Australian Midwives

by Paula Heelan

  Mark had applied for the NSW Air Ambulance job two months before he left Scotland to return to Australia. ‘At last I was going for the flying job I’d wanted for so long. I knew I’d need a lot of experience to get it and didn’t think I’d have much of a chance. We arrived back in Australia in April and still hadn’t heard anything. The recruitment period took about three months back then so we decided to take off on a six-week road trip around Queensland. It was a great way to show David the country. We were having an amazing time on the Great Barrier Reef when I got the phone call. They said, Congratulations, you’ve got the job. Can you be in Sydney on Tuesday? It was Friday. I said, Yes, no problem. I hung up and in full snorkelling gear on the Low Isles, told David we had to be in Sydney by Tuesday. And David, not realising the full scale of Australia, raised his eyebrows and nodded approval. He didn’t have a driving licence, so I drove all the way. We rocked up with our seventeen kilograms of luggage and nowhere to live.’

  Mark was 26 years old when he started the job in 2009 – the youngest flight nurse they’d ever employed. ‘I started while David found us an apartment. Our funds were running dry, but he found a furnished place. I was flying and not contactable most of the time. I came home one day and he said he’d found us an amazing apartment. We moved in. We were smack bang in the middle of Kings Cross in a back alley near all the nightclubs and several brothels nearby. It was a huge eye-opener for us. We’d sit on our rooftop terrace and watch drug deals below. At the time they were filming the TV series, Underbelly. There was a lot going on. Two and a half years later we moved to the port side of Kings Cross to Rushcutters Bay, just 500 metres down the hill. It’s on Sydney Harbour and it’s a place we love.’

  Mark settled quickly into his new job as a flight nurse. ‘I absolutely loved it. I hadn’t been aware of how much training was needed to become part of an aeromedical team. I’d always been a bit of an aviation geek and plane spotter and I think it helped me get the job when I told them my story about being flown to Mackay in the air ambulance. At first I was geographically challenged. I was flying around not knowing what part of New South Wales I was in. We were flying to places like Bourke, Lightning Ridge, Walgett, Mungindi, Ivanhoe, Griffith, Tumut, Dubbo, Mudgee, Orange, Forbes and Parkes. Most of the calls for midwifery would come from the state’s north-west due to the lack of services out there. The Indigenous mothers would present late for antenatal care. Understandably they preferred to birth on country. We would fly out to help birth their babies or retrieve women that needed assistance.’

  Mark was in western New South Wales on a job once and just happened to be in the hospital when the midwife asked if he’d mind answering a buzzer while she went off to do something else. He walked into the ward and found it was the birth suite with a woman in the throes of birthing her baby. ‘Within minutes I had a baby in my hands and handed it to the mother. She said, Who are you?

  ‘The gardener, I said with a big grin. I was in uniform but she didn’t appreciate my humour and I had to promptly explain I was actually a midwife.’

  As NSW Air Ambulance is an emergency service, the vast majority of call-outs involve high-risk, medical trauma and other serious cases. The majority of patients are transferred to a high level of care.

  For example, most of the women Mark worked with were those experiencing high blood pressure in pregnancy, premature labour or other complications. There were also those few term women that refused to travel long distance to have their babies. ‘Women are sent from their communities for the sit-down period to wait at the larger centre for the baby to be born, which could be from four to six weeks. Many have to pay for accommodation and it becomes an expensive wait. So it’s understandable that many don’t want to go off country. Instead, they present late, when the ship has already sailed. It can be hard to convince women to take a plane and head for a city when at home they are surrounded by extended family – aunts, sisters and grandparents. This includes Indigenous and non-Indigenous women. Birthing on country applies to everyone. Girls from my school in Clermont can’t birth there anymore either. They, too, have an attachment to the land and their home. It’s not fair on them.’

  One night Mark flew to the high altitude ranges of central New South Wales for a woman in premature labour with twins. In sleet and snow, they brought her out to the aircraft. ‘She was having contractions, but I decided it would be safe to set off for a 40-minute flight,’ he says. ‘Just before take-off we got a call asking if we could hold because they had someone with a bleed on their brain coming in from another small town further west and needing to see a neurosurgeon in Sydney. With two stretchers on the plane, we had room so we waited. I had the woman expecting twins up front and when the other woman arrived in the ambulance we made the decision to walk her up the stairs instead of using the stretcher because she looked okay and it would be faster and warmer for her. As she reached the top of the stairs she had a major seizure. The brain bleed had extended. Then suddenly the pregnant woman told me she wanted to push and that the first baby was on the way. So while I’m attending the lady having a seizure, doing all I needed to do putting airways in and dealing with a brain bleed, I’m calling out to the other woman, It’s alright, breathe through it, I’ll be with you in a minute. Luckily the paramedic crew was still there. When the woman with the seizure was stable again, they took her to the regional referral centre, where she was put on life support and evacuated later. I headed off to Sydney after assessing the pregnant woman to make sure the babies weren’t coming right then and there and elected to go. The twins were born within an hour after arriving in Sydney.’

