Australian Midwives

by Paula Heelan

  A non-government organisation initiated 40 years ago to assist people living along the railway line and on cattle stations in remote South Australia, RICE is administered by the people it services. The vast job environment was quite a change for Marg, who had previously worked in country hospitals and health clinics based in remote Aboriginal communities. Her workplace spans 655,000 square kilometres from the mid-north to northern South Australia up to the Queensland border. Each year Marg travels more than 40,000 kilometres to deliver health care. She takes her nursing and midwifery skills to parents on stations with newborns through to five-year-olds, and does antenatal and postnatal checks for mothers. ‘We provide in-home health care as well as “on-air” sessions for children and parents and we keep people up to date with the latest and greatest.’

  Some of the places Marg visits include Mannahill, Broken Hill, Birdsville, Oodnadatta, Marree and the Flinders Ranges – calling into cattle stations along the way. She regularly travels the iconic Strzelecki Track and Birdsville Track across desert country and along the edge of the vast Lake Eyre basin. The 459-kilometre Strzelecki Track was pioneered by bushman Harry Redford in 1871 and is only passable to conventional vehicles during the dry season. Pull up on the side of the road and you begin to understand the sense of emptiness and desolation explorers must have felt 150 years ago as they struggled over parched, stony, red earth. If Marg is travelling with others they spend time planning and organising other trips, email and make phone calls until they have driven out of range. ‘If I’m travelling alone, I listen to podcasts audio books, Radio National or music,’ she adds. ‘I do get sick of driving sometimes and I have to do a lot of walking plus long bone and lower back exercises to counteract the long sitting – but generally I love my bush car office.’

  Recently, the RICE team travelled to Oodnadatta for a health expo run by the town’s health clinic at the local gym. After recent rain the stony plains and rocky hills were covered in wildflowers, and stands of glistening red river gums and coolabah trees lined the waterways.

  With the four-wheel drive packed with scales, the mobile toy set-up, hearing- and vision-testing equipment, measuring and weighing gear for observational developmental check-ups to make sure the babies are meeting the milestones, Marg rolled into town with Nicole, the crèche/play day leader, and Manoah, the wellbeing and social worker. Oodnadatta has a roadhouse, a school, a health clinic and a pub that was on the Ghan train line. But there haven’t been any trains through here for more than 30 years. Today it’s a largely Aboriginal community with limited services.

  With the aquatic play set up, the kids washed dolls and cars, floated boats and sprayed coloured paint on cloth. It was organised chaos, and each child lapped up the rare opportunity for group play. ‘It’s lovely to watch the transition from shy bush kids to noisy, active participants as the day moves on,’ Marg says.

  Marg takes a mobile story puppet show with her to stations and events. ‘The puppet show and storytelling are a fun and effective way to help children with speech delay. And they’re more relaxed when we go on to do a health check because they’re not in a clinical environment. In the bush child speech delay is not uncommon – but with some help this can be turned around.’

  In between the water play, Marg provides antenatal information for pregnant mothers and discusses all things maternal, including where to birth the babies. Mothers make the most of the chance to talk over any concerns, ask questions and share stories. Marg also fits in the preschooler and six-month child checks. ‘I make sure the hospitals let me know, particularly if it’s across the border in Queensland, when the babies are born so I can arrange to get back to the families once they’re home for their postnatal visits.’

  Marg’s bush experience goes back to her bush nursing days in remote Aboriginal communities. ‘Back then there was very little support out in the field,’ says Paul, Marg’s husband. ‘She was pretty much the sole operator in remote places. It was very much pioneering work and she had to be self-reliant. When you’re out there you experience droughts and floods and all the extreme conditions that come with living in remote areas. She learned how to keep an eye on the weather, road conditions and vehicles – she was a quick learner when it came to bush skills and she’s not a quitter. She’s only five-foot-three and small-framed, but she can change a tyre on a four-wheel drive and will be the first to get in and get the work done. Her current job has brought together all the skills she’s accumulated over the years in midwifery, nursing, teaching and remote settings. You’d be hard-pressed to find somebody with the experience and skill sets like Marg’s and who can work on any front.’

