Mobile Midwives: Transforming Birth Options

By Marge Foley

Mobile Midwives: Transforming Birth Options takes readers on a journey through Marge Foley's far-reaching career as a midwife in Australia. Marge was a senior midwife and hospital maternity unit manager before becoming a director of Mobile Midwives NT in the country's tropical Top End.

During her midwifery career, she supported m

• Language: English
• Publisher: Marge Foley
• Release date: Jan 19, 2022
• ISBN: 9780645293319

Marge Foley

Marge Foley grew up on a rural property near Ulverstone in North West Tasmania. Her midwifery career has seen her work in diverse locations. She lived in Darwin for nine years where she and three other midwives became directors of a company called Mobile Midwives NT Pty Ltd. She is passionate about increasing the options of care available for pregnant women that will result in women being joyful and satisfied with their birth experience. Her memoir Mobile Midwives: Transforming Birth Options gives readers an insight into her remarkable midwifery journey, which spans over forty years. By sharing her experiences, Marge hopes to influence midwives to bravely step away from their comfort zone and seek employment in services that offer one-to-one midwifery care. The midwifery insights she has included throughout the book may also provide valuable information to students and midwives. She also hopes the stories will inspire pregnant women to actively seek information about birth so that they understand the process. Being fully informed about what to expect will help to make the birth experience more meaningful and provide increased likelihood of a joyful birth.

Book preview

PART ONE

Born to be a Midwife

Preface

There is no one way to sum up what being a midwife means. No singular definition can describe the role or the persona of a midwife. Each midwife will have completely different experiences in life, in learning, in being and in practising midwifery. Once becoming a midwife, the women, the families, the colleagues and the workplaces will influence the way each midwife provides care to women. In part one of this memoir, I describe my personal journey to becoming a midwife and the influences that helped to shape the midwife I became.

I have memories of a cherished time in my midwifery life that also involved three other amazing midwives. Part two charts our incredible journey between 1996 and 2002 when Mo Davy, Meryl Hammond, Jennifer Gilbert and I joined forces to become Mobile Midwives NT. I remember the highs and lows as well as the incredible enthusiasm and physical efforts of our united team. Mo Davy said recently, ‘This is a book waiting to be written. It is history that should not be forgotten. It should be recorded for midwifery insight, and for mothers and midwives of the future.’

Without any planning, my life experiences and the influence of others propelled me on my path to midwifery and eventually to becoming a director of Mobile Midwives NT. We established a service that provided options of care for women where they felt empowered, joyful and satisfied with their birth experiences. There was no five-year or ten-year plan for this journey; it happened in a fast and furious manner, and we were just taken along for the ride.

I have written this memoir in the hope that I can inspire and motivate midwives who plan to establish their own businesses or work as homebirth midwives. I also hope to boost the courage of women planning pregnancy or already ‘with child’ by sharing my experience and knowledge gained from practising midwifery both inside and outside the mainstream system.

The anecdotes included throughout provide valuable insight into the power of women who are freely able to make choices that then influence their birth outcomes. The stories will enhance practical knowledge for midwives and mothers and contribute to changes that will ultimately improve midwifery care.

Part three of this memoir details the miracle of birth and some of the wondrous (and traumatic) experiences that contribute to this. For both the midwife and the woman selecting the options for care during pregnancy and birth, making informed choices will not be an easy road. Each woman will need to be strongly independent and focused on what they want to achieve. I want to be upfront about that and reassure everyone that I will not be sugar coating anything. It is important to be fully involved in your choices and consider all options carefully.

Midwives are people first. Every experience has an effect. Here is a poem I wrote about the range of feelings midwives experience:

Midwives experience a range of feelings.

Wonder and admiration for the power of women.

Fatigue after supporting a woman during a long and difficult labour.

Joy and exhilaration at the time of birth.

Fear and anxiety when faced with a crisis.

Delight at observing the baby welcomed to the family.

Sadness when faced with loss.

Exhaustion after a long day providing support.

Anger at feeling powerless.

Trauma as a result of a negative experience.

And for the mothers:

Women need to be physically well-prepared

and healthy.

