Davison, C. (2019). Looking Back and Moving Forward: A History and Discussion of Privately Practising Midwives in Western Australia (Doctoral Thesis). Curtin University, Perth WA.
The overall aim of this historical narrative research study was to fill a gap in the literature by investigating, analysing and describing the history of Privately Practising Midwives in Western Australia (WA) from colonisation to the present day (approximately 1830-2018). This study embedded within a naturalistic, feminist paradigm analysed oral history interviews from fifteen midwives and three doctors, along with archival documents to reconstruct the history and explore the experiences of Privately Practising Midwives (PPMs) in WA.
Since the beginning of recorded history midwives have assisted women in childbirth. Midwifery is recognised as one of the oldest professions; midwives are mentioned in ancient Hindu texts, featured on Egyptian papyrus and in The Bible. Up until the seventeenth century childbirth was the responsibility of midwives, but the gradual emergence of barber-surgeons, then man-midwives and obstetricians heralded a shift from women-led and community-supported birth to a patriarchal and medical model. Throughout the twentieth century childbirth practices in the Western World have continued to change, leading to a move from midwifery-led care at home to doctor-led care in the hospital.
Privately practising midwifery is thought of as a relatively new concept; however, until the early twentieth century, birth in Australia generally occurred at home with a privately practising midwife in attendance. The first non-Indigenous Australian midwives were not formally trained; they came on ships bringing convicts to Australia and are described as ‘accidental’ midwives, as assistance in childbirth came from whoever was available at the time. This period was followed by what was called the ‘Aunt Rubina’ period where older married women helped younger women in childbirth. Throughout the early 1800s untrained or ‘lay’ midwifery care continued alongside the more formally trained midwives who had arrived with the colonists. The decline of midwifery as an independent profession in Australia began in the early twentieth century as nursing and medicine began to encroach on traditional midwifery practice. By the 1930s in WA, midwives as practitioners became almost non-existent. However, the desire for independent midwifery care continued, with a small but stable number of women choosing to give birth with a PPM.
Today, PPMs in Western Australia offer caseload midwifery care to women. Caseload midwifery is an organisational model considered to be the gold standard of midwifery-led care. In this model, the midwife is the primary carer responsible for the planning and execution of midwifery care for an agreed number of women. With the introduction of government health care rebates which cover some of the cost, the choice of a PPM is once again becoming more widely available in Australia.
Using historical and narrative research methods, this study explored the history of PPMs in WA and discovered rich data that described the experiences of these midwives. Four main interrelated themes and subthemes emerged. The first major theme was ‘Midwives in the community: the journey of the Privately Practising Midwife (PPM)’ and its subthemes ‘Building a relationship and providing continuity of carer’ and ‘Birth within the home’. This theme describes how midwives’ desire to work within the community was central to their experiences of being a PPM. An important part of being a community midwife was the ability to provide care in the community, usually in the childbearing women’s own homes. The midwives in this study provided care throughout the pregnancy, labour and birth and into the postnatal period, thereby providing continuity of care and building a relationship with the woman based on mutual respect and trust.
The second major theme that emerged from the qualitative analysis was ‘Trusting women and birth is central to midwifery philosophy’ and its subthemes ‘Medicalisation of birth’ and ‘Midwives use of intuition and the concept of authoritative knowledge’. A component of the midwifery philosophy shared by midwives in this study, was the belief that birth was a normal physiological process, and this included the midwives trusting women’s knowledge and instinct to birth their babies. The midwives rejected the medicalisation of birth, choosing to work within the community, where they were able to provide holistic, individualised midwifery care. PPMs within this study described how they use intuition as a form of authoritative knowledge and how they also value the childbearing woman’s embodied knowledge and intuition.
The third major theme identified in this study, ‘Power and control of the Institutions’ describes how the interviewees felt that the mainstream maternity system in Western Australia, which they defined as a collection of ‘patriarchal’ institutions, sought to control women and midwives. The subtheme ‘persecution and reporting of midwives’ explores how the PPMs had either had experience of being persecuted and reported to their governing bodies themselves or had witnessed the persecution of other PPMs. The subtheme ‘Legislation: jumping through the hoops and all the red tape’ explores the PPMs concerns that the increasing restrictions on their scope of practice was reducing women’s autonomy and access to PPMs.
The final theme explored within the study ‘Breaking through the fear: continuing to support women and each other’ included two sub themes, ‘Collaboration’ and ‘Getting educated and gaining power’. ‘Breaking through the fear: continuing to support women and each other’ describes how the PPMs and doctors in this study were at times persecuted, faced vexatious reporting and were often marginalised. Some had ceased practice altogether due to the stress and increasing legislation. However, despite these challenges they were adamant that they would continue to support women and each other to enable current PPMs to provide midwifery care that aligned with their philosophy. ‘Collaboration’ explored how the participants in this study felt that collaboration was an essential element of safe care for women and babies. The final subtheme in this study, ‘getting educated and gaining power’ describes how the PPMs and doctors had always been involved in education, both officially and unofficially.
Understanding the development and evolution of the midwifery profession can help future directions of the profession. The findings of this WA study, therefore, make an important and original contribution to midwifery knowledge by giving a unique insight into the experiences of PPMs in WA. This thesis fills a gap in the literature by providing an in-depth understanding of the challenges and triumphs of these midwives, and the doctors who supported them. The key finding of this thesis is that there are reoccurring themes throughout the history of midwifery in WA which have ongoing impacts on autonomous midwifery practice. The suppression of independent midwifery is not a new phenomenon and continues to lead to a reduction in women’s autonomy during the childbearing period.