by Paula Heelan
After a three-and-a-half-hour labour, the doctor still hadn’t arrived. The protocol is to notify the doctor when the baby is expected to birth soon, but on this occasion he wasn’t able to make it on time. The midwives birth the babies and if everything is normal, the doctors are just on hand. Generally, the midwife and the woman have built a trusting relationship over time.
Everything was going so well and Olivia was excited to think she was going to be able to birth the baby on her own. And suddenly, without fuss or complication, a baby girl was birthed into her hands. She lifted the baby and softly spoke to the mum. ‘Open your eyes.’ The mother reached for her baby and placed her against her chest. Filled with emotion, she looked up at Olivia and whispered, ‘Thank you. We’re calling her Florence Olivia Faith.’ Olivia was deeply moved. ‘I thought, This is incredible. Everything is as it should be. The dad was excitedly cuddling his wife and brand-new little girl and we were all in tears. It was an experience I will never forget,’ Olivia says.
Despite enjoying working in Tasmania again and particularly being able to spend time with her close family and friends, Olivia’s longing for adventure doesn’t let up. She also facilitates on the Remote Emergency Care training course with CRANAplus at remote locations around Australia. ‘I mainly teach patient transfers (boat, land and air), maternal emergencies, airway emergencies, envenomation (for example, snakebite), spinal and basic life support.’ But what’s next? ‘I’d like to work for my friend Christie, who I met on the Mercy Ship. She runs a maternity hospital on the Tanzanian–Kenyan border. Her stories are amazing and she never writes that it’s volatile or unsafe. It probably won’t be long before I head off again.’
CHAPTER
11
Jo Hunter
When Jo Hunter’s phone rang early one Sunday morning at her Blue Mountains home to let her know an expectant mother she had been caring for had gone into labour, she grabbed her kit, raced out the door and jumped into her car. She had spent the past seven months caring for the mother, who was pregnant with her second child, and had come to know the family very well. She was excited. The couple’s daughter, Amity, just three years of age, had been involved in all the antenatal appointments at their home. She had loved helping midwife Jo gently palpate her mother’s abdomen to check the baby’s growth and position. And she’d loved taking a turn of the blood pressure cuff and stethoscope and using the Doppler to find her brother’s heartbeat.
Amity and her father greeted Jo at the door. Wide-eyed and clearly thrilled, they led her through to the mother who, having started contractions, had moved from the shower to a mattress on the floor. Jo knew Amity’s parents had spent a lot of time preparing her for what happens during labour and birth. ‘It was left up to Amity to decide if she wanted to be present,’ Jo says. ‘She was adamant she did and said if it happened at night she wanted to be woken up. As I walked in I thought, I wonder how she’s feeling and if she still wants to stay to watch the water birth. Her mum and dad had an alternative plan of support if she chose not to be there on the day.’
Amity sat down on the mattress next to her mum and began softly massaging her shoulders and rubbing her back. ‘When the time came to hop into the birthing pool the mum relaxed into the water and continued to labour beautifully. Amity set about filling her mum’s glass with water and offering regular sips.’ The labour was fast and after just four hours of established labour the mother’s contractions changed to pushing.
‘The baby emerged slowly and beautifully in the water,’ Jo says. ‘Amity stood beside me the entire time with a look of wonder on her face as she watched him emerge. When his head was half out she announced excitedly, The baby’s head is coming out of Mummy’s vagina!’ And with that her gorgeous little baby brother was born into his mother’s hands. Together with her mum and dad, Amity was exhilarated.
Then, interested in the third stage, Amity donned gloves and inspected the placenta with Jo. Jo has a head torch she wears when checking whether or not stitches are needed. ‘While I was doing this, Amity was intrigued. She asked me what I was doing. I said, I’m just checking to see if Mummy’s vagina is okay after pushing the baby out. And this explanation satisfied her. Mum didn’t need stitches, so I took off the head torch and went into the bathroom to get a pad.’ When Jo walked back into the room, Amity had the head torch on and was closely inspecting her mum’s vagina. ‘Her mum smiled and rolled her eyes at me. It’s all fun and games in this house, she said. I couldn’t help thinking, I wonder if Amity might one day become a midwife.’
Jo is a midwife in private practice. Based in the Blue Mountains, she provides one-to-one midwifery care for women who plan to birth at home. She delivers care in a holistic manner across the antenatal, labour, birth and postnatal periods. ‘I start giving care to women from the early stage of their pregnancies right through to six weeks post-birth.’ She provides complete maternity care for about 30 to 40 women a year from a variety of social, economic and cultural backgrounds. ‘The youngest mother I have cared for was fifteen years old and the oldest, 48 years old.’
Jo’s passion is to support women who strive to achieve a normal, natural birth. ‘This not only includes women considered low-risk or expecting their first baby, but also those who have experienced previous caesarian births, a postpartum haemorrhage (PPH) or physical and emotional trauma.’ With a caseload of two to four women birthing per month, Jo works full-time with the care provided in the woman’s home. In Jo’s view, pregnancy and birth are a normal state for healthy women and an integral part of family life. Midwifery is trust based and built on a strong belief in partnerships with childbearing women and their families, as well as respecting birth as a natural process and a normal life event.
