Australian Midwives

by Paula Heelan

  One day Marg was caring for a baby who was very slow at feeding and hadn’t picked up. ‘The baby was tired after feeding,’ Marg says. ‘We called in a paediatrician to take a look and it was found the baby had a heart condition and needed to be flown out. The plane couldn’t come in for three days due to bad weather, so I cared for baby until it could land. The father of the baby was the local dentist. I went to him a few months later and he talked me into some expensive dental work. I went ahead with it reluctantly, and then he wouldn’t charge me.’

  Marg loved working in Terrace. ‘As Paul wasn’t eligible for a work visa he did the parenting and some volunteer migrant literacy and numeracy teaching. All our married lives we’ve swapped the breadwinning job – sometimes I’m the principal earner and sometimes Paul is. It’s worked really well for us.’

  While in Canada the family toured a lot of the country and at one stage the health services department called for nurses to do some work on Queen Charlotte Islands (now known as Haida Gwaii), an archipelago off British Columbia’s northern coast. ‘On my days off I flew in by seaplane for two lots of four days. The pilots knew I was an Aussie tourist and flew low so I could get a really good look. Made up of more than 200 mostly uninhabited islands, Haida Gwaii is home to an abundance of sea life and onshore, seabird colonies, bald eagles and bears. It’s a spectacular place,’ Marg says. ‘We have had so many rich travel experiences through my midwifery work. Leah and Jack absolutely loved the school in Terrace and were very happy there. Jack didn’t want to leave. Katherine and Anthony visited and Anthony stayed with us for eighteen months.’

  A new position came up at the Cleve Hospital in 2008, so Marg applied for it while she was still in Canada and got the job, so the family moved back to South Australia. ‘I worked as a general nurse and did some midwifery community work. Paul worked in Port Lincoln and commuted from Cleve. In 2011 we decided to move to the little town of Willowie, a farming community in the Flinders Ranges, 65 kilometres south-east of Port Augusta. It has a population of 30 and there are no shops. But we’re only twenty minutes from several larger country towns. We still live in Willowie and we all love it here. The children are now at school in Port Pirie to give them more subject options and extend their social life – a common reality of remote and rural life.’

  When the maternity ward closed at Cleve, Marg began work with the Crystal Brook midwifery clinic team, 197 kilometres north of Adelaide. It was similar to the rural midwifery work she did in England, and she enjoyed working there for more than eighteen months. Her friend and colleague Liz Morris-Elliott worked with Marg at Crystal Brook. ‘Nothing was ever too much trouble for Marg, she’d go out of her way to help, even when she lived so far out of town. She showed initiative and was incredibly dedicated. We worked across both the Port Pirie Regional Health Service and Crystal Brook Hospital sites and had our midwifery caseloads. We worked very much in a team. On one occasion I’d worked a really long day, pushing fifteen hours and Marg came in to relieve me in Port Pirie,’ Liz says. ‘I was caring for a young woman with pre-eclampsia and she was in established labour. I couldn’t stay on with her, because I was very tired and well over my twelve-hour limit. While I was handing over to Marg and sitting at a desk writing notes so Marg would know where everything she might need was, the woman had a seizure. Marg and I flew into action together. Afterwards I said to Marg, Wow, I’m so glad it was you that was here with me. We just worked really well together in that emergency situation. And it was nice to know someone with her experience and expertise was there to support me.’

  The hospital was small at Crystal Brook, with quite rustic conditions compared to the bigger regional hospitals. ‘We had to make do and Marg’s remote-nursing experience was a great help – she was always coming up with innovative solutions and she took everything in her stride,’ Liz says. ‘Marg doesn’t shy away from hard work and she continues to give and give and give.’

  Marg took a break from on-call work, and family wise she was happy, but before too long she started to miss midwifery, which led to her current work as nurse and midwife with RICE.

