by Paula Heelan
Quite often Jo is called away from home – or perhaps from a wedding, a family dinner or some kind of special event. Her husband, Phil, is a project engineer and works Monday to Friday. He steps in to help Jo whenever he’s needed. ‘He’s incredibly supportive of what I do and takes the family reins if I need to be gone for a long time,’ Jo says. ‘Sometimes I can be gone for several days. Phil just takes over. It can be difficult at times, but the positives far outweigh the negatives – midwifery is incredibly rewarding.’
To assist as back-up midwife when Jo needs a break, she calls on her dear friend and colleague Jacqui Wood. Jacquie was a homebirth midwife in New Zealand and then moved to Australia in 2008. Recently, she took time out from her private practice to work in the justice system as a midwife, where she looks after pregnant women in prison. ‘She’s my back-up and loves attending the occasional homebirth that I can’t get to. I do have to plan holidays nine months in advance and don’t take on any women if their babies are due when I know I’ll be on holidays. That wouldn’t be fair. Women hand-pick their midwives and are paying a reasonable amount of money to have the person of their choice at the birth. So I take two weeks either side of the holiday off as well in case women are overdue or birth early. It just means I have to have a big slab of time off.’
Because the women Jo works with are low-risk, which is important for homebirths, very few emergencies unfold. ‘Midwives don’t often work at home with high-risk pregnancies like the birth of twins, triplets or breech births. The safety assurance for me is how well you get to know a woman over the pregnancy term. With at least ten antenatal visits, each an hour long, there’s a lot of time to get to know each other and for me to gain an understanding of any birthing history. An emergency is very rare in homebirths. Usually there is early warning if things are not going well, allowing plenty of time to transfer to a hospital if needed. Things can happen and we have all experienced sad outcomes and difficult births, but usually there’s time to take the appropriate action.’
Getting to know each woman is vital in Jo’s work. ‘Women let me know what they want out of the birth, how they want it facilitated, who they want at the birth and the clinical history. I record what’s going on for each woman, including any physical or emotional issues. But with only three women a month, it’s easy to remember what’s going on for each of them.’
Louise McKervey has had three births with Jo and is now pregnant with her fourth child. Despite now living in the remote NSW town of Cobar, seven hours from the Blue Mountains, Louise still wants Jo as her midwife. She plans to rent a house with her family near Jo for a few weeks before her due date.
‘The first baby I had was born in a hospital and Jo was training as a midwife at that time,’ Louise says. ‘A friend recommended I join up with Jo as part of the hospital’s midwife program and that’s how I got to meet her. I ended up asking Jo more questions than the doctor because I grew to trust her more. When I went into labour I had to get to the hospital and wait for staff to contact Jo to tell her I was in labour. I thought, I can’t do this without Jo. I was so relieved when she arrived a couple of hours later and in time for the birth.’
When Jo arrived at the hospital Louise was in the bath, in labour and close to birthing her baby. ‘Then suddenly the hospital midwife said, Okay, it’s time to get out of the bath. I’m like, What? And she said, There are no water births allowed here. I tried to protest. I’m not moving, the baby’s coming. Jo leaned over and whispered to me, Sit on the plug, sit on the plug!’ Louise recalls, laughing.
‘But the midwife pulled the plug out on me and I birthed my baby without any water in the bath. The cord was around the baby’s neck so they cut the cord immediately and whipped her away for oxygen. I had to get out of the bath and into bed before they brought her back to me. I wasn’t happy with that either. Jo asked me if I wanted a cup of tea and, parched, I said, Yes I really do. But the midwife said I couldn’t have anything until the placenta came.’
Louise had requested a physiological third stage. ‘The midwife asked me to give the baby to my husband and to go and have a wee. When I told her I didn’t need to, she said if I didn’t wee, I would have to have a catheter put in, in case my bladder was full and in the way for my placenta to get out. She said, If you are so scared of a tiny needle after having a baby and you don’t want a catheter, then you have to go and wee. I didn’t need to, so she put the catheter in and for me that was worse than the birth itself. She started massaging my tummy and pulling on the cord. There was blood everywhere and my body was in shock with a retained placenta. It was 45 minutes after the birth and on top of this I had separation anxiety from my baby. Things were happening that I hadn’t wanted.’