One day Jo attended a birth with a woman experiencing some emotional problems. ‘When she first came to me I could see she was a quiet, private woman and I liked her immediately,’ Jo says. ‘At eight to ten centimetres dilated and nearing the end of labour, she seemed to be caught in transition.’ When women cry out, I can’t do this anymore, I want to go home, or if they are at home, I want go to hospital, it is a sign that the birth is imminent, that labour is getting tough and they simply want it to be over. It’s at this stage when the support team moves in close and offers more encouragement. ‘It was no different with this woman, however her distress was at a high level and labour didn’t seem to be progressing. I knew she wouldn’t be okay with an examination – she didn’t want any touching at all.’
When the woman’s family left the room, she opened up to Jo. ‘She said, I just want to talk. And I just want you to listen. I held her hand and in a flood of tears she revealed to me that she was frightened. She said she was worried the baby was going to be a boy because the men in her family were evil. They had sexually abused her and she was scared if she had a boy, then somehow the evil would carry through to her child. After sharing her fear with me, her mood lifted and she continued to labour.’
After her emotional release the mother asked Jo to give her five minutes alone. ‘I left the room and joined her family outside. Almost right away we heard her cry out during a contraction, and moments later we heard a baby’s cry. We walked back in and there she was in the birth pool holding her baby boy. She had birthed and lifted him out of the water. And instantly, she fell madly in love with him. Often we have to work out what’s holding the labour up – is it physical or emotional? I think experiences like this show the power of the mind.’
Jo was born in Tunbridge Wells in the United Kingdom in 1971. The youngest of five children, she immigrated to Australia with her family on the Ten Pound Poms scheme when she was three years old. In a bid to attract more skilled English people to Australia, the government offered trips for whole families. One full fare was charged and every other person paid ten pounds. ‘We took six weeks to arrive by sea – I guess we were the original boat people,’ Jo says, laughing. When she finished school Jo became a preschool teacher and a few years later travelled extensively
through Europe, where she worked as a mothercraft nurse with families with new babies. She returned to Australia three years on with an English boyfriend, Phil, who she married in 1994. Jo continued preschool teaching before falling pregnant in 1996. ‘My sister-in-law had had a homebirth and I desperately wanted one, too,’ Jo says. ‘But we had absolutely no money to pay for a midwife.’
Jo’s first baby was born in a birth centre in Sydney, and while the birth was straightforward, she experienced problems in the third stage during the placenta delivery. ‘I requested a physiological third stage; this means allowing the body to do the job of birthing the placenta in its own time without drugs [Syntocinon], fundal massage [manipulation of the postpartum uterus] or controlled cord traction [pulling on the cord] – all of which are required with active management of the third stage. The midwife on shift thought a physiological third stage just meant not giving Syntocinon to help expel the placenta. She continued with controlled cord traction and in doing so, pulled the cord off, leaving the placenta inside me.’ This resulted in the need for Jo to be taken to theatre and given a general anaesthetic to manually remove the placenta. She also experienced a PPH and lost a massive 1500 millilitres of blood, which meant a blood transfusion was needed. ‘At the time I was deemed high risk due to the PPH, even though it was caused by third-stage mismanagement. This meant I would have to have my next baby in a labour ward and not a birth centre.’
When Jo fell pregnant again she felt strong and well and determined to homebirth. She and Phil saved every penny so Jo could have a homebirth with the midwife of her choice. ‘I went on to have three babies at home with the same midwife. I was supported to achieve an uninterrupted, drug-free, exhilarating and empowered childbirth,’ she says exultantly. And this is when Jo’s passion for supporting pregnant and birthing women was ignited. She could see the benefits of woman-centred, one-to-one care and homebirths. ‘I completed a course and became a childbirth educator and a doula – a birth companion who assists a woman before, during and after childbirth, as well as providing physical assistance and emotional support for the woman’s spouse and family.
‘After I had my second baby we moved from Sydney’s inner west to the Blue Mountains, where I had two more babies. My midwife travelled to be with me at my homebirths and my best friend and doula, Lu McCarthy, was at the births of my three youngest children.’ Jai is now nineteen, Bronte seventeen, Riley fifteen, and Maya is fourteen. Lu says Jo has been her mentor and go-to person since they met when they were both pregnant with their first babies in Sydney. They now live about five minutes from each other and their eldest two children are the same age. Their families are extremely close, and their children have grown up together.
Lu says people gravitate to Jo’s warm nature and sense of humour. ‘She’s also very grounding,’ she adds. ‘And that’s what I love about her. Having worked in maternity wards in hospitals, the first thing I noticed about Jo was the way she connects and responds to pregnant women. It’s something I hadn’t seen in a hospital environment, which is more clinical and regulated. She quickly gains trust and expectant mums thrive under her assuring nature and professional care. Jo has been my mentor whether it’s personal or work related. We have supported one another at each other’s births.’
