Adams, K., Faulkhead, S., Standfield, R., and Atkinson, P. (2018). Challenging the colonisation of birth: Koori women’s birthing knowledge and practice. Women and Birth, 31, 81-88.

A B S T R A C T

Background: The 2007 United Nations Declaration on the Rights of Indigenous Peoples states that Indigenous peoples have the right to self-determination for social and cultural development. This fundamental right has been impeded worldwide through colonisation where many Indigenous peoples have had to adapt to ensure continuation of cultural knowledge and practice. In South East Australia colonisation was particularly brutal interrupting a 65,000 year-old oral culture and archives have increasing importance for cultural revival.

Aim: The aim of this research was to collate archival material on South East Australian Aboriginal women’s birthing knowledge and practice. Methods: Archivist research methods were employed involving a search for artefacts and compiling materials from these into a new collection. This process involved understanding the context of the artefact creation. Collaborative yarning methods were used to reflect on materials and their meaning.

Findings: Artefacts found included materials written by non-Aboriginal men and women, materials written by Aboriginal women, oral histories, media reports and culturally significant sites. Material described practices that connected birth to country and the community of the women and their babies. Practices included active labour techniques, pain management, labour supports, songs for labour, ceremony and the role of Aboriginal midwives. Case studies of continuing cultural practice and revival were identified.

Conclusion: Inclusion of Aboriginal women’s birthing practices and knowledge is crucial for reconciliation and self-determination. Challenging the colonisation of birthing, through the inclusion of Aboriginal knowledge and practice is imperative, as health practices inclusive of cultural knowledge are known to be more effective. 

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Barclay, L., 2008. Midwifery: A case of misleading packaging?. The Australian Journal of Advanced Nursing, 3(3), pp.21-26.

Summary: This paper presents midwives’ own description of their role and function in the health team. The impetus for the survey came from concerns expressed by the National Midwives Association about the lack of knowledge of how midwifery  is practiced in Australia, and their support for establishing content and collecting data was an essential contribution to the project. It is estimated that nearly nine percent of practicing midwives cooperated to provide information that can be used to identify the unique contribution of midwifery and assist in policy development and education.

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Barclay, L., (1989). What are the origins of the regulation, training and practice of midwifery in Australia (Presented at the ACMI 6th biennial conference, Darwin, NT). ACMI Journal, pp.29-30.

No abstract

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Barclay, L., 2008. A feminist history of Australian midwifery from colonisation until the 1980s. Women and Birth, 21(1), pp.3-8.

Summary: This paper uses a feminist interpretation and secondary sources to describe the history of Australian midwifery from colonisation until the 1980s. There have been too few midwife scholars who have had access to or used primary data collections to describe the role and place of midwives in the colonising community. I draw on a range of biography, medical literature and work by sociologists and economic historians to produce a limited picture of the history of professional midwifery. This helps to explain the position of midwives today and the problematic relationship we often have with medicine.

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Best, O., & Gorman, D. (2016). ‘Some of us pushed forward and let the world see what could be done’: Aboriginal Australian nurses and midwives 1900-2005. Labour History, 111: 149-164.

ABSTRACT

This paper locates the voices of Aboriginal nurses and midwives which only emerged in publications from the 1950s onwards. It seeks to privilege the voices of Aboriginal nurses and midwives, and recognise their contributions to the nursing and midwifery professions. It identifies two key developments in Australian history that influenced the acceptance of Aboriginal people into a career in nursing and midwifery: the gradual decline of policies of protection, segregation and assimilation, and the shift of nursing education from hospitals into the tertiary sector. The authors identify four key themes that emerge from this review of Aboriginal nurses’ publications: (1) the ongoing experience of racism faced by Aboriginal nurses and midwives, which was first reported in the 1950s and continues to be reported today; (2) the desire of Aboriginal nurses and midwives to work in their communities and contribute to improving the health of Aboriginal people; (3) the call for improved education about Aboriginal health issues as part of the broad nursing curriculum; and (4) the value of targeted strategies to recruit and retain Aboriginal nursing students.

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Best, O., & Bunda, T. (2020). Disrupting dominant discourse: Indigenous women as trained nursesand midwives 1900s–1950s. Collegian, 27: 620-625. https://doi.org/10.1016/j.colegn.2020.08.005 

ABSTRACT

Background: The history of Indigenous nurses and midwives in Australia is yet to be fully examined. Thereis a dearth of Indigenous-led research that identifies the rich and complex involvement of Indigenouswomen in Australia’s nursing and midwifery labour force.

Aim: This paper contributes to the history of Indigenous women’s participation in nursing and midwifery in Australia by examining how it was possible for some Indigenous women to pursue nursing and midwifery qualifications when this was not widely acceptable. The paper specifically seeks to investigate theenablers and limitations placed on Aboriginal women in accessing training.

Methods: Underpinned by historical methods and using an Indigenous lens for interpretation, this paper adopts a descriptive case study methodology to make visible the little-known yet important contributions of Indigenous nurses and midwives before 1950. It positions the case studies within the context of the Acts of Administration that controlled the lives of Indigenous Australians.

Findings: Through three case studies, this paper exposes the consequences of the debilitating, racialisedlaws of the time, which rendered Indigenous people invisible. The case studies demonstrate that Indigenous women did train as nurses and midwives in the early 1900s, even though they are largely absent inthe historical record.

Discussion: Writing historical accounts of Indigenous Australian nurses and midwives is challenging,partly because they are largely excluded from the historical record, and partly because of the normalisedtechnique used to frame history in Australia. Much historical discussion fails to account for Australia’sracialised biases and produces (race) obstructionist histories. An alternative approach is offered, centredon Indigenous women’s work to meet the individual, institutional and ideological racialised limitationsset by context (nursing and midwifery history), historical period (1900s–1950s) and place (Australia).

Conclusion: Obstructionist histories mean that the history of Indigenous nursing and midwifery inAustralia has not been well researched, interrogated or published. There is a need to document these histories and recognise the Indigenous women of the era who, in spite of the challenges they faced, forged careers in nursing and midwifery and laid the foundations for the Indigenous nurses and midwives who followed.

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Bogossian, F. (1998). A review of midwifery legislation in Australia – History, current state, and future directions. ACMI Journal, (March), 24-31.

