Australian Midwives

by Paula Heelan

  When Kate reached the clinic she found Mary wasn’t yet in established labour. She did what she could to make her comfortable, recorded the necessary observations and phoned the aeromedical retrieval crew to reschedule the pick-up. Morning dawned, but still no baby. Nor had there been any indication of the aeromedical retrieval pick-up time to the hospital. Kate was well aware that for the safety of mother and baby it was preferable to get Mary to the hospital. ‘Women are usually transferred pre-labour or after the birth for any necessary medical care,’ Kate says. ‘With no further signs of labour, Mary rested for the day with lots of family and friends popping in and out to visit her.’

  West of the halfway point between Alice Springs and Darwin, the community is close to the centre of Australia in semi-arid country on the edge of the Tanami Desert, where the climate is hot and dry. It has an almost exclusively Aboriginal population of more than 800, and Warlpiri is the dominant language. Non-Indigenous people are the visiting service providers, including health-centre staff, teachers, police and council administrators. Despite the harsh, isolated setting, it was one Kate quickly embraced.

  Late that afternoon the health centre doctor phoned the flight medical officer from Darwin, who didn’t seem too concerned about the flight delay for Mary’s retrieval. ‘You have a midwife,’ he said.

  ‘At about 9 pm the aeromedical team finally phoned me with an estimated time of arrival of 11 pm,’ Kate says. ‘I thought, That’s great, now I can do the necessary paperwork and prepare for an evacuation. There wasn’t a bassinet or cot at the health centre, so while I was waiting I fashioned a crib by lining a little box with linen and placed it on the second bed in the emergency room in case it was needed.’

  Suddenly, Mary began very strong labour contractions. Kate contacted the on-call nurse, Jennie, who although not a midwife was a mother of two. Kate knew she would be a great help. Jennie rushed in and asked Kate what she needed her to do. ‘It was winter in the desert,’ Kate says. ‘And with no way to warm towels, I asked her to warm them in the laundry dryer outside. It was a bitterly cold night and we would have to keep the baby warm.’

  A short time later, with quite a fast and uncomplicated birth, a healthy baby girl was born into Kate’s hands. ‘We were surrounded by supportive, loving grandmothers and aunties,’ she says. ‘It was a very happy occasion and I thought, Thank goodness my first birth here has gone well.’

  But it wasn’t over yet. Mary had low blood pressure and had lost a considerable amount of blood, although this didn’t surprise Kate with Mary’s birthing history. Kate contacted the medical evacuation team again and they gave an updated arrival time of 5 am. ‘After breastfeeding her baby and having a short sleep, Mary wanted to have a shower,’ Kate says. ‘With the shower outside the health centre and on such a cold morning, we suggested she sit on a chair in front of the basin and have a nice warm wash.’ But as Mary was sitting on the chair she began to feel very faint. ‘Jennie was holding the baby and I called to her, Quickly, put the baby in the box! We laughed about my outburst later. I was glad I got to use my little makeshift crib. We helped Mary back to bed and ameliorated her symptoms from the blood loss. She recovered and when we heard the plane finally come in we transferred mother and baby to the airstrip.’

  As it was one of the coldest nights Kate had experienced in the desert, she was quite concerned about her patients. ‘While it only took the evacuation team a short time to prepare the loading mechanism for the stretcher, we were all feeling the cold. Safely at the hospital and with the help of a blood transfusion, Mary recovered without any problem.’ By the time Kate finished in the emergency room it was after 6 am. She had been awake for 28 hours. ‘I was very happy to have the next day off to recuperate,’ she says. ‘It was such a joy each time I went back into that community over the next twelve months to watch that little girl grow. It doesn’t matter where a baby is born; it is always an incredibly special time.’

  It was only in her wildest dreams Kate imagined that one day she’d be delivering babies in some of Australia’s most remote places. Born in 1952, she grew up in south-east New South Wales on a large cattle property, Clear Springs Station, which her father managed. With her older sister, Jan, her childhood was idyllic. ‘My parents had another two daughters, Margaret and Robin, quite a bit later and by the time the eldest was five, Jan and I had left for boarding school. Our parents gave us a lot of freedom and we were mad on our horses. My mother was a physiotherapist and a great naturalist. She knew flora and fauna very well. In 1953 my father had the property declared as a wildlife sanctuary, which meant no one could come shooting on the land without a permit and we shared it with the wildlife. My parents planted thousands of trees as plantation trees.’