When Louise fell pregnant for the second time, Jo was a qualified midwife in private practice. ‘There was no way I was going back to a hospital,’ Louise says. ‘And this time, with Jo, it was completely different. Everything went perfectly. With a homebirth midwife you can have coffee on your lounge for your antenatal visits; the kids get involved – they take the blood pressure and put the Doppler on and Jo brings dolls and things for them to learn about and play with, DVDs and books – everything is so much better.’
Louise had a trouble-free water birth at home with her second baby with Jo assisting. ‘My mum, who had been terrified at the thought of a homebirth for a long time, was actually hooked on it after that,’ Louise says with a chuckle. ‘My third baby was, however, a harder labour. The cord was around the baby’s neck three times (we didn’t know this of course, until he was emerging) and Jo had to quickly get him out and get him going with some oxygen. In the meantime my husband called the ambulance, but by the time it arrived the baby was feeding and pink. Jo had him settled perfectly. So that was a stressful birth, but at the same time I know he was born in the right place. My waters hadn’t broken until the baby actually came. With every contraction I felt there was a jerk at the end of it. Jo said it was probably because the cord was pulling him back each time – which proved to be right. But because the waters hadn’t broken he was still nice and soft and floating around. In hindsight, I think had I been in hospital I might have asked them to break my waters because I was so uncomfortable and wanted to hurry things up and that could have ended with a distressed baby. So while his birth had some complications – everything turned out well.’
Because she lives in Cobar and is unable to birth a child in the small remote town, Louise had to decide where to have her fourth child. ‘Despite being able to go anywhere in Australia to choose the birthplace, we have decided to rent a house near Jo so I can have another homebirth with her. She is the midwife I know and trust. I can just ring her if I need anything or we can Skype. I’ll see her early in the New Year when we go back to the Blue Mountains for a family visit and I’ll have my eighteen-week ultrasound results sent through to her by the GP in Cobar. I feel a great sense of relief and calm just knowing she’ll be with me again.’
It’s Jo’s ability to build trusting partnerships with women, as in Louise’s case, that has allowed her to be so successful in her work. In addition to this, she believes that the relationship of midwife and the woman in her care doesn’t have a hierarchy. ‘Women should be placed at the centre of their own experience and supported to empower themselves with knowledge and skills. It’s the midwife’s role to have patience and trust in the innate ability of women and babies and to be comfortable and confident to support this process.’
Because in a homebirth women hand-select the people they want present during the birth and invite them into their home, this in effect empowers women and allows them control of their birth experiences. That’s why Jo feels childbirth should be a feminist issue. ‘Homebirth is a lot different to coming into a hospital ward where rules have to be followed. The woman can do whatever she likes when she’s in her own home. Unlike doctors on scheduled hours, the midwife never leaves and she doesn’t have women in other rooms she needs to go off to. Once she is there with the expectan
t mother, she’s there for the long haul.’
The basis of midwifery philosophy is woman-centred care. And while there are set guidelines to follow, the rights of the woman come first. Jo supports the notion that midwives are autonomous care providers who work directly with a woman to assist her to make informed decisions about her care. They believe in the woman’s right to informed consent and her right of refusal. ‘We help her to understand the risks and benefits so she can make the best choice for herself and the baby.’
Women requesting a homebirth generally approach it from a very educated position. They do their research before contacting Jo and know what they want. ‘Occasionally the men aren’t on board, but I tell you what, those that start out a little resistant are the ones that become the biggest advocates by the time their baby arrives,’ Jo says.