When Jo’s son Riley was born, her midwife was late arriving because Jo’s labour was very fast. Lu was thrilled about that. ‘I made it to her place just in time,’ she says. ‘We were both heavily pregnant and when it was clear Riley was about to birth, I hitched up my pregnancy overalls and stepped into the pool just in time to catch him. Jo was totally focused and strong and it was a speedy, uncomplicated birth. I think Phil was glad I was there. It was amazing and of course there were floods of happy, emotional tears.’
When Jo started work as a doula, she attended two to three births a month in the hospital system and ran private antenatal classes that quickly grew in popularity. Her classes were consistently full and this is where a lot of her doula work originated. ‘Women would come to class and ask if I’d be their support person at the birth,’ she says. ‘In the last three years of my work as a doula the local homebirth midwife asked me if I’d like to work with her. She employed me and together with her I attended two to three homebirths a month for about three years. I’d wanted to study midwifery for a long time, but with so many little kids – four born in just over five years – it was difficult. I wasn’t in the headspace or in a financial position to return to study.’
But when Maya turned five and started school Jo enrolled to study midwifery. It was the second year of the direct-entry course at the only university in New South Wales offering a three-year Bachelor of Midwifery without a prerequisite nursing degree. ‘Before that students had to do a three-year nursing degree and an eighteen-month postgraduate midwifery course. I studied with the intention of becoming a homebirth midwife and with no intention of working in a hospital.’
When Jo was having her babies she became closely involved in the homebirth movement as a consumer activist. The national convener of Home Birth Australia (HBA) for five years, she lobbied government and advocated for homebirths and homebirth families. The system had moved from state to national registration and all health professionals had to have indemnity insurance in order to register. ‘The problem was there was no insurance protection for midwives in private practice. The latest statistics show there are 270 homebirth midwives around Australia – not enough for it to be financially viable for an insurance company. When we could see we weren’t going to get anywhere, we organised a rally.’
Despite blustery, cold winds and pelting rain, the ‘Mother of all Rallies’ drew more than 3000 homebirth supporters from across Australia. Laden with banners, babies, prams and signs, people turned up at Parliament House in Canberra to protest over the government’s refusal to extend medical insurance for homebirths. It was a massive plea for non-intervention homebirthing and Jo was thrilled.
It was September 2009 and she, along with many others, had been lobbying hard for a better system for some time. As one of the ‘Mother of all Rallies’ coordinators, she couldn’t believe the turnout. She knew things were going well when she heard airlines had gone into meltdown because they didn’t have enough baby carriers on board flights. ‘People braved drenching rain,’ Jo says. ‘They were chanting homebirth rocks and declared they’d haunt the Health Minister Nicola Roxon over the government’s refusal to insure homebirths.’
Nicola Roxon announced just before the rally that she would put an exemption for requiring insurance for intrapartum care in place for private-practice midwives for the next two years while a solution was sought. Since then the exemption has been extended again and it’s now due to expire in 2016. ‘The College of Midwives is trying to find a solution. It’s a worldwide problem – not just in Australia. While there is insurance for antenatal and postnatal care, there isn’t any for the actual birthing. It’s not a perfect system yet.’
In her third year of midwifery Jo decided to resign from HBA in preparation for her move into a professional role as a midwife. ‘I felt I needed to draw a distinct line between the professional role and the consumer role,’ she explains. ‘I found that quite difficult because I generally look at things from a consumer perspective. But I realised that could cloud my view on a professional level. I still find this a challenge.’
When she finished her degree, the fact that she had worked with HBA and with a midwife for several years meant she had a sound idea of how to set up a private practice. ‘I hadn’t been doing clinical work like listening to babies’ heartbeats or vaginal examinations, but I had attended births and supported women physically and emotionally during and after pregnancy for many years.’
With this competent, all-round understanding of midwifery, in 2009 Jo set up her own private practice in the Blue Mountains. ‘I knew all of the Sydney homebirth midwives, which gave me an excellent support network of women. I could call on them at any time if I needed advice or assistance at
a birth. Going straight into private practice, I was very lucky to have that advantage. To be honest I thought my first year in private practice would be quiet and take time to build. But I think because I’d attended so many births as a doula, when the women went on to have their next baby and the midwife I’d worked with had retired, I was the next person to call on. From the outset I was flat out.’
Jo delivers her midwifery services in homes and travels a wide boundary for antenatal, birth care and postnatal care. ‘The whole idea of homebirth is to do everything at home – to stay in your own environment and maintain the control. I think women are more comfortable in their own homes. I try not to take on more than three women a month, but sometimes there are more because there are so few midwives in private practice. I often need to work seven days a week, depending on how many women have birthed recently. It can get crazy busy when babies are born close to each other and I’m seeing women from twelve weeks pregnant through to six weeks postnatal. Occasionally it’s quiet and I can have two or three days off a week. It ebbs and flows.’
Jo’s daughter Bronte says having a parent that can disappear at any moment can affect family life at times. ‘I was about three when Mum started being on call and we’re used to her coming and going – that’s just part of the midwife’s job and everyone understands that. If she’s on call we have to be somewhere close to home so she can get to the women quickly and the phone is always on the loudest ring. Once we were away camping and Mum was on call. She ended up going to two different births while we were camping so she was actually not there for most of the trip. It was quite funny. We just know she’s got to do what she’s got to do.’