  With her mind set on a nursing career, Kate began her three-year training in 1969 at the Canberra Hospital. ‘I aspired to several of the women in my family who had nursed here and overseas,’ she says. ‘When my maternal grandmother’s male friends were heading off to the First World War, she sailed to England under her own volition and joined the Queen Alexandra’s Imperial Medical Nursing Service Reserve (QAIMNS), where she became the matron of St David’s hospital on Malta, one of the receival hospitals for the servicemen injured at Gallipoli. She died in 1918 on her way home.’

  When she trained, Kate and her fellow nurses were all just seventeen years old and by the second year, at all of eighteen, they were often left in charge of a ward on night duty for eighteen to twenty patients. ‘There weren’t enough nurses, so they just let us loose. We, patients and nurses, were in the lap of the Gods!’

  Kate thrived in this environment. On graduation, without a second thought, she eagerly chose obstetrics to work in maternity and children’s nursing. And for six months after training she worked in a children’s ward.

  In 1973 the Tumbarumba Hospital (where her mother worked as a physiotherapist) was looking for a nurse to fill a casual vacancy. The 36-bed hospital was 480 kilometres south-west of Sydney and had an aged care and maternity unit. It was where Kate’s first experience with assisting the birth of a baby unfolded.

  ‘It was in the middle of the night and the midwife said to me, Quickly, leg. Leg? I asked. Then she told me to get up on the bed and hold the mother’s leg up. That was in the days when midwives delivered babies with the mothers lying on their left side. So I did what I was told and jumped up on the bed and held up the leg. Then I had to jump back down to hold the baby as it birthed. And as I did, all the amniotic fluid ran down my uniform into my shoes. I wasn’t quick enough, nor did I know it was a good idea to put on a long plastic apron before you jumped up on the bed and legged. I’ve remembered that clearly ever since – you don’t do it twice.’

  With Tumbarumba and district population at more than 3000, it was a busy little hospital. Understaffed and with only one doctor, it was an arduous job for Kate, who was on call following her shifts in case a transfer to Wagga Wagga was needed. ‘As much as I loved the work, it was a bit out of control. It worried me that I couldn’t really give people the amount of time I wanted to. After twelve months, I thought I needed to get back to study and midwifery was really what I wanted to do.’ She enrolled for the course at the Royal Women’s Hospital in 1974 in Melbourne, and while shifting from a small rural hospital to the city was hard because she wasn’t a city girl, she loved the training.

  Later that year Kate met Peter, who was studying at an agricultural college in Geelong. They married the following year, six months after Kate finished her midwifery training. They moved to Victoria’s western district, where Kate worked in a few small hospitals and Peter became an overseer on a cattle-and-sheep property at Colac.

  ‘Soon after we bought a farm at Mortlake, and in 1978 our daughter Penny was born,’ Kate says. ‘Belinda arrived in 1979, then Stuart in 1982 and Sal in 1986. In between having children I worked part-time as a midwife at a 30-bed busy little maternity unit at the Terang Hospital. Back then women stayed in hospital with their newborns for five days
and rested. It was a lovely place to work. I even delivered a few friends’ babies there. They just happened to come in when I was on duty. That was the nice thing about country nursing.’

  Living in Victoria in the eighties was a punishing time for rural families. In 1982 Victoria was gripped by drought, and not long after in 1987 interest rates skyrocketed to eighteen per cent, making it impossible for people to make ends meet. ‘We lived too far out of town for our children to attend school as day students, so we decided we had to change course,’ Kate explains. ‘Peter got a job with the stock-and-station-agent company Dalgety in Albury and we moved there. But after a while we were all desperate to get out of town again and move back to the country.’