Some women may have experienced trauma in their last pregnancy and don’t want to go back for seconds. It can be very rewarding when they choose a midwife, build the trust and everything goes well. ‘Often you can see where things have gone awry in previous births and it’s often due to intervention,’ Jo says. ‘A woman might be ten days overdue and an induction is recommended. But clearly the baby is not ready and ends up in distress because of the intervention. Often it results in a caesarian. While we thank God for hospitals and caesarians in emergencies, they can be overdone,’ she adds. ‘We’ve gone from a fifteen per cent caesarian rate in the 1980s to 33 per cent – that’s one in three women. Pain relief messes with physiological birth. When in labour endorphins kick in to offset the pain – you can see it. The woman begins to fall asleep between contractions, which is Mother Nature giving her endorphins to help her manage the pain. But when the pain reaches, let’s say, five out of ten, and a woman is given an epidural, the pain continues to rise but she’s not feeling it and her endorphin levels stay stagnant. If the epidural is decreased to allow her to push to have the baby, she endures incredible pain because the endorphins haven’t been rising with the pain – the hormones aren’t keeping up because of intervention.’
Water births are the least stressful. ‘When the baby arrives it needs to be completely submerged in water, so it’s moving from water to water at the time of birth,’ Jo says. ‘Under water the baby is still being oxygenated with nutrient-rich blood through the umbilical cord. As soon as the baby is born and is lifted out of the water, it opens its lungs and breathes on its own.
‘We don’t advocate keeping the baby under water. It should be lifted out as soon as it’s born. The nice thing about a water birth is that no one has to catch the baby. If the woman is in a reclining position she can simply pick the baby up on her own. Or if she’s leaning over the side of the pool, I’ll gently push the baby between her legs, ask her to sit back and pick up the baby herself. Almost every time, no one needs to be handling the baby apart from the mum.
‘It makes sense that because the mother is submerged in water the birth is going to be less painful. The tissues are softened and stretch better, preventing or decreasing tearing. And the baby and mother can be taken out of the water quickly if there is any concern.’
Jo sees midwives as the keepers of normal birth and woman-centred care. ‘We are skilled specialists in normal birth and at the same time, trained to recognise possible problems or complications. We’re aware of our limitations and scope of practice and offer referral and consultation with other healthcare providers when necessary. I wholeheartedly believe in, support and advocate for one-to-one midwifery care and believe women feel safe when their midwife is self-assured and has the competence to support their choices in whatever setting they choose to birth.’
The Blue Mountains has the second-highest homebirth rate per capita in New South Wales. The highest is in Byron Bay. ‘Everyone knows everyone here in the mountains; it’s a lovely community,’ Jo says. ‘The homebirth group meets fortnightly and runs a meal roster for new mums. They take turns cooking meals and try to guarantee dinners for two weeks. They don’t go into the new parents’ homes – an esky is left on the front porch and members of the homebirth group just leave food, cakes, cookies in the esky, usually with a little congratulations note. They’re even mindful of dietary requirements.’
On top of her private practice Jo has gone back to the books. She’s studying part-time to complete her Bachelor of Midwifery honours degree through research, on private-practice midwives, at Western Sydney University. ‘There’s a rich body of evidence supporting the safety of a planned midwife-attended homebirth for low-risk women,’ she says. In Australia private-practice midwives attend the majority of homebirths. The most recent Australian data shows 307 midwives practise privately across Australia and 270 attend births at home as the primary midwife.
‘It’s well known that increased intervention rates during pregnancy, labour and birth can have long-term impacts on the health for both mother and baby. By offering services to keep healthy pregnant women out of hospital, we reduce the unnecessary intervention rates and therefore improve long-term health. Maternity accounts for the biggest number of hospital bed stays. Supporting and promoting homebirth saves the government lots of money and keeps hospital beds for those who really need them.’
CHAPTER
12
Pia Croft
As Pia Croft drove through the darkness on her way from her home at Ocean Grove in Victoria to Barwon Heads, she thought about the woman who had been in her midwifery care for the past six months, and was now about to give birth. She was glad they lived so close – at two in the morning it was only a ten-minute drive away. ‘I wasn’t expecting the baby to come that soon,’ Pia says. ‘The mother had had two previous hospital births and both those babies were late at 42 weeks. I thought, She’s 39 weeks today. She’ll be surprised and excited that she’s about to have her first home water birth. And I was excited to be going in as their first midwife.’