  Marg has the ability to deal with anything that comes along and she has great empathy for the people living in remote places. ‘I’ve been out with her and I’ve seen how much station people appreciate what she does,’ Paul says. ‘They know how far she travels and how much she cares – you can see the appreciation and joy on their faces when she turns up.’

  On a recent trip to a station near Broken Hill to visit two families with young children, Marg finished at one house and as she arrived at the second family’s house the husband called in on the two-way radio. He just said, ‘Tell Marg, go now, go now!’ Torrential rain had come unexpectedly and fast. The usual one-and-a-half hour drive took Mark nearly two and a quarter hours with slipping and sliding through the rain and mud. ‘It was actually a pretty hairy drive,’ Marg says. ‘I arrived back with a vehicle covered in mud – not a speck of white to be seen.’ Days like that can be long and trying.

  The RICE team often drives to the lead- and zinc-mining town, Roxby Downs, 570 kilometres north-west of Adelaide, where they stay the night before heading out the next morning to Stuart Creek Station, 40 kilometres north of Roxby Downs and bordered by Lake Eyre South. The short-lived watercourse Stuart Creek runs through the property’s sandhills, breakaways, mound springs and gibber plains. ‘Recently with our health checks, playtime and postnatal visit done, Manoah and I continued along the Oodnadatta Track to overnight at the pub. This put us closer to Marree, our next day’s destination.’ In Marree’s town centre beside the old railway line is outback legend Tom Kruse’s timeworn mail truck that he drove on the track between Marree and Birdsville delivering mail from 1936 to 1957. Rolling stock stands rusting at the disused station. It’s a true desert settlement and the town’s solitude and isolation is palpable.

  The following morning Marg and Manoah drove along the Birdsville Track, past Lake Harry Station, Clayton Station and on to Dulkaninna Station for more postnatal and new-baby checks. Marg tries to visit mothers and new babies within the first month of a birth for the ‘universal’ contact visit.

  After Dulkaninna they went on to stay the night at the Birdsville Hotel. The next morning they backtracked 30 minutes south-west of Birdsville to Pandi Pandi Station for a six-month-old baby and four-year-old check-up. Then they travelled back down to Marree for the night before returning to Port Augusta the next day. The drive from Birdsville to Port Augusta is 896 kilometres and takes nearly fifteen hours.

  The RICE days provide just as much fun and benefit to the mothers as they do for the kids. ‘When you’re worried about your child, it helps to swap notes with other mothers and share experiences,’ Marg says. ‘We also run a mother’s group teleconference which is very popular. It’s a phone link-up, where expectant mothers and mothers with babies and young children can exchange information, support one another and discuss child development and health. Sometimes we bring a child expert in to talk on a subject.’

  Born in 1957, Marg grew up in Sydney’s Sutherland Shire and was one of five children. With a hankering to become a nurse, she completed her training with an emphasis on paediatrics in 1978. After some time travelling extensively overseas with a friend, she returned to Australia to work in several nursing positions. In 1988 she trained as a midwife at the Lyell McEwin Hospital in Adelaide, and while she was there a friend who had worked as a bush nurse in a remote area suggested Ma
rg give remote nursing a go.

  Marg found placements in remote Aboriginal communities in South Australia as a locum, and while she waited for a permanent position she updated her accident and emergency skills at the Alice Springs Hospital.

  In 1989 she began as nurse and midwife for Urapuntja Health Services in Central Australia’s Utopia region, 350 kilometres north-east of Alice Springs. Urapuntja consisted of thirteen outstations (homeland centres) located on the eastern perimeter of the Western Desert and covering more than 6000 square kilometres. Marg was based at Urapuntja with one other nurse. They took turns to have every third weekend off and generally drove the three hours to Alice Springs for a break. ‘At the time a lot of our work was over the two-way radio and we liaised with the RFDS. Aboriginal Health workers were based at several of the outstation communities and we talked to them every morning. They relayed medical cases or emergencies and let us know if anyone was unwell. We regularly drove out to the outstations in a vehicle fitted out like a mobile clinic.’