  When Mark started as a flight nurse in 2009 he called one of his best friends, Amanda Bianchi, at the end of a tough retrieval job. The two had grown up in Clermont together. Amanda’s phone rang at 2 am and Mark was on the other end sobbing. ‘He rarely breaks down so I knew it was a big deal. Just breathe, I said. Is everyone okay? What’s going on? He told me he’d just got home. He had been tasked to fly out to a remote area to retrieve a labouring woman pregnant with twins at 26 weeks. Mark stabilised her for the flight, but midway she started to bleed. He was working on his own and had to care for the mother and her babies independently. The mother was bleeding and the babies were in great danger. There he was caring for the three of them on his own. I asked him how it ended. He said, I got them all off the plane alive – with both babies in utero and the mother stable. But it had completely drained him. He’d given everything he had to give. He kept saying, Don’t tell anyone I called you, I have to do a debrief. I just said, Honey, I am your debrief. And you can hold this story up high. He was in his mid-twenties and he saved three lives that night.’

  NSW Air Ambulance base executive assistant Suzanne Bristow is one of Mark’s closest work colleagues. She says that as an elite flight nurse, Mark is exceptional in what he does. ‘Everybody loves him,’ she says. ‘There are not many flight nurses in the world. They are looking after patients in the sky without a doctor. To get to this level they have to be the best at what they do. Not too many come with the entire package. There’s a lot of training involved and Mark has clocked up some wonderful achievements, including raising the profile of flight nurses through his role as president with Flight Nurses Australia. He knows how to read people and how to deal with them and is very professional in his work. He has a way with patients and is extremely generous in nature with whomever he is dealing with. His compassion shines through and patients and pregnant women love him. I don’t know where he finds the hours to do all he does. It’s not just his job he gives one hundred per cent to, he does a lot of vital voluntary work in rural and remote areas.’

  On 23 May 2015 Mark and David were legally married in Edinburgh. ‘Mum and Dad came as well as a bunch of my friends. A few months later we had a reception, for want of a better word, in Sydney so more of our Australian friends could celebrate with us.’

  Three years ago Mark moved into an education role with NSW Air Ambulance and does fifty-fi
fty flying and ground-based education. As a flight nurse/midwife educator he teaches new recruits, predominantly on the midwifery side, and makes training videos. Using a simulator he teaches crew in a replica aircraft cabin complete with camera, microphones and intercom. ‘We close students in and put them through scenarios while we watch from another room. Then we debrief them – there’s a very strong educational framework behind it. It could be a postpartum haemorrhage, involving a lot of fake blood that we simulate, and the classroom is in the air.’

  Mark has also joined the Council of Remote Area Nurses of Australia (CRANAplus), which runs maternity, emergency, and midwifery upskilling courses around the country and educates, supports and represents all health professionals working in Australia’s remote sector. On a voluntary basis and on his days off he facilitates on four three-day courses a year. ‘It takes education to the people, not vice versa, and we go to far-flung places across Australia to deliver maternal courses to places like Roma, Blackall, Katherine, Darwin, Alice Springs and Western Australia. I like to think I can inspire some non-midwives to consider midwifery and take it back to their local communities. I’ve managed to convert a few to take it on as a career. Birthing in the bush is much better because they are almost always natural. I like to get on my high horse about the closure of birthing facilities in rural and remote communities. So much of my formative years were in the country and this is a great way to give a bit back.’

  Mark was the first male student to go through the University of Southern Queensland as a midwife and the first male midwife in the Cairns Hospital for many years. He was the 110th male midwife to register in Queensland. Today, men make up about 10.5 per cent of the nursing workforce and only one per cent of registered midwives.

  CHAPTER

  6

  Joy Motter

  Joy Motter was sound asleep in the nurses’ quarters at the Fitzroy Crossing Hospital when at 2.30 am a loud bang on the door woke her. Instinctively, she knew something was wrong. She opened the door to find Barry, the teacher from the Aboriginal school based on a cattle station twenty kilometres away. He was with Martin, an Aboriginal man who worked on the station. ‘You’re needed,’ Barry said anxiously. ‘Martin’s wife has gone into labour and is in a lot of pain. Can you come?’

  Responding at once, Joy picked up her maternity bundle and hastily packed drugs from the fridge. From the grounds of the small remote hospital in the West Kimberley region, she walked briskly behind two men across the hospital lawn down to the river. She knew they’d have to cross the water to get to a waiting Jeep. Joy hadn’t had to do this at night before and tried not to think too much about the risks or voice her concern. ‘It was the wet season and I knew we’d have to wade across a knee-deep, croc-infested, rushing river. I thought, Oh God, the current will be strong enough to wash us away.’

  The only thing in their favour was a full moon. In pale, luminous light they could make out the Jeep on the other side. Martin entered the water first. Joy paddled in closely behind him, firmly gripping the belt around his shorts, and Barry scruffed the back of Joy’s shirt as they moved. In this makeshift lifeline and against a strong current, the three strode across, clinging to each other. In was 1968 and Joy was 24 years old.

  When they arrived at the station, Joy followed Martin and Barry up to the men’s kitchen at the main building where the manager lived. She worried about what she might find. ‘I thought, I’ll have to clear all the men out and deal with this as best I can,’ Joy says. She knew Martin’s wife. She had seen her recently at the hospital for an antenatal check and knew this would be an early delivery.