The mother’s contractions began an hour before she called Pia. But no sooner had she walked through the door than the baby’s head began showing. Pia observed the mother lift up her baby through the water with her husband kneeling beside them. The baby went straight onto his mother’s chest and within a few seconds she could see him breathing and moving in his new surroundings. Pia had her bag with emergency equipment and oxygen, but as with as with most times, she didn’t need to open it. ‘It’s almost always a case of just watching the incredible moment when parents meet their babies for the first time – I’m so lucky to be a midwife and to share that magic. The woman and her husband were both relaxed and going along beautifully. They had had time to fill the pool and then five minutes after hopping in and without pain relief or fuss the baby boy was born.’
His two big brothers woke around 6.30 am and joined their parents and new baby brother in bed. ‘As far as birthing experiences go, they don’t come much better,’ Pia says. She stayed for about four hours after the birth to make sure mother and baby were well, then left with a promise to return that evening. The mother and baby stayed at home and as their midwife, Pia made regular postnatal visits for six weeks post-birth. ‘It’s wonderful how they don’t have to leave their home – they can relax and focus on the baby,’ Pia says.
Pia was born in 1975 in Nuremberg, Germany – the eldest child of quite a lot of siblings. She grew up in a home constantly busy with birth, babies and breastfeeding. ‘That’s where my passion for midwifery started,’ she says with a laugh. ‘I’m the only child from my mother’s first marriage. Mum went on to have three more babies and Dad had six more with my stepmother. I was constantly surrounded by babies – and was even present at a few of the births. I guess I was a little mum myself. I was always minding babies and helping – I loved it.’
When Pia met her husband, Chris, he was based in Hohenfels, close to Nuremberg, with the US Army. Chris had left Australia at sixteen for the United Sates where, at eighteen, he joined the army. A good-looking young man from Melbourne, he fell for the girl with long dark-blonde hair, blue eyes and vibrant nature.
Pia was a shy but strong-minded young girl. And he won her heart at first glance. The two met in a pub. ‘The drinking age back then was only sixteen,’ Pia says, blushing. ‘That’s how old I was. Chris went on to Berlin and Mannheim for a while and then a year later we met again when he came back to Nuremberg. He was five years older than me and we badly wanted to stay together.’ Chris decided to leave the army in 1992 during the Gulf War. However, that meant he was in Germany illegally without a work permit or a permanent visa. The only way he could stay in the country legally was to marry Pia. To help them get by until they could marry (when Pia turned eighteen), Pia decided to leave school and work at a bakery full-time to earn enough money for their own apartment. At the same time she enrolled at night school five nights a week to study for her high school diploma.
They married in 1994 and their first daughter, Freya, was born a year later. Chris and Pia went on to have another four children with the last born in 2010.
Pia had yearned to become a midwife for as long as she could remember. She applied for the midwifery school in Erlangen, close to Nuremberg, through the hospital-based system, but as her children were still quite young she was advised to wait. She found work in areas connected to midwifery so that when the time came to study it would be easier for her. ‘The birthing system in Germany is quite different to Australia’s,’ Pia says. ‘It’s common in Germany for women with low-risk pregnancies to have a midwife and homebirth. High-risk women go to hospital, but a lot more babies are born at home and the national health system supports homebirths.’
In 2000 Chris felt homesick and the family made the life-changing decision to move to Melbourne. Their daughter, Freya, went to school and her son, Thorben, began kindergarten. They didn’t speak much English because Chris spoke German at home. ‘It amazed us how quickly they picked it up,’ Pia says. ‘After a few months we couldn’t even hear their accent. It was a great experience to start from scratch and we were all so happy with just the little things. Then we moved to live in Ringwood. Chris started work as a removalist and I worked at a supermarket stacking shelves and cleaning chicken ovens during the nights. I still didn’t have the midwifery training I yearned for.’