  In October 2015 Marg received the Health Award from the South Australian Regional Awards – from more than 2000 nominations across seven regions. She was recognised for her unique and challenging role providing a broad variety of health services to geographically isolated families across the vast pastoral and outback areas of South Australia. She was also recognised for re-establishing the phone link-ups for pregnant women and women with young children to enable them to exchange information. She accepted her award at a ceremony in Port Augusta. When RICE management called Marg into the office to let her know she’d won, she didn’t think for a minute it would be about an award. ‘I thought I was going to get in trouble for the aerial that had fallen off my vehicle – which I hadn’t reported,’ she says, laughing.

  Marg’s award meant a lot to her family, particularly Paul, because it was an acknowledgement of the pioneering work people still do in the bush. ‘They stretch themselves in all sorts of ways to deliver services with limited resources. Marg is out there doing the hard yards – I’ve been out with her and you could tell how much the people she sees appreciate her. They know how far she travels to help them, and at times in pretty awful conditions. She makes a big difference to the lives of many people.’

  CHAPTER

  5

  Mark Holmes

  Mark Holmes’ first day on the job working as a midwife in a major hospital began on a high. Brimming with cheerful anticipation, the 23-year-old entered the birth suite to meet the young woman who had been assigned to his care. Conscious of the importance of building a positive relationship with the expectant mother and her family, he was keen to gain their trust and confidence. He wanted them to feel completely at ease with their midwife.

  A bottle of champagne sat on a bench in the room, ready to pop on the baby’s arrival. In the excitement of the pending birth with the parents, Mark chatted happily about his liking for a bit of champagne. Warming to their six-foot-one, broad-framed midwife, the young couple enjoyed sharing stories and jokes with Mark. They appreciated the talking and laughing. It eased the nervous wait.

  Everything was going swimmingly – until the woman’s second stage of labour when the best of his midwifery skills were unexpectedly called on. Out of the blue he had to perform his first ever episiotomy – a surgical incision to quickly enlarge the opening for the baby to pass through. It was the first birth where he’d assisted independently. ‘It’s rare to have to do an episiotomy, and when it does occur an audit follows because there needs to be a good reason for one,’ says Mark. Apart from this, everything seemed to be going well for a beautiful birth. ‘But call it midwives’ intuition, I felt something was wrong and when the baby was born he wouldn’t breathe.’ The baby was born pale and floppy. ‘He just would not breathe so I quickly moved him to the infant Resuscitaire and pressed the emergency buzzer,’ Mark says. ‘People came from everywhere and quickly alerted the neonatal team in the adjoining nursery. Suddenly the situation moved from a calm, relatively straightforward birth environment to that of bright lights, cold steel and action stations. This was not how I had experienced birth over my student years. Far from it. I was like a rabbit in headlights. I was trying to explain what was going on to the woman and trying to birth the placenta. It was noisy, crazy, organised chaos.’

  The baby was gently placed on the hard hospital grade surface under the radiant warmer. ‘It smelled like heated disinfectant – you know that hospital-grade cleanliness.’ Mark says. He was sweating from nervous tension, which was exacerbated by the strong heaters turned on to keep the baby warm. Mark quickly rubbed the baby with firm but gentle, tactile stimulation, hoping against all hope this would help the baby to breathe. But it was ineffective. With trembling hands he positioned the baby to try to open his airway to artificially breathe life into him. The neonatal team arrived with a bustle of stainless-steel trollies carrying more advanced life-sa
ving equipment. ‘I still remember the more experienced neonatal nurse expertly and calmly guiding me aside. Her movements implied I’ve got this.’

  The four responders pounced on the baby. Alarms buzzed and then life-saving orders and options were firmly uttered. Fluorescent lights flood-lit the area, gloves snapped and drawers were flung open as the neonatal resuscitation team expertly flicked through the sterile, plastic artificial airways.

  Quietness followed as the paediatrician guided a small thin tube into the baby’s mouth and into his lungs. Everyone’s breath caught – had this extremely difficult intervention been successful? Would the baby’s lungs be flooded with much-needed oxygen, allowing the floppy, now translucent blue little boy a chance at life?