  The accommodation on outstations was less than basic. ‘At Munindunginya our lodging was a small tin shed,’ Marg says, laughing. ‘We had to light a donkey heater [a fire lit in a barrel] to get hot water and we had an emergency generator that we had to crank to start.’

  Three weeks after Marg’s arrival in Urapuntja a heavily pregnant woman with baby pains presented at the clinic door after dark one night. ‘I heard cars and people arriving, so I went out to see what was happening,’ she recalls. ‘The woman was lying on the ground and I had to examine her right there and then outside the clinic using torchlight.’ With some help, Marg moved the woman into the clinic. ‘We managed to get her in and settled and I prepared for the birth,’ Marg says. ‘I was still in my late twenties and new to midwifery. Knowing a neonatal medical team was a long way away, I was frightened. I could see the baby was about to arrive and knew the RFDS wouldn’t get there on time,’ she says. ‘More women arrived and sat outside the clinic and sang through the night to support the expectant mum.’

  To Marg’s great relief the baby birthed a few hours later in the early hours of the morning. There were no complications, and the mother and child returned a few days later to their outstation. ‘I visited every day to check on them both,’ Marg says. ‘And I was thrilled to be invited to attend the baby’s smoking ceremony held one morning at dawn. I arrived to find the baby asleep next to her mother in a little indented coolamon [a traditional Indigenous carrying vessel carved from wood] lined with batik. It was very poignant.’ The women in the Urapuntja region are very well known for their extraordinary art and batik work.

  Six months later another woman with labour pains presented at the clinic. ‘She was in second-stage labour and already ten centimetres dilated,’ Marg says. ‘She wasn’t far off birthing, and expecting her sixth child, I knew she was at risk of a postpartum haemorrhage (PPH). I rang the RFDS and spoke to a new doctor. He was Scottish and I had trouble understanding his accent over the crackly radio. He was trying to tell me to bring her in – but there wasn’t time and as I couldn’t hear or understand what he was saying, I switched the radio off. I thought, I just have to focus on this birth that’s about to happen and just do all I can to help. The birth was uncomplicated and my colleague, who was better at suturing than me, gave the mother some necessary stiches. Later I ended up working with the woman whose baby I helped birth. She was a health worker and we became great friends as a result of that unexpected but wonderful birth.

  ‘We visited the mum and baby every day for five days across the Sandover River,’ Marg says. ‘Unfortunately, after that big rain fell and the river came up. We watched as the water rose quickly and knew we wouldn’t be able to get back over for quite some time.’

  After twelve months on the job at Urapuntja Marg fell very ill with infected gallstones and needed surgery. She flew to Sydney for an operation and with complications was hospitalised for six weeks, and it took her quite some time to return to the Territory. ‘I wasn’t able to go back to full-time work until 1992 – nearly two years after falling ill,’ Marg says. ‘I started work for the Central Australian Aboriginal Congress as an Aboriginal health educator. It involved teaching health workers in Alice Springs and out in communities.’

  In her late thirties, Marg met Paul. He’d been working in Aboriginal health and education for a long time and had two children, Anthony and Katherine, from a previous marriage. They met when they were both in the Northern Territory for the second time around.

  Wanting a break from nursing, Marg had been in Sydney to train as a teacher in the Steiner education system. ‘I applied for a job in Katherine and Marg was encouraged to apply for the founding teacher’s job at a new Steiner school in Alice Springs,’ Paul says. ‘We both got the jobs and we were there at the same time when a mutual friend asked if I’d like to take a passenger with me on my upcoming drive to Sydney. Marg wanted to visit her sister in northern New South Wales for Christmas. I thought, Well, you don’t want to go on a long trip like that with someone you don’t get along with, we should meet first.’