ABSTRACT

The legislative regulation of midwifery in Australia, as elsewhere, governs the practice of midwives in the profession and controls the entry of new practitioners. Legislation exists in all states of Australia, and since 1992 there have been marked changes in the nature and scope of legislated control. This paper explores the origins of midwifery regulation, the recent changes in legislation and reviews the current Acts, Ordinances & Rules governing midwifery. In doing so, it examines common themes and areas of discrepancy across the country. The implications of both are discussed in terms of present implementation and future development.

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Boyer, ,K., Hunter, B., & Davis, A. (2021). Birth stories: Childbirth, remembrance and ‘everyday’ heritage. Emotion, Space and Society, 41, available online 9 October 2021. https://doi.org/10.1016/j.emospa.2021.100841 

ABSTRACT

 Based on the work of critical and feminist heritage scholars who have argued that heritage sites need to pay more attention to everyday experience, we argue that the omission of birth stories from mainstream heritage sites is a problem that needs rectifying. Through an analysis of oral histories undertaken with mothers and midwives in mid 20th Century Wales, we trace out key themes on which such a project could focus, highlighting themes of corporeality, emotions and sense of place. We conclude by signaling some of the steps that would be needed to make such a project happen, and suggest that this move would not only extend understanding of “everyday” heritage, but also add greater depth and nuance to how place is narrated within such spaces. 

Australian Midwifery History Group Note: Whilst the academic speak, particularly at the beginning, may be a bit off-putting to some, it’s worth persisting: this paper is about the extended knowledge of women’s experiences of childbirth in a historical context, and argues for the inclusion of women’s bodily and reproductive biographies from heritage spaces. It highlights three conceptual frames that could inform such a project, focusing on themes of bodies, emotion and place.

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Brodie, P., & Barclay, L. (2001). Contemporary issues in Australian midwifery regulation. Australian Health Review, 24(4), 103-118.

ABSTRACT

This paper reports on research that examined the Nurses’ Acts, regulations and current policies of each state and territory in Australia, in order to determine their adequacy in regulating the education and practice of midwifery. This is part of a three-year study (Australian Midwifery Action Project) set up to identify and investigate barriers to midwifery within the provision of mainstream maternity services in Australia. Through an in-depth examination and comparison of key factors in the various statutes, the paper identifies their effect on contemporary midwifery roles and practices.

The work assessed whether the current regulatory system that subsumes midwifery into nursing is adequate in protecting the public appropriately and ensuring that minimum professional standards are met. This is of particular importance in Australia, where many maternity health care services are seeking to maximise midwives’ contributions through the development of new models of care that increase midwives’ autonomy and level of accountability.

A lack of consistency and evidence of discrepancies in the standards of midwifery education and practice regulation nationally are identified. When these are considered alongside the planned development of a three-year Bachelor of Midwifery, due to be introduced into Australia in mid-2002, there exists an urgent need for regulatory change. The need is also identified for appropriate national midwifery competency standards that meet consumer, employer and practitioner expectations, which can be used to guide state and territory regulations.

We argue the importance of a need for change in the view and legal positioning of the Australian Nursing Council and all Nurses Boards regarding the identification of midwifery as distinct from nursing, and substantiate it with a rationale for a national and consistent approach to midwifery regulation.

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Brodie, P. (2002). Addressing the barriers to midwifery – Australian midwives speaking out. Journal of the Australian College of Midwives Inc., 15(3), 5-14.

ABSTRACT

This research gives a voice to midwives in identifying the barriers and current problems in the organisation of maternity care in Australia. Using a critical feminist research approach, data was collected from a cross section of midwives nationally. Through standard qualitative research methods, themes were identified that enabled analysis of significant issues affecting the current status of midwifery.

The system of maternity care was identified as being dominated by medicine, not evidence based and restricting of women’s choices, with midwifery autonomy not recognised or supported. The invisibility of midwifery within the community was identified as a significant barrier which, in conjunction with the occupational imperialism of obstetrics, ensures ongoing strategic control of maternity services and a denial of the rights of consumers to access midwifery care.

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Cornwell, C. (2019). The more things change, the more what’s important stays the same. Australian Midwifery News, 19(3), 16–21. https://search.informit.org/doi/10.3316/informit.629185245292226

Much has changed for both women and midwives over the last few centuries. These indisputable facts, however, have remained unchanged: that women need to be cared for and valued through their childbirth experience and midwives need to be ‘with woman’.

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Dahlen, H. (2006). Midwifery: ‘at the edge of history’ (Keynote address given at the 27th International Confederation of Midwives, Brisbane, Australia, July 28th 2005, edited version). Women and Birth, 19: 3-10

SUMMARY

The paper focuses on possible future pathways in maternity care for midwives and nations to consider. The paper blends personal and professional experiences to outline priority areas facing midwives in the future. It begins by examining maternal mortality and morbidity in the developing world and considering the potential of the ten high priority action messages (1997) in helping to improve the plight of women and children in the future. The paper then examines major issues facing midwives in the developed world including: the way birth is viewed; the medical-midwifery divide; marketing midwifery; and finally the challenge of dealing with fear around birth. The third part of the paper examines a part of society where the two worlds meet and there are issues from both the developed and developing world to consider. The paper focuses on women from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander women and women birthing in remote and rural areas. By looking at these three worlds separately the paper examines different concerns facing midwives in the future but also draws on common issues that face us all as citizens of this planet and particularly as predominantly women. The paper challenges midwives to be politically active and dare to change the world.

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Dahlen, H., Homer, C., Leap, N., & Tracy, S. (2011). From social to surgical: Historical perspectives on perineal care during labour and birth. Women and Birth 24, 105-111. doi:10.1016/j.wombi.2010.09.002

Abstract A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98—138 A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care.

With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention — most notably seen in the widespread use of episiotomy.

There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum.

In the last 30 years, in much of the developed world, there has been a reemergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care.

Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice.

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Davison, C., McKenzie, B., & Hauck, Y. (2021). Looking back moving forward: The history of midwifery in Western Australia. Women and Birth, In Press, corrected proof, 1 November 2021.

To date there is has been very little research into midwifery in Western Australia (WA), therefore this paper addresses a significant gap in the literature. The aim of this paper was to gain insight into the history of midwifery in WA… The historical suppression of midwifery in Australia has impacted the understanding of the role of the midwife in the contemporary setting. Understanding the development and evolution of the midwifery profession in Australia can help future directions of the profession.