  He is pinking up, Mark said looking at the dangerously low red numbers on the monitor click in an upwards motion switching to orange and then finally green. ‘It hit 90 and then the alarms went silent and the lights stopped flashing. We all looked at each other tensely. Time had stopped. It felt like an hour, but in reality it was a millisecond; each of us in the room knew the unspoken truth. Things were bad.’

  The moment was broken by the neonatal nurse redirecting the team to what came next. ‘I couldn’t believe things could change in an instant like that,’ Mark says. The baby survived the initial resuscitation but care was withdrawn a couple of days later and he died. Mark was devastated. After two years of training and not experiencing a neonatal death, it had happened on his first day on the job. ‘That was really tough,’ he recalls. ‘I was given a lot of support and this is when midwives really come to the forefront. They gathered around me and knowing I was extremely upset, they helped me. Every midwife has a similar story. For me it came back to that power of womanhood and mothering. I visited the baby each day and cried with the parents. I wasn’t there when the baby died, that was their time, but I saw them afterwards.’

  The day before the baby died a CAT scan showed he had suffered a major brain haemorrhage and he wasn’t able to breathe for himself. At this stage Mark didn’t know when or how the baby had haemorrhaged. As the business of the hospital hurried on, Mark was beating himself up, trying to work out what he’d missed. ‘I went over and over my notes and thought, Could I have done something differently? Was there something I could have picked up on earlier that was suggestive of an intrauterine foetal brain haemorrhage?’ He had to wait for investigations and a post-mortem to determine the cause of death.

  It was only when the post-mortem result came out about six months later that it was found the baby had suffered a haemorrhage, which had happened some time after the eighteen-week scan and before the birth. ‘The prolonged period of waiting to find out was a big knock to my confidence and triggered a huge amount of self-doubt as a new graduate. I worried that I’d done something wrong. It was very difficult to go back in and work with another woman the next day without being overly cautious. And I could only imagine the agony and frustration the parents must have felt during the prolonged wait.

  ‘Midwives talk about working in a wellness model – working with well women and low-risk birthing. It was hard for me for quite a while not to over-treat. I kept thinking it might happen again.’

  It took Mark a long time to conquer that over-cautiousness. He couldn’t relax and was afraid of becoming complacent. He dreaded being caught out by another surprise. ‘I’d seen sick babies and a whole gamut of complications that had been picked up throughout pregnancies, but after that baby died, I lost my faith in the power of the birthing process. It eventually came back and I realised knocks like that were part of the fabric of midwifery. I still remember the baby’s name and every now and then when I see a bottle of champagne, I think about that unopened bottle sitting in the mother’s room. I like to think she would have gone on to have more healthy babies.’

  Mark grew up in the close-knit community of Clermont and attended the local high school. Clermont is a small agricultural town with a population of 2200 in Queensland’s Isaac Region, 274 kilometres south-west of Mackay. The district is home to some of Australia’s most valuable mixed farming and cattle-producing country as well as being a major hub for large coalmines.

  In 1992, at ten years of age, Mark suffered a ruptured appendix and was raced off from Clermont to the Mackay Base Hospital in central Queensland by air ambulance. Needing surgery, he had a prolonged stay. He says the experience sparked his interest in health care and the idea of becoming a nurse, doctor or midwife with an aeromedical organisation. He hung on to that ambition.

  As a teen, the signs of his pending career were not hard to spot. When his family’s cat was locked up waiting to be spayed, Mark was desperate for her to have kittens. ‘I may have let her out for fifteen minutes before my parents got home from work,’ he admits. ‘And surprise, surprise, the cat had an immaculate conception and gave birth, with my help, to a litter of kittens.’

  When Mark was in high school he let a local midwife and close family friend Marg Schifcofske know he was interested in nursing. Over the years Marg became a mentor and key role model to Mark. After a 40-year career in nursing and midwifery, she retired in 2015 and to this day the two have remained friends. Recently Mark flew to Clermont for Marg’s 60th birthday.