  ‘Sally had been taken from the camp up to the cook’s quarters. The cook was the only other woman on the station at the time and she had tried to make Sally comfortable. During the wet season the women took off,’ Joy says. It was 3.30 am by the time Joy reached the expectant mother. ‘She was lying on the bed in the men’s kitchen. The long-time station manager was up and having coffee. He was the boss of everyone and he “needed” to know about everything that happened. He was grumpy and asked me what was going on. I knew I’d have to be firm with him. Just stay out of the way. I’ll deal with it. Just leave me alone and everything will be fine.’

  She told everyone to stay away while she tended to Sally. ‘The baby’s legs were out and the head was stuck,’ Joy says. When she saw this, she knew instantly that the baby had died and her heart sank. It was a breech delivery. ‘I thought, Oh dear, I’ll just have to do this as best I can,’ she recalls. ‘When I told Sally I would give her a needle to ease the pain, she covered her face with her hands. She didn’t want to see what I was doing.’ Joy knew she just had to get the baby out and try to keep the mother calm and as pain free as possible. ‘I talked to her all the time, trying to keep her mind off the pain I knew she would be in.’ Joy thought back to her midwifery training days, remembering a lecture that could help her. ‘We were discussing breeches and difficult births one day. The lecturer said not to worry, if it ever happened, there’d be a doctor to take over. A student nurse had the sense to ask, But what if you were in the back of New Guinea and there wasn’t a doctor around? I think we should know what to do. So the lecturer took us through the procedure.’

  Then, in the tiny hours of that morning, in a remote part of Western Australia, Joy drew on those instructions. Working in the low, shimmering light of a kerosene lantern, she found the baby’s head above the pelvic bone with her hand and pushed gently. Then she put her hand underneath the chin with one finger in the baby’s tiny mouth and softly wriggled up and down, trying desperately not to injure the mother’s birth passage. ‘The largest part of the baby, which usually paves the way, was coming out last,’ Joy says. ‘Like the majority of Aboriginal women, this mother was incredibly stoic. She just uttered a few soft groans. There was no screaming or complaining whatsoever. When I birthed the baby, she knew it wasn’t alive. I wrapped it up gently and showed Sally her baby’s face. Then I placed the infant on the floor and gave Sally a needle to stop further bleeding.’

  By then the sun was rising and men were trying to enter the kitchen. In no uncertain terms, Joy told them to come back later. ‘Sally needed to go to the hospital. I asked the cook to make her some tea and bread and jam.’ When Sally was feeling a little stronger, Martin, Barry and Joy bundled her up and settled her in the Jeep. When they reached the rising river, they realised they wouldn’t be able to carry her across. ‘The hospital was on the banks of the river on the other side, so we just kept beeping the horn and yelling in chorus, Patient, police, patient, police! Eventually one of the nurses appeared.’

  To Joy’s relief the police arrived at the edge of the river with the boat used during the wet season to cross. ‘We got Sally back to the hospital and called the Royal Flying Doctor Service [RFDS]. But it was Good Friday and they had shut down for the long weekend. So I called around and found another pilot. He flew in and evacuated Sally and her deceased baby to our nearest regional base, Derby.’ While it had been a very difficult and sad experience, Joy felt pleased with the outcome. Working levelheadedly and without panic, everything had gone to plan. She had saved Sally’s life and birthed the baby without gravely injuring her.

  Born in 1943, Joy grew up in the country town of Mortlake in Victoria’s western district. She lived on a mixed farm with her parents, two sisters and a brother. When she finished school at sixteen she didn’t know what she wanted to do. ‘Mum said, Well you’re not coming home to the farm. I didn’t really want to anyway,’ Joy says. She left home to board with relatives and work in an office in Warrnambool, 40 kilometres away on the coast. When she turned eighteen, she knew she wanted to become a nurse. She trained at the Warrnambool District Hospital (now called South West Healthcare Hospital) for three years and stayed on as a junior sister. ‘They had a private midwifery section staffed by trained nurses. Every now and then there weren’t enough on duty, and as I was working in the private patients’ section and was one of the senior nurses by thi
s stage, they called on me to help.’

  One day there was a delivery in the labour ward. A nurse went to get Joy and said she was needed to hold a woman’s leg. In those days, women had the option of giving birth on their side, where one leg is on the bed and the other held by someone to expose the delivery area. ‘So here I was kneeling on the bed, hanging onto her leg. Sweat was pouring off my face. I’d seen births before of cattle, dogs and cats, but here was a human and I was fascinated. The doctor said, You’re sweating, are you alright? I was sweating because the floodlight was three inches from my head and aiming at me. That was the first birth I’d participated in.’ And that’s when Joy knew she wanted to be a midwife.

  Joy did her twelve-month midwifery training at the Royal Women’s Hospital in Melbourne. ‘I absolutely hated it,’ she says. ‘I liked looking after the mothers and babies and the women seemed to like me and could talk to me, but coming from a little country hospital I was shy and outside my comfort zone.’ As soon as she passed her exam, she left Melbourne.