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Donnellan-Fernandez, R., Creedy, D., & Callander, E. (2018). Cost-effectiveness of midwifery care for women  with complex pregnancy: A structured review of the literature. Health Economics Review 8:32. https://doi.org/10.1186/s13561-018-0217-3

ABSTRACT

Background: Critical evaluation of the cost-effectiveness and clinical effectiveness of continuity of midwifery care models for women experiencing complex pregnancy is an important consideration in the review and reform of maternity services. Most studies either focus on women who experience healthy pregnancy or mixed risk samples.

These results may not be generalised across the childbearing continuum to women with risk factors. This review critically evaluates studies that measure the cost of care for women with complex pregnancies, with a focus on method and quality.

Aims / objectives: To critically appraise and summarise the evidence relating to the combined cost-effectiveness, resource use and clinical effectiveness of midwifery continuity models for women who experience complex pregnancies and their babies in developed countries.

Design: Structured review of the literature utilising a matrix method to critique the methods and quality of studies.

Method: A search of Medline, CINAHL, MIDIRS, DARE, EMBASE, OVID, PubMed, ProQuest, Informit, Science Direct, Cochrane Library, NHS Economic Evaluation Database (NHSEED) for the years 1994 – 2018 was conducted.

Results: Nine articles met the inclusion criteria. The review identified four areas of economic evaluation that related to women who experienced complex pregnancy and continuity of midwifery care. (1) cost and clinical effectiveness comparisons between continuity of midwifery care versus obstetric-led units; (2) cost of continuity of midwifery care and/or team midwifery compared to Standard Care; (3) cost-effectiveness of continuity of midwifery care for Australian Aboriginal women versus standard care; (4) patterns of antenatal care for women of high obstetric risk and comparative provider cost.

Cost savings specific to women from high risk samples who received continuity of midwifery care compared with obstetric-led standard care was stated for only one study in the review. Kenny et al. 1994 identified cost savings of AUS$29 in the antenatal period for women who received the midwifery team model from a stratified sub-set of high-risk pregnant woman within a mixed risk sample of 446 women. One systematic review relevant to the UK context, Ryan et al. (2013), applied sensitivity analysis to include women of all risk categories. Where risk ratio for overall fetal/neonatal death was systematically varied based on the 95% confidence interval of 0.79 to 1.09 from pooled studies, the aggregate annual net monetary benefit for continuity of midwifery care ranged extremely widely from an estimated gain of £472 million to a loss of £202 million. Net health benefit ranged from an annual gain of 15 723 QALYs to a loss of 6 738 QALYs. All other studies in this review reported cost savings narratively or within mixed risk samples where risk stratification was not clearly stated or related to the midwifery team model only.

Conclusions: Studies that measure the cost of continuity of midwifery care for women with complex pregnancy across the childbearing continuum are limited and apply inconsistent methods of economic evaluation. The cost and outcomes of implementing continuity of midwifery care for women with complex pregnancy is an important issue that requires further investigation. Robust cost-effectiveness evidence is essential to inform decision makers, to implement sustainable systems change in comparative maternity models for pregnant women at risk and to address health inequity.

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Donnellan-Fernandez, R., Creedy, D., & Callander, E., Gamble, J., Toohill, J. (2020). Differential access to continuity of midwifery care in Queensland, Australia. Australian Health Review 2020. https://doi.org/10.1071/AH19264

ABSTRACT

Objective. To determine maternal access to continuity of midwifery care in public maternity hospitals across the state of Queensland, Australia.

Methods. Maternal access to continuity of midwifery care in Queensland was modelled by considering the proportion of midwives publicly employed to provide continuity of midwifery care alongside 2017 birth data for Queensland Hospital and Health Services. The model assumed an average caseload per full-time equivalent midwife working in continuity of care with 35 women per annum, based on state Nursing and Midwifery Award conditions. Hospitals were grouped into five clusters using standard Australian hospital classifications.

Results. Twenty-seven facilities (out of 39, 69%) across all 15 hospital and health services in Queensland providing a maternity service offered continuity ofmidwifery care in 2017 (birthing onsite).Modelling applying the assumed caseload of 35 women per full-time equivalent midwife found wide variations in the percentage of women able to access continuity of midwifery care, with access available for an estimated 18% of childbearing women across the state. Hospital classifications with higher clinical services capability and birth volume did not equate with higher access to continuity ofmidwifery care in metropolitan areas.Regional health serviceswith level 3 district hospitals assistingwith,500 births showed higher levels of access, potentially due to additional challenges to meet local population needs to those of a metropolitan service. Access to full continuity of midwifery care in level 3 remote hospitals (,500 births) was artificially inflated due to planned pre-labour transfers for women requiring specialised intrapartum care and women who planned to birth at other hospitals.

Conclusions. Despite strong evidence that continuity of midwifery care offers optimal care for women and their babies, there was significant variation in implementation and scale-up of these models across hospital jurisdictions.

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Donnellan-Fernandez, R.E. and Eastaugh, M. (2003). Midwifery regulation in Australia: a century of invisibility. In Christine Quirke, (Ed.) 6th International Conference on the Regulation of Nursing and Midwifery: Innovations in Regulation, 26-28 October, 2003, Melbourne, Victoria.

This paper examines the status of the midwifery  profession in Australia, with specific reference to its legislated context under state based nursing regulatory frameworks, past and present. It provides an historical and contemporary critique of the relationships between midwifery, the state, and medical/nursing institutionalised symbiosis and dominance. Whose interests these relationships silence, and whose they serve is examined, as is their power to influence and situate women’s health and childbearing outcomes in an increasingly global and market oriented environment.

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Fahy, K. (2007). An Australian history of the subordination of midwifery. Women and Birth, 20, 25-29.