  From 1989 to 2009 Kate managed a small private health facility. In fact, according to Peter, Kate set up the first day-surgery business in southern New South Wales. ‘When it was sold another group of practitioners bought it and built a new facility in Albury and Kate was charged with developing the new clinic in that building. There was a lot of planning involved and liaison with the Health Department. There are a lot of things Kate has done that the majority of nurses would never have been involved in,’ Peter says. ‘She gets in and makes things happen – she’s highly experienced.’

  Over that time Kate gained a postgraduate diploma in advanced nursing in rural health through La Trobe University in Wodonga. She also received a scholarship to complete a master’s degree in nursing through the University of Newcastle. Her goal was to get back into rural or remote nursing and to work as a midwife.

  In 2009 Kate left to join Aspen Medical’s Remote Area Health Corps (RAHC). RAHC was initiated in 2008 to support the health workforce in remote Indigenous communities across the Northern Territory. It provides nurses, doctors and allied health professionals as primary healthcare providers for the shortfall in health-service delivery in remote communities.

  At first, Kate was based at the Latchford Barracks, an Australian Army base in Bonegilla, east of Wodonga. Before long she obtained placements in remote Indigenous communities and was tasked to focus on children’s and maternal health and midwifery. Her priority was (and still is) to raise the health profile of women and children in remote areas and she works determinedly to achieve this. ‘My RAHC contract blocks range from three to six weeks in any one place,’ she says. ‘It took me a little while to learn the ropes and adjust to work in remote areas, but once I did I absolutely loved it.’

  Kate has worked in myriad community clinics in the Northern Territory as a midwife and remote nurse, including Groote Eylandt, North East Arnhem, Croker Island, Oenpelli (Kakadu), Douglas Daly District, Maningrida and Milingimbi Island. The first remote community she stepped foot into was Lajamanu at Hooker Creek Station on the western desert of the Tanami in March 2010. The station had been taken over by the Aboriginal Land Council back in the 1980s and Lajamanu community was developed. Kate was flown in for a six-week stint. ‘I soon became aware of just how short remote communities were of midwives,’ she says. ‘This was a terrific opportunity for me to get back into practising midwifery – and since then my work has involved 90 per cent mid.’

  From 2009 to 2012, based in Albury, Kate flew out to the Territory to work and then in 2012 she and Peter moved to a property at Blackbutt, near Toowoomba in south-east Queensland. Kate now flies to work from Brisbane, a two-hour drive from the farm.

  In 2011 Aspen Medical was contracted by the government to implement a program called the Nursing and Allied Health Rural Locum Scheme (NAHRLS) and Kate works for this program as well. ‘The aim is to relieve nurses and allied health professionals in rural and remote areas while the local staff attend education programs,’ Kate says. ‘I work at health clinics and small country hospitals – wherever the need is.’

  Working in remote areas is different to working in rural and regional hospitals and Kate has become very passionate about it. Geographically, rural and regional areas are closer to a major city and therefore a much higher level of medical/nursing care can be accessed much faster. And in most rural and regional towns there are more health-service providers available, for example doctors, specialists, radiology services and pharmacies which together provide a much greater collegial effort for the patients. ‘As a remote midwife, you are almost always the only trained midwife, so you have no one on the ground who is a professional colleague for back-up and assistance, so it’s a more autonomous role.

  ‘I also love that autonomy. Clinically you have to be prepared for anything. It’s not only having the confidence and competence to work with emergency cases with a minimal amount of equipment and support, but it’s also essential to be culturally sensitive. In midwifery terms, Indigenous men have minimal input with a woman’s pregnancy. If you have to go to a house to see a woman who’s pregnant, there’s no way you would mention the word “pregnant” in front of any male member of her family because it’s sacred women’s business,’ Kate says of the communities she has worked with. ‘In a lot of communities, you do see men in the health-centre waiting room with their wife or partner, but a lot won’t come in to the women’s room because they know there are photos on the wall of pregnant women.

  ‘We start talking with the mums early on in their pregnancies about birthing their babies in the hospital and transferring for sit-down,’ Kate explains. ‘We help them to understand that going to a hospital is the safest option for themselves and their babies. Even for a healthy woman a planned normal delivery can sometimes go awry with tragic consequences.’