They need to have a deep understanding of

labour and birth,

Knowledge of how the body works,

Awareness of possible complications of birth,

Belief in their own ability and enduring

strength of will,

A positive attitude and a supportive birth partner.

Women need to carefully choose

their options for care.

Researching options for care during pregnancy is the first step to a joyous and satisfying birth experience and weighing up the advantages and disadvantages of each option is the second. Eventually, a judicious choice must be made. Even once that choice is made, there is always the option to change if a mother-to-be has concerns or it doesn’t feel right.

The Mother

The gentle movement of the life within

Reminds her that she needs to find safe care.

She reads, she searches, and asks her kin.

She listens and wonders and puzzles. Where?

Who will keep us both safe?

She talks softly to her little one safe within

And covers her belly with her hands.

She wants this baby born in a gentle way,

Safe and surrounded by love.

Marge Foley 2021

One

Birth has always fascinated me. I think of it as a personal and special event for every family. It is a moment to be cherished and revered by all who are present.

From my perspective as a midwife, I find every birth to be different depending on the mother, the baby and in a broader vision, the whole family unit. Birth is also influenced significantly by those present, and there is something valuable to learn from every birth experience.

Both my elder brother and I were born by forceps delivery while my mother was under general anaesthetic. I can’t be sure what agents were used, but I have found reference to the use of a combination of drugs to induce what was known as ‘twilight sleep’. This was the recommended way to give birth in the 1940s. Many years later, Mum told me that obstetricians didn’t want women to be in pain. Once fully dilated and pushing had commenced, anaesthetic was administered, an episiotomy was performed and the baby was delivered by forceps. The women almost always required suturing. Only when the new mother was fully awake could she see and respond to her baby. Of course, that wasn’t immediately, as the baby had been transported to the ‘sterile’ nursery where it was bathed, dressed and swaddled, and where it would stay until the next feed time.

What were they thinking back then? The woman went through the pain of labour and when the positive time of birth arrived, when she could actually begin to push and deliver her baby, she was suddenly put to sleep! This quite possibly had a detrimental effect on the baby and must have left the mother feeling frustrated, confused and sometimes violated.

I was the second eldest of six children but the oldest girl. I grew up on a farm in North West Tasmania, a quiet rural property with rich fertile fields and a view over the Leven River and the Bass Strait. Our four-bedroom home of concrete brick was built by my father in the post-war years and looked out over the fields to the quiet little town of Ulverstone.

My father, tall and lanky with green eyes, rugged features and dark hair, was a hard-working man who loved his family. He sometimes sat with a cane by his plate at the dinner table. It was rarely used, but he liked to eat his meal in quiet and without the chatter of small children. After a hard day out on the tractor, he just wanted silence!

Out of all the siblings, I was the one who loved to talk the most. While I didn’t get the cane, I was often sent to the vestibule to sit on a shoe box, which was built into a passage way and had a hinged wooden lid about three feet from the ground. I would hoist myself up and let my feet dangle while I ate my dinner alone and reflected on things (not a word I was familiar with at the time).

The vestibule was surrounded by floor-to-ceiling large, curved wooden cupboards, which gave it a sense of quiet comfort and insulation. While it didn’t teach me to be silent, it did give Dad the calm he needed to eat his dinner in peace. It taught me that solitude was not all bad, and if I’m honest, it really didn’t feel like punishment. Perhaps it taught me to stop the needless chatter and to think carefully before I spoke. However, I grew up to value the benefit of social interaction during meals and always encouraged my children and grandchildren to talk freely at any time.

Over the years, my dad became something of an expert in animal husbandry and in assisting animals with complicated births as there was no local vet in the area at that time. He spent many years on the farm breeding Aberdeen Angus (black) cattle and Dorset sheep. Behind our home was the birthing paddock. It was a small green field that backed on to the garage, which was sheltered by the house and trees from the prevailing winds. Strangely enough, this was off limits to the girls of the family when birthing complications arose.