ABSTRACT

This paper analyses the history of the subordination of midwifery to medicine and nursing. With the important exception of Evan Willis’ work on medical dominance and Annette Summers’ work on the takeover of midwifery by nursing, other histories of Australian midwifery have taken a neutral approach to issue of power and control. The aim of analysing this period is to identify the strategies of power that were used to subordinate midwifery. With increased consciousness of how power has operated in the past, midwives and woman of today can be more empowered when seeking to promote normal birth and midwifery models of care. Concepts of ‘power’, ‘the state’ and midwife are defined and discussed. A summary of the decline of midwifery and the rise of obstetrics in Europe and the United Kingdom (UK) gives a background against which to understand the Australian experience. The historical account given here draws to a climax by focussing on the period 1886—1928. It was during this time that medicine forged an alliance with nursing and achieved both legal and disciplinary control of midwifery. Knowing how this was done is important because it helps us to recognise the power strategies that are currently being used by medicine. This is helpful when planning how these strategies might be matched or countered by contemporary woman and midwives when seeking to promote normal birth and midwifery models of care.

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Gorman, D., Nielsen, A., & Best, O. (2006). Western medicine and Australian Indigenous healing practices. Aboriginal and Islander Health Worker Journal, 30(1): 28-29.

INTRODUCTION

The health status of Indigenous Australia as reported by the Australian Bureau of Statistics is among the worst of any group in the so-called first world, suffering more ill health, experiencing more disability and poorer quality of life and dying younger than non-Indigenous Australians[1]. This appalling situation continues to exist, despite attempts over considerable time to address the issues.

One of the possible reasons for some attempts being unsuccessful is the relevance of the strategies, or lack of it to the communities and/or individuals being helped. Most projects undertaken by government health organisations are formulated on values and beliefs about health and illness that are derived from Anglo/Celtic culture. Health beliefs differ between cultures and it has been identified that the differences in the Indigenous and non-Indigenous constructs of health impacts negatively on the effectiveness of mainstream healthcare provided to Indigenous peoples[2]. This implies that strategies that incorporate, or better still are derived from, Indigenous health beliefs have a greater potential to be effective.

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Gray, J.E, & Smith, R.M. (2017). Any action? Reflections on the Australian Midwifery Action Project. Women and Birth, 30, 177-183.

ABSTRACT

Background: In 1997 a group of midwifery academics, researchers and practitioners met to discuss issues of concern related to the midwifery profession in Australia. It became clear from this discussion that midwifery in Australia was lagging behind similarly developed countries and that urgent action was required. From this meeting, a plan was developed to seek funding for a major national study into midwifery education and practice standards and as such, the Australian Midwifery Action Project (AMAP) was born.

Discussion: This discussion paper presents an overview of a number of midwifery education and regulation changes within the framework of the recommendations from the Australian Midwifery Action Project. A key question arising from this discussion is whether our current midwifery education and regulation standards provide a fit-for-purpose workforce that ensures all women and their families receive best practice midwifery care. Over the past 20 years the Midwifery profession in Australia has undergone significant changes and developments and these changes have had, and continue to have, significant impact on midwifery education and therefore on the quality of midwifery practice in Australia.

Conclusion: Many changes have been implemented in the nearly 20 years since AMAP was first conceived. However, many of the issues that provided the impetus for a project such as AMAP remain and are still to be resolved. The midwifery profession continues to be subsumed with nursing, it is not possible to gain accurate midwifery workforce data and, despite the development of national standards for midwifery education, wide variations in courses still exist across Australia.

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Grehan, M. (2004). ‘From the sphere of Sarah Gampism’: The professionalisation of nursing and midwifery in the Colony of Victoria. Nursing Inquiry, 11(3), 192-201.

ABSTRACT

In the nineteenth century, while the Colony of Victoria was still a fledgling settlement, many of the hospitals of England, Scotland, Ireland, and Europe had instituted forms of nursing and midwifery training. When graduates of these training schemes emigrated to Australia with their knowledge, skills and experience, they found health practice to be haphazard and lacking in organisational standards. Individual immigrant women rose to prominence as managers of Victorian hospitals, and superintendents of homes for trained nurses. Through professional networks of their peers and compatriots, these women succeeded in placing the profession of nursing on a firm footing, and were instrumental in the emergence of professional organisations for trained nurses and midwives in Victoria, including the Melbourne District Nursing Society, the short–lived Nurses Association of Australasia (1892), and the Victorian Trained Nurses Association (1901). Their leadership was to have a profound influence on the way nursing and midwifery were regulated in twentieth century Victoria. In this historical review, we trace the movement to professionalise nursing and midwifery which emerged in the Colony of Victoria during the late nineteenth and early twentieth centuries.

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Grehan, M. (2009). ‘A most difficult and protracted labour case’: Midwives, medical men, and coronial investigations into maternal deaths in nineteenth-century Victoria. Provenance: The Journal of Public Record Office Victoria, 8. 

ABSTRACT

Birth in nineteenth-century Australia was an event shrouded in mystery. The care of women at confinement was discussed in private domains such as the Medical Society of Victoria, a professional medical organisation, and comprised the work of women’s hospitals such as Melbourne’s Lying-in Hospital and Infirmary for Diseases Peculiar to Women and Children, now known as The Royal Women’s Hospital. Generally speaking, birth was not a subject for public discussion. Nineteenth-century women diarists, who occasionally make reference to birth and miscarriage, do so in the most euphemistic of terms. Coronial records pertaining to maternal deaths in this era therefore offer a unique window ontowhat was otherwise an intensely private matter.

Coronial investigations into the circumstances surrounding suspicious deaths began in what became the colony of Victoria as early as the 1830s. By the 1850s, coronial investigations had extended to maternal deaths, that is, those in which a woman died as a result of childbirth. Inquest files concerning maternal deaths vary in their contents and many are not weighty documents. Some files, particularly those of the 1850s, contain only two pages of evidence and a judgement, with little analysis of the circumstances of the death. In other cases, inquests reported upon in newspapers have no file held by Public Record Office Victoria. Others contain witness statements from a range of people: childbirth attendants such as midwives, nurses, and neighbours; husbands and family members; and medical attendants, some of whom may have attended the deceased or performed an autopsy under coronial direction. Occasionally the files contain correspondence, such as that between the police and the coroner, which helps to explain the broader circumstances of deaths.

Nineteenth-century coronial inquiries into maternal deaths consist largely of text. There are rarely diagrams or other figures. The grim accounts of what happened to women are conveyed entirely in the disarming words of deponents, often in response to specific questioning by the coroner or his jury. Given that most women in the nineteenth century gave birth at home, depositions highlight the complexities of providing care in an era when everyday household conveniences now taken for granted, such as telephones, running water and electric light, were not available. Using a combination of evidence provided to coronial inquests, it is possible to build a picture of the nature of care provision, including who provided it and what ‘care’ meant in individual circumstances. Coronial investigations into maternal deaths illuminate the challenges of administering justice in what was a contested professional arena in the nineteenth century.

