervention rate – far too much medical intrusion. Hospitals are starting to respond by offering continuity of midwife care.”
Aside from her academic work, Professor Dahlen is a practising midwife with Midwives @ Sydney and Beyond. One of the few midwives in New South Wales with admitting rights, she has the same rights as a VMO to admit and discharge her clients to hospital and prescribe medicine. “We provide all the antenatal care so you know a lot about the woman by the time you catch the baby, and then we provide six weeks of postnatal care.”
Last year midwives at her private practice obtained visiting rights to Westmead Hospital, the only NSW hospital to offer this option. Fighting for practising rights for midwives hasn’t been a completely smooth transition though, she said. “Other health providers will report you to AHPRA,” she says, citing a case where a doctor ignored a labouring woman’s request that he not intervene. When he went ahead and the private midwife told him ‘She said no,’ he reported her to AHPRA for “obstructing a medical procedure”.
It is for these reasons, as well as the tendency to replace midwives with nurses on maternity and postnatal wards, that we must “recognise midwifery as an autonomous profession,” says Professor Dahlen. “We’re reclaiming our heritage as the midwife in the village who caught the babies, gave advice and came in the middle of the night.”