Mum was short with dark hair and brown eyes, and she was always a calm, loving and gentle person. She wasn’t incredibly strong, but occasionally she went to assist with really difficult births while we girls and the younger boys were asked to stay inside. Off they went wearing their gumboots, Mum in her warm skirt and jumper covered by an old coat, and Dad in his combination overalls. I remember being very curious about what went on but two factors kept us inside. The first was the weather as lambing season was in spring, and it was often frosty, windy and sometimes raining, but always cold. The second was that we had learned we must obey our father and we knew that Mum colluded with him on this matter. In her quiet way, she demanded discipline, and we all loved her so much we did our best to please her.

Sometime later, our parents would come inside and place a floppy bloodstained lamb in a box beside the fireplace. We would wipe it dry with an old towel, keep it warm and often feed it a bottle until it regained strength. Once it had recovered, it would be taken back to the mother, or if the mother ewe had not survived the birth, sometimes to a foster mother.

We know a great deal about pheromones now, but in those days, my father sometimes placed the skin of a lamb that had died over the skin of the one that survived and took it to a foster mother whose lamb had died. The ewe would sniff the lamb, recognise the scent and allow the little one to suckle. Sometimes both Mum and Dad would come back to the house looking dejected, and we knew then that the mother and baby had both died. We did see animals birthing naturally, which fascinated us as small children. But what went on in the birthing paddock was animal obstetrics, and we were protected from it. I sometimes wonder if my interest in what was happening in the birthing paddock remained in my mind and was one of the factors that led me to be a midwife. To this day, I would much rather see a baby born in a gentle way than be involved in an obstetric birth where the baby is delivered with instruments.

When expecting her third child, my mother gained a better understanding of birth after she bought a copy of Childbirth Without Fear by Dr Grantly Dick-Read, which was first published in 1942. It was possibly the only text available to mothers at the time.

According to Britannica:

Grantly Dick-Read, a British obstetrician, developed a technique of delivery called natural childbirth that minimized the surgical and anaesthetic aspects of delivery and concentrated upon the mother’s conscious effort to give birth to her child. Although opposed by many physicians who felt that it denied the progress of modern medicine and needlessly primitivized the process of birth, the method was gradually accepted and by the late 1950s was practiced by a sizable percentage of women, especially in the United States and England.¹

The most significant part of this statement for me is that other obstetricians felt it denied the progress of modern medicine!

I wonder if today’s obstetric interventionists believe they are progressing modern obstetrics. If so, there is evidence that there is a significant negative impact on the lives of women on whom they practice. Sadly, as they believe that what they are doing is in the best interests of women, they are unlikely to ever understand the issue.

As they ground their arguments using statements relating to the safety of the baby, women and their partners are coerced into agreeing without question. Sometimes midwives are forced to stand quietly by and support procedures they know are not essential and may not result in the best outcome for the mother. Please be assured, however, these comments do not relate to obstetric deliveries that are essential for the safety of the mother and/or the baby.

Looking back at those earlier generations, it seems abhorrent that women would labour up until the birth, and right when they were at the point of being able to push productively, preparing to welcome their baby for the first time, they were suddenly put to sleep. They then missed the joy of hearing the first cry while welcoming the baby at the moment of birth and feeling rewarded for their hard work. Perhaps this practice was a result of some obstetricians not being comfortable with women’s instinctive behaviour to grunt, moan and move about during the hard work of pushing that made them desire to put labouring mothers to sleep.

My mother went on to have six children, but only the first two were forceps deliveries. My youngest brother was born in May 1962. There was a great drama associated with his birth as my mother had an O-negative blood group and the doctor was certain the baby would need an exchange transfusion. The staff set up for it just in case as knowledge of the Rhesus factor was in the early stages.

I remember my mother saying the staff made her very fearful that her baby would be very sick when he was born. My brother was born rosy pink and healthy, thankfully, which was surprising as several of my siblings and I later proved to be Rhesus positive. This should have resulted in her having Rhesus antibodies, but somehow she had escaped the problem. My brother’s birth story was when I first realised how much doctors and midwives can influence women by creating fear and altering the atmosphere surrounding birth.

I was two weeks away from my fourteenth birthday when my youngest brother was born. I was very keen to see my mother and my new baby brother, but the age of entry to the maternity ward was fourteen years, and even though I had only two weeks to go, I was