This paper uses the 1869 inquiry into the death of Mrs Margaret Bardon, summarised in two parts as a case study, and draws on other inquests to discuss the relationship between midwives, doctors, and coronial investigations of maternal deaths, and to consider elements common to inquiries conducted in this era.

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Grehan, M. (2009). Heroes or villains? midwives, nurses, and maternity care in mid-nineteenth-century Australia. Traffic: university of Melbourne Graduate Student Association. 

ABSTRACT

Commonly accepted narratives of nineteenth-century maternity care history in Australia report that all female midwives were uneducated and incompetent, and that professionalised nursing replaced these dangerous maternity attendants. Recently, this perspective has been questioned by a reinvigorated midwifery profession, which argues that midwives were unjustly maligned by the nascent profession of nursing in its professionalisation and by the medical profession to reduce competition in the lucrative marketplace of maternity care. This paper examines the veracity of these disparate readings, by reconsidering some of the evidence on maternity attendants and midwifery in nineteenth-century Australia.

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Hastie, C. (2006). Midwifery: Women, history and politics. Birth Issues, 15(1): 11-17.

ABSTRACT Much has ben made of evidence-based practice in health care and in particulate, in maternity  care. Numerous studies have indicated that small maternity units plus midwifery, as a primary health care practice, is best for the physical and emotional health of the majority of childbearing women and their babies. However, despite various State and Federal Government reports recommending midwifery led care, and a flurry of alternative birthing services pilot programs in the early 1990s, Australian governments and health care organisations have not generally shifted from a medically dominated approach to a social health model for maternity care provision. History suggests that t odd so conflicts with  the professional and economic interest of medicine. This paper explores the history, the politics, and women’s place in society within a midwifery context, so that midwives have a wider perspective on contemporary issues associated with midwifery practice. Such broad view will enable newer members of the midwifery profession to recognise that the current negativity from some medical colleagues about moves to increase midwifery-led options for childbearing women and the associated midwifery autonomy have long standing historical and political roots. Such an understanding will help make sense of the current political and practice landscape.

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Homer, C.S.E., Passant, L., Kildea, S., Picombe, J., Thorogood, C., Leap, N., & Brodie, P. (2007). The development of national competency standards for the midwife in Australia. Midwifery, 23(4), 350-360.

ABSTRACT

Objective: To develop and validate national competency standards for midwives in Australia. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care.

Design: A multi-method, staged approach collected data through a literature review, workshop consultations, interviews, surveys and written submissions in order to develop national competency standards for Australian midwives. Subsequently, direct observation of practice in a range of settings ensured validation of the competencies.

Setting: Maternity care settings in each state and territory in Australia.

Participants: Midwives, other health professionals and consumers of midwifery care.

Findings: The National Competency Standards for the Midwife were developed through research and consultation prior to being validated in practice.

Key conclusions: The national competency standards are currently being implemented into education, regulation and practice in Australia. These will be minimum competency standards required of all midwives who seek authority to practise as a midwife in Australia. It is expected that all midwives will demonstrate that they are able to meet the competency standards relevant to the position they hold.

Implications for practice: The competency standards establish a national standard for midwives and reinforce responsibility and accountability in the provision of quality midwifery care through safe and effective practice. In addition, individual midwives may use the competency standards as the basis of their ongoing professional development plans.

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Homer, C.S.E., Passant, L., Brodie, P., Kildea, S., Leap, N., Pincombe, J., & Thorogood, C. (2009). The role of the midwife in Australia: views of women and midwives. Midwifery, 25, 673-681.

ABSTRACT

Objective: to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care.

Design: a multi-method approach with qualitative data collected from surveys with women and interviews with midwives.

Setting: participants represented each state and territory in Australia. Participants: midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism.

Key conclusions: midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. Implications for practice: a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role.

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Hunter, B. (1999). Oral history and research part 1: uses and implications. British Journal of Midwifery, 7(7), pp.426-429.

ABSTRACT Much of the history of ‘ordinary’ midwives has gone unrecorded. This is a great loss to midwifery knowledge, as the experiences of midwives in the past have potential relevance for current practice. This article is the first of two that discuss the use of oral history research to access such information. The article describes how oral history research may be performed, and considers the relative advantages and disadvantages of the method. Its uses and implications for midwifery are discussed.

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Hunter, B., 1999. Oral history and research part 2: current practice. British Journal of Midwifery, 7(8), pp.481-484.

ABSTRACT This is the second of two articles investigating the use of oral history research in midwifery. This article explores the relevance of oral history research findings for contemporary and future practice. PreNHS community midwives provided one-to-one, midwifery-led care, which resembles the practice recommended by current government policy. Concerns have been raised as to the sustainability of such practices. This article uses the themes proposed by Sandall (1997) to analyse the practice of preNHS midwives, and suggests that occupational autonomy is of particular significance in maintaining job satisfaction and morale.

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Ireland, S., Belton, S. McGrath, A., Saggers, S., Wulili Narjic, C. (2015). Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town. Women and Birth, 28, 293-302.

ABSTRACT Background and aim: Maternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.

Methods: Our research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.

Findings: We identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.

Conclusions: The introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.

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Kildea, S., Tracy, S., Sherwood, J., Magick-Dennis, F., & Barclay, L. (2016). Improving maternity services for Indigenous women in Australia: moving from policy to practice. Medical Journal of Australia, 205(8): 374-379. doi: 10.5694/mja16.00854

SUMMARY

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality.

Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life.

Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia’s National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory).

We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas:

The Indigenous maternity workforce;

Culturally competent maternity care; and;

Developing dedicated programs for “Birthing on Country”.

The timeframe for the NMSP has expired without notable results in these priority areas.

More urgent leadership is required from the Australian government.

Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities.

Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

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Leap, N. (1999). The introduction of ‘direct entry’ midwifery courses in Australian universities: Issues, myths, and a need for collaboration. ACMI Journal, June, 11-16.