  Marg remembers when Mark came to the hospital for work experience. ‘He was just so loveable. He was considerate of everyone, funny and smart. He watched his first delivery with me and another midwife. He was over the moon. It was unusual for a male student to be so interested in nursing and Mark had an unquenchable thirst for learning. He soaked up everything we shared with him. Back then there was always a bit of a stigma about male nurses. But he did so well with us girls.’

  Academically Mark excelled. ‘He was one these nurses that had brains as well as bedside manner,’ Marg adds. Initially, when Mark let Marg know he was interested in becoming a nurse or a doctor, she tried to talk him out of it. It was in the late nineties, when birthing services in Queensland were on the decline and Clermont was facing the loss of its birthing facility. There was a doctors’ crisis, rural medical services were cut and centralised and the insurance crisis was going on. Marg was feeling a bit jaded with it all.

  But Mark loved what she did. ‘She was a big hero of mine,’ he says. ‘There were other midwives in Clermont, too, a group of them, who I had quite a close relationship with – mostly through the swimming club, and they all helped guide me on my path to nursing.’ At fifteen, Mark volunteered at the Clermont Hospital for work experience. ‘I got to watch the birth of a baby,’ he says. ‘It left me with a new respect for the power of womanhood and the miracle of life. The woman gave birth without pain relief or fuss. It was completely natural and straightforward. It was the biggest defining event in my career – even though I didn’t have one at that stage. It was one of the most amazing things I’d ever seen and I was hooked from then on. I love how with just one breath a whole new person enters the world and instantly becomes a major part of a family.’

  At first, Mark considered becoming an orthopedic surgeon, but when he saw the birth of that baby, it changed his career aspirations. He was set for nursing and midwifery. ‘I could see they were the ones that got to work and interact closely with the patients.’ In the following year he volunteered to work at the hospital in his own time, outside school hours. ‘When a baby was about to be born, the midwives used to call me in. I saw a couple of caesarians and natural births. The doctor was also really good to me and tried to talk me into becoming a doctor instead of a midwife. But back then to gain a medical degree in Queensland you had to do a non-medical undergraduate course first. So all the advice was to get a nursing degree in order to have a reasonable-paying job to pay for the medical degree later.’

  Mark attended the University of Southern Queensland in Toowoomba to gain his three-year nursing degree. ‘I did do some bush practicals, knowing the variety and experience would be greater – more births, more of everything, and I loved that. Nursing and midwifery mean working across the life
span, being able to do it all.’ Mark did his graduate year at St Andrews in Toowoomba on the Darling Downs and then went to the Cairns Hospital. In Cairns he did his Master of Midwifery.

  As a male midwife Mark stood out. ‘If I did something or said something wrong I’d hear about it,’ he quips. ‘One night a woman having difficulty feeding her baby was at her wit’s end after trying for days. I truly believe breast is best, but sometimes there can be a pragmatic approach to facilitate this. I had to go through a massive rigmarole to get some formula. It was locked up and I had to get consent. But when you’ve got a tired mum who has a difficult transition to early parenting, the last thing that going to help is stringing out her anxiety. In the end I just said, We’re going to get some formula and we’re going to feed and settle this baby. Which we did. After some sleep and a settled child, we were able to get the mother to establish breastfeeding and she left the hospital a more confident mum. However, it was a huge deal. When I came back in after my days off, the lactation consultant headed straight for me. She’d been told the male midwife gave the baby the bottle. I was in for it. She said I was representing the patriarchy and had failed in my duty as a midwife … blah, blah. I stood my ground and just said, No, I think it was the best thing for that baby. And I asked how we could work together from this point on to help this particular woman.

  ‘Acutely aware of my gender, generally I go out of my way to win over trust. Women would say things like, Oh the male midwife didn’t make me do that, or nurses would say, I don’t know what you’ve done to her, but she won’t listen to me, she wants to do it your way. My practice was very visible. Midwifery is very political and tied up in women’s rights. There are a lot of very passionate midwives and with that comes a lot of healthy debate about what’s right and what’s not.’