  Another cultural difference Kate has noticed is that young girls having their first babies are escorted into town by their grandmother or aunt. ‘And in my experience it’s the grandmothers who name the children, not the parents. If girls go into labour prematurely and the baby is born in the community, then it’s the grandmothers who usually come in to support the mothers. It’s always a very exciting time with a flurry of activity and celebration for the women and children. While I haven’t seen a father come into the health centre at the time of a birth, most are very hands on and involved once the baby is at home.’

  Across the Northern Territory, when Aboriginal mothers and babies return to the community, the babies sleep with their mothers, rather than alone in a bassinette or cot, often sharing with older siblings as well. ‘That’s the way it has been done for thousands of years,’ she says. ‘The babies are rarely put down – there’s always a willing pair of hands to hold or carry them. Babies are almost exclusively breastfed, most for at least two years, anywhere, any time. All babies seem to have many grandmothers and there is certainly no need for a childcare centre.’

  In most places there is very strict tribal clan business and customs to abide by. ‘Living in a remote community is certainly all encompassing,’ Kate says. ‘It’s Indigenous country and we’re here as guests. English is usually a second or third language for most people. Unfortunately, when in conversation or consultation we move constantly between native language and English, so a lot can get lost in translation.’

  Once Kate was relieving in a small community in West Arnhem for two weeks as a nurse – not as a midwife. ‘I wasn’t aware of the antenatal list so it was with surprise when I received a call from a woman just after 1.30 in the morning, to tell me her daughter was having baby pains. Goodness, where are you? I asked. With anxiety in her voice the woman replied, We at the clinic, she can’t sit down, she having really bad pains.’ Kate rushed over to the clinic and when she walked in found the young girl was certainly experiencing baby pains. ‘She was seventeen and a very small girl,’ Kate says. ‘She was about seven and a half months pregnant – so a little early. She was at that point of her labour where she felt a desperate urge to go to the toilet. It was difficult to take her obs, but it was important to listen to the baby’s heartbeat. I contacted the permanent midwife to come in to assist. There wasn’t a doctor in the community.’

  Just as the midwife walked in, the young girl’s waters broke and almost right away a tiny baby g
irl with a hearty cry was birthed. ‘The baby weighed two-and-a-half pounds [just over a kilogram],’ Kate says. ‘The time from the call-out to the baby’s arrival was less than an hour. Phew! We settled the mother and baby and made sure they were both warm and comfortable. We transferred them both by air to the tertiary hospital later in the morning, where they made great progress.’

  Kate’s youngest daughter, Sal, says she and her mother are very close. ‘I think very highly of my mum,’ she says with pride. ‘She has always been a tremendous role model for me and my brother and sisters. I have two stepchildren and it’s now that I appreciate all Mum did for us,’ Sal says. ‘Recently I juggled work and a birthday party and my mother-in-law asked how I had managed to do so much when I was working full-time. I thought later, That’s all I know. Mum always did that. She did it all – it was just a matter of being organised and she passed that skill on to us. I think her mother was the same kind of inspiration for her too.’

  In 2012 Kate began flying into an island community in north-east Arnhem to work month on, month off as the permanent midwife. She shares the roster with another midwife. ‘It works well for Peter and I,’ Kate says. ‘When you have someone to share the roster, the job can be very flexible.’ On the island the average house occupancy is fourteen to sixteen people in a three-bedroom house. Kate says generally the whole family shares the bedroom and everyone sleeps on mattresses on the floor. ‘The people don’t have a great deal in the way of material possessions,’ she says. ‘Respiratory, skin and rheumatic heart disease are a major problem in Indigenous communities. The bush and grass is regularly burnt, which can cause respiratory problems, but largely it’s the number of people living in such close quarters that causes infection to spread. Family life tends to be very simple. Power is bought by cards from the store and is supplied by a generator on the island. There’s minimal air conditioning, ceiling fans or refrigeration, and in the tropics it can get extremely humid, causing damp clothing and bedding. Aboriginal priorities and perspective of time are often far removed from Western culture. Parents are often unaware of the date of their birthdays or of their children’s.’