ABSTRACT

This paper identifies some of the issues within the debate regarding the introduction of ‘direct entry’midwifery education in Australia. It addresses questions that have been raised around terminology; the current midwifery education system; whether midwives also need to be nurses; how nurses who want to become midwives might enter the same programme with recognition of prior learning; and whether ‘direct entry’ midwifery education should become a mainstream option. A case is made for a collaborative initiative to consider all aspects of developing a national framework for Bachelor of Midwifery programmes.

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Leap, N., Brodie, P., & Tracy, S. (2017). Collective action for the development of national standards for midwifery education in Australia. Women and Birth, 30, 169-176.

ABSTRACT This article describes a sequence of events that led to the development of national standards for the accreditation of Australian midwifery education programmes for initial registration. This process occurred within a climate of polarised opinions about the value of the introduction of three-year degree programmes for midwives who are not nurses (known as the BMid in Australia) and concerns about the invisibility of midwifery within nursing regulation, education, policy and nomenclature.
Concerted efforts to develop standards to inform the introduction of BMid programmes through a process of collective action are described. This involved arguing successfully for the positioning of midwifery as a separate profession from nursing, with a need for its own discreet regulation.
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Lewis. M.J. (2014). Medicine in colonial Australia 1788-1900. Medical Journal of Australia 201(1): S5-S10.

INTRODUCTION

In this supplement, all the articles except this one focus on the period from about 1900, when modern scientific medicine came into its own in Australia. Here, I provide an overview of medicine in colonial Australia, as well as background to the post-1900 articles. For reasons of space, I confine my account of the period after about 1850 to the colonies of New South Wales, Victoria and South Australia, where the new university medical schools were located. I do not cover psychiatry because in the period under consideration it was almost exclusively practised in the asylum system and was not an integral part of mainstream medicine; its colonial history is discussed elsewhere. Nor do I discuss public health in detail, as the focus of this supplement is clinical medicine, but its history is extensively covered in other publications.

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Madsen, W. (2003). The age of transition: Nursing and caring in the nineteenth century. Journal of Australian Studies, 27(78): 39-45. doin 10.1080/14443050309387869

INTRODUCTION

The history of nursing is inextricably linked with caring activities — indeed, much of the early literature on nursing uses these terms interchangeably. Over the past 150 years, this relationship has been both exploited and actively rejected by nurses. For example, the Queensland Nurses’ Union’s recent campaigns have pivoted around the slogan, ‘Nurses Care’. However, during the latter part of the nineteenth century, nurses as a group of emerging professionals sought to distinguish themselves from carers. This paper will examine the relationship between nursing and caring throughout the nineteenth century, as it was during this period that differences between these two concepts became evident. In particular, those groups of people who undertook nursing and/or caring activities in Australia will be explored. The groups identified include convicts, early hospital workers, families, neighbours and charity workers, as well as untrained, trainee and trained nurses. In keeping with this broad overview, both community and hospital locations will be explored.

The relationship between nursing and caring was particularly blurred throughout the nineteenth century. As Dingwall, Rafferty and Webster observe, there was little delineation between the various groups of health providers, and it was conceivable for one person to move between the groups as his or her circumstances altered. Indeed, Pearson and Taylor note the difficulty of distinguishing ‘nursing work’ as carried out by carers from work done by nurses.

For the purposes of this discussion, a distinction is made between nurses and carers, although it is recognised that, during the nineteenth century, many activities within the two categories were identical. Nurses were those who had gained nursing knowledge and skills, either formally or informally, and who were paid for their services. Carers are defined here as those who undertook nursingtype activities, but who had little prior knowledge and who received no remuneration for their efforts. Groups included in this latter category are inmates and the domestic household. These definitions incorporate most of the groups who were involved in nursing activities, with the single exception of trained nurses who were members of religious orders. This latter group of women usually underwent a period of training, but did not receive wages per se. In many respects, it is helpful to visualise those who provided nursing-type activities as part of a health providers continuum, with nurses and carers at the extremes. Maggs suggests that the documentation of nursing history has been restricted in its approach, tending to focus on the professional end of the spectrum of health provision. In particular, the literature dealing with nursing since the middle of the nineteenth century has almost entirely focused upon the professional nurse. This approach has marginalised the caring roles undertaken by many women and men in Australia, and throughout the world. This caring role has often been credited with forging the foundations of professional nursing.

Whether it is appropriate to make this claim regarding nursing and caring is unclear, with some authors suggesting that professional nursing is essentially a modern invention, commencing in the nineteenth century. However, it must be acknowledged that a relationship has existed between nurses and carers for at least a century, and it is a relationship that has recently gained more attention with the increasing prevalence of untrained assistants in nursing.

Dingwall et al. identify four separate groups who undertook nursing and caring roles in Britain at the beginning of the nineteenth century. These included members of a domestic household; handywomen, or paid nurses drawn primarily from the working classes, often characterised as the notorious Sairey Gamp; private nurses, who undertook nursing duties for the more privileged classes; and treatment assistants, who could have been considered as medical apprentices within hospital settings. In addition to these groups, Norton adds a further group of carers — inmates of poorhouses tending each other. Religious orders also reemerged within nursing and caring domains throughout the nineteenth century in Britain. By the end ofthat century, treatment assistants had been virtually replaced by formally trained, female nurses. As Australia had a large influx of immigrants from Britain from the end of the eighteenth century, similar social structures and health systems were established in this country.

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McCalman, J. (1998). The power of care: The Women’s Hospital 1884-1914. Nursing Inquiry, 5: 204-211

INTRODUCTION

The effectiveness of late-nineteenth-century nursing care should not be  underestimated. The archive of patient records at Melbourne’s Women’s Hospital reveals a commitment to patient care more often than not that made the difference between life and death in the recovery from major surgery or postpartum infection. These records suggest the need to reassess the role of medical care in the mortality transition after 1850.

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Peters, M. (1995). Unity in diversity oration (presented at the Inaugural Investiture of Fellows of the Australian College of Midwives Sydney, 11 September, 1995). Australian College of Midwives Incorporated Journal, 8(4), 8-16. https://doi.org/10.1016/S1031-170X(05)80049-2 

Introduction

Tonight is one of the great occasions in the relatively short life of the Australian College of Midwives.

I am very aware that a tremendous honour has been granted to me by my colleagues in being invited to give this, the Inaugural Oration, on the occasion of the First Investiture of Fellows into the College.