  So the two met and within days were off on the long road trip to New South Wales. Along the way they camped and got to know each other well. ‘It was a really nice road trip and I dropped Marg off at her sister’s place,’ Paul says. Back in the Territory they met up again close to Easter time and began a relationship

  Paul and Marg married in 1997, a year after meeting. Their daughter, Leah, was born in 1998 when Marg was 40, and Jack came along in 2000 when she was 42. ‘They were born at the Alice Springs Hospital and I had a midwife,’ Marg says. ‘The hospital had a very innovative midwifery clinic and I didn’t have to see a doctor – even though I was considered high risk having a baby in my forties. Because of my slight build, medical staff insisted my daughter was too small. But Paul’s only five-foot-three as well and I knew everything would be fine. I went on to have a normal, natural birth and midwives visited me for postnatal care. We did consider a homebirth when I was pregnant with Leah, but because Anthony, who I call my bonus son, was seventeen and staying with us when she was born, I didn’t think he’d want to see that.’ When the kids were little Marg juggled a few casual jobs, including a position with the health department as a community nurse on weekends and as a midwife at the Alice Springs Hospital. She’d race home and breastfeed on her breaks.

  As Paul is originally from Yorkshire in England, he and Marg decided to spend some time in England when Leah and Jack were four and two years old. ‘Paul was recovering from hip surgery, so he stayed at home to mind the children while I worked full-time as a midwife at the Southmead Hospital in Bristol,’ Marg says.

  Working in a large hospital, Marg assisted births every day. ‘I did an upskilling course there and was required to attend 100 births in sixteen weeks. I was a busy girl. In Australia at the time, training midwives only had to attend twenty normal and twenty abnormal births. At Southmead there were 5000 births a year and with a wonderful training and mentor system at the hospital I learned a great deal.’ After that Marg worked with the hospital’s home midwifery team. She lived 45 minutes from Bristol in a rural community and later she got work with a nursing service that ran a team of six midwives to assist families in rural villages.

  ‘We worked twelve-hour days on either day or night duty. The work also involved antenatal, birthing and postnatal care for female prisoners. In England, women can choose to have a hospital birth or a homebirth and the National Health System supports both. I would follow through with the woman in my care and one of us would be there for the birth, and a second midwife was always in attendance. The system for homebirths is extremely well set up in the United Kingdom. I did this for twelve months and loved the diversity. One day I could be caring for a mum struggling in a very poor district and the next I could be with a wealthy family living in a beautiful historic home on farmland. Paul and I had an old Sherpa van decked out with hammocks and we tripped all over the place on weekends and holidays. It was a
wonderful family time.’

  After their period in the UK the family returned to Australia and moved to the Eyre Peninsula in South Australia to be near Paul’s family. Marg worked as a nurse and midwife at Cleve District Hospital in the rural heart of the Peninsula. ‘It was a small twenty-bed facility and the doctor was usually around, but only came in for a birth if there was a complication,’ Marg says. ‘I was honoured to be at the last birth in that small country hospital before the facility had to fold and women had to have their babies in a larger area.’

  In 2007 with a new adventure high on the agenda, Marg and Paul took the children to Canada, where Marg worked as a nurse and midwife for twenty months. ‘I had to sit a nursing exam in Canada first, so Paul and I flew over and my sister looked after the kids for ten days,’ Marg says. ‘We’d met some Canadians by chance on a road trip in South Australia and they suggested we think about Terrace, where they lived. When we decided to go, we made contact with a hospital in Terrace, where one of their relatives worked. I passed the exam and got the job and was given a relocation allowance, which paid for our move. Lea was nine and Jack was seven.’

  Terrace is four hours from the Alaskan Panhandle in south-east Alaska, northern British Columbia. It was a logging town with a population of 20,000, including an Indigenous population of about 3000. ‘There was a river through the middle of the town and we found it very similar to Alice Springs – just in the northern hemisphere,’ Paul says. ‘It was surrounded by remote communities and we got to know quite a lot of the Indigenous people in town.’ At the hospital where Marg worked, the midwives cared for pregnant women right up to the last minute before the birth and then the doctor would usually come in.