I am also privileged to be the first to wear the Orator’s gown.

There will be, I am sure, many a learned discourse that will follow this humble effort for which Ihave made great efforts to keep above the level of a harangue.

The choice of topic for tonight’s presentation is mine, and I hope as I proceed you will understand why although I believe unity is important, so is diversity, creative dissent and commitment to the one concept does not preclude inclusion of the other in the workings of the College or any other organisation.

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Potter, L. (2018). Janet McTavish: Tasmanian immigrant, midwife, and prominent citizen. Tasmanian Historical Studies, 23: 49-65

INTRODUCTION

Childbirth as a universal human phenomenon has received little research attention in colonial historiography of Australia, despite the critical need to stimulate economic growth and prosperity by increasing the Australian colonial population in the early nineteenth century. It was only with the New South Wales Report on the Decline of the Birth-Rate in 1904 that any official recognition was given to the importance of childbirth. The under-emphasis on human reproduction until this time was due in some measure to the universality of giving birth: its everydayness masking its importance. At the same time, the historical documentation of the role and significance of colonial midwifery, because it is so closely aligned with childbirth, has been unacknowledged, unexamined and under-evaluated.

The perception of colonial midwives as ignorant, unskilled and caricaturing the Dickensian image of Sairey Gamp persisted due to the prominence given to a few midwives whose practice was fraudulent, unethical or dangerous. Contrary to the common perception about midwives and the bad press they often received, it is the contention of this article that the majority of colonial midwives made significant contributions to the society in which they lived as businesswomen and providers of maternity health care. Focussing only on the professional aspects of midwives while excluding their participation in significant personal relationships, such as family and their community, is a theme denounced by North American nurse historian Patricia D’Antonio, who writes:

Women’s culture and experiences can never be completely recounted solely in terms of their relationship with paid labor; that is, situations outside the workplace – women’s places within the social fabric of their communities, their neighbourhoods, and their families -have emerged as equally powerful determinants of their consciousness, their roles, and their sense of agency. As a result, we have discovered the almost seamless interconnectedness of women’s working and private lives.

This article elucidates how the life and work of one woman and midwife challenges the common perception of midwives in the early nineteenth century colony of Australia and how her life as a distinguished citizen challenges the agency of women in early colonial times. What was it like to be a midwife in early colonial times? How did midwives practice their craft and assist women in childbirth? The life and professional status of Janet McTavish, working in Hobart Town in the early 1800s, before there was any professional registration or organisation of midwives, reveals some remarkable facts about midwifery in this early period and will help to answer these questions.

The multifaceted web of associations surrounding Janet McTavish, both within her family and in Hobartian society, will identify her unique historical reality. Positioning midwifery, and in particular this midwife, in the milieu of colonial Hobart Town, in the local economy and in the domestic sphere, will lead to a better understanding of the important contribution the colonial midwife made to maternity and infant care.

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Potter, L. (2020). Midwifery, nursing, and medical care on the high seas: An immigration voyage to colonial Australia 1848-1849. Collegian 27: 4600-605.

ABSTRACT

Background: The lives of individuals are infinitely fascinating, especially when viewed at the intersectionof their relationship with other people and their environment. Of interest in this article are the incidents ofchildbirth and the role of midwife and doctor in these crucial life events. Perhaps of greater significance is the story of those on board this one voyage of the Steadfast within the grand narrative of British immigration to Australia in the nineteenth century.

Aim: This article aims to demonstrate that it was the human cargo and their need of health care in the voyage of the Steadfast, which contributed to the historical narrative of immigration and quarantine, the prelude to life in the colonial environment.

Method: This is qualitative research using historical methodology involving the selection of available doc-uments. The primary document sourced is that of the surgeon-superintendent’s journal on the Steadfast. The methodology used is narrative, recording the medical information as well as providing backgroundcontext for the main characters for the purpose of situating them in the immigration story.

Findings: Health care, particularly maternity care, on immigration ships was limited. Birthing at sea was a dangerous process for an immigrant woman often resulting in her death, the death of her infant or both mother and child could perish. If disease occurred during the sea voyage, then quarantine of the ship and passengers was instigated on arrival at Sydney Harbour.

Discussion: This article draws on the journal notes of the surgeon superintendent which logs the health incidents of immigrants requiring midwifery, nursing and medical care on a sea voyage from London to the colony of New South Wales in the mid-nineteenth century. This article focuses on the maternity events and the necessity for quarantine measures to prevent the spread of infectious diseases in the colony of New South Wales.

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Reiger, K. (2000). The politics of midwifery in Australia: Tensions, debates, and opportunities. Annual Review of Health Social Sciences, 10(1): 53-64.

INTRODUCTION

The recent international resurgence of midwifery has involved the profession’s seeking to  gain greater independence and the lessening of medical dominance. In such a context, issues currently facing Australian midwives are significant. This paper outlines the development of research questions with regard to midwives’ professional consciousness, and considers the structural context of maternity services/ It then explores changing political consciousness and dilemmas. in particular, the  emergence of an autonomous professional identity for midwives as articulated by the Australian College of Midwives Incorporated (ACMI), has not been straightforward. Unevenness of educational preparation and a projected shortage of midwives together with growing frustration at inadequate recognition of midwives’ distinctive knowledge and skills all pose challenges to  policy moves to encourage a greater midwifery role in maternity care.

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Reiger, K. (2006). Domination or mutual recognition? Professional subjectivity in midwifery and obstetrics. Social Theory & Health, 6: 132-147.

ABSTRACT

Traditional rivalries between midwives and obstetricians continue to generate tension, mistrust and poor communication in many maternity care settings. The resulting negative emotional climate affects workplace well-being and the care of birthing women. To address these problems, this paper uses critical social theory to consider the ways in which midwifery and obstetrics continue to be positioned, and position themselves, as the ‘Other’ against which each can be defined. The first section reports on fieldwork observations and interview data from qualitative research into professional work in maternity units in Victoria, Australia. In order to interpret the ways in which professional conflicts are experienced, the paper then develops a conceptual framework drawn from historical sociology of the professions, psychoanalytic debates on subjectivity, and moral and feminist philosophy concerning disrespect and domination. As the search for recognition by the ‘Other’ profession has become distorted into domination, it is argued, aspects of each professional identity became split off and projected onto the Other. The paper argues that remedying inter-professional conflicts therefore requires replacing long-standing, and deeply gendered, dualism with the dialectical process of mutual recognition.

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Schillace, B. (2014). Naissance Macabre: Birth, Death, and Female Anatomy. New York Academy of Medicine, History of Medicine & Public Health Library Blog, July 30.  https://nyamcenterforhistory.org/2014/07/30/naissance-macabre-birth-death-and-female-anatomy/

INTRODUCTION

The danse macabre, or dance of death, features whirling skeletons and other personifications of death stalking the living. These images appeared regularly in the medieval period, particularly after outbreaks of bubonic plague. One of the salient features was death and life pictured together, frequently in the form of a young and beautiful woman. The juxtaposition symbolized how fleeting life could be, and served as a warning against vice and vanity. While death and the maiden might remind viewers of their own mortality, another set of images became far more instructive to the preservation of life: death and the mother — the anatomy of the pregnant womb.

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Small, K., Sidebotham, M., Fenwick, J., Gamble, J. (2016). Midwifery prescribing in Australia. Australian Prescriber 39, 215-218. doi 10.18773/austprescr.2016.070

 SUMMARY

Suitably qualified Australian midwives may prescribe drugs. By June 2016, 250 midwives were endorsed to prescribe. 

The range of drugs that midwives may prescribe is determined by state and territory legislation. There are therefore significant variations across the country in what can be prescribed. 

Midwives must undertake additional training to become competent to prescribe. Clear guidelines for consultation and referral also underpin safe prescribing. 

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Stojanovic, Jane. (2010). Midwifery in New Zealand, 1904-1971. Birthspirit Midwifery Journal, 2: 53-60.

Abstract

Childbirth for European women in early twentieth century New Zealand was family centred. The majority of births took place in the home, accepted as a difficult but natural part of a woman’s role in life. Midwives were mostly married women who worked autonomously and had usually borne children themselves. By the 1970s this picture had dramatically changed. Virtually all births took place in hospital and were under the control of medical men and women. When legislation was passed (the Nurses Act 1971) that removed the right of New Zealand midwives to practice autonomously, New Zealand midwifery had largely been subsumed by nursing, controlled by medicine and displaced from a community based profession into a hospital based workforce. This article examines how the trends of medicalisation, hospitalisation, and nursification changed the New Zealand maternity services from 1900 to 1971, outlining the effect those changes had on the midwifery profession. The changes described here were also common to other western societies; examining how they occurred provides a context for understanding the history of midwifery in New Zealand.

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Summers, A. (1997). Sairy Gamp: Generating fact from fiction. Nursing Inquiry, 4: 14-18.

ABSTRACT

Australian midwives today are generally employed by maternity hospitals as obstetric or maternity nurses and specialize in only one area of the childbirthing process, under the umbrella of medicine. This is quite different to the provision of midwifery care in the nineteenth and early twentieth centuries in Australia, when childbirthing took place within a home setting, with a community midwife in attendance under the umbrella of the household. Australian midwives are now attempting to regain some of the autonomy that they believe was possessed by midwives of the past by being professionally accredited to operate as independent midwives. The de-institutionalization of childbirthing cannot simply come about by giving midwives accreditation to operate as autonomous practitioners, as the forces that led society to institutionalize childbirthing practices, as well as the avenues for change, are complex. This paper examines one of the forces behind that change: the denigration of the image of the community midwife by the medical and nursing professions, through the character of Sairey Gamp created by Charles Dickens. By examining the historical terrain and the historical influences that led to the demise of the community midwife, we can provide answers for debate on the present status of the midwife.

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Summers, A. (1998). The lost voice of midwifery: Midwives, Nurses and the Nurses Registration Act of South Australia. Collegian, 5(3), 16-22.

INTRODUCTION

The proposed review and amendments to the Nurses’Act in South Australia has caused intense debate in this state especially between nurses and midwives. On the one hand midwives claim that the new changes will affect their ability to deliver optimum care to the childbirthing woman and so affect their role as midwife. While on the other hand nurses counter claim that the proposed changes to the Act will not make any difference to midwifery care and cannot understand what all the fuss is about. Yet midwifery has never sat comfortably under the umbrella of nursing and this debate is not new. This paper takes a historical look at the professionalisation of nursing prior to the implementation of the original Nurses’ Registration Act of South Australia in 1920. It explores the implications of this for the midwife of the time, highlighting the unresolved differences between these two professions that have contributed to the debate of today.

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Summers, A. (2000). A different start: Midwifery in South Australia 1836-1920. International History of Nursing Journal, 5(3), 51-57.

ABSTRACT

It is the  popular belief of many nurses and midwives in Australia that midwives of the nineteenth and early twentieth century in this county practiced totally independently of medicine, resorting to medical assistance only if the labour and delivery did not progress normally. There is also the opinion that only affluent childbirthing women had a medical man in attendance at the delivery and poorer women had a midwife. Indeed, much of the Australian historical literature supports these notions. However, evidence suggests that in South Australia this was not the case and that generally midwives practiced in collaboration with medical men. Apart from some exceptions, both midwives and medical men attended the deliveries of most childbearing women from all strata of society. This paper will explore the provision of midwifery care in the early days of the settlement in South Australia and show how the relationship between the community midwife and general practitioner developed. In doing so, this paper will establish that the normal place of delivery in nineteenth-century South Australia was in the home with both a doctor and a midwife in attendance as part of normal community life.

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Summers, A. (2007). Three nursing legacies: Nightingale, medicine, and technology and their impact on nursing practice. Asian Journal of Nursing, 10(1), 6-11.

ABSTRACT

Recently, there have been many changes to the delivery of health care in Australia and other developed countries. Australia appears to be in permanent crisis over the provision of health care to the community, despite improvements in technology. It is unclear whether this crisis is related to changes in the relationship between the general public and health professionals, economic policies, or increasing advances in technology. There is no doubt that there has been a significant shift in the expectations for and delivery of health care in Australia. The result is that health care is provided in a complex political, economic, global, and technological context. Nursing and midwifery have not escaped these changes in the provision of health services and this has affected nursing practice. During the past century, developing countries have emulated western advances in health care. However, western medicine has many legacies that have provided both positive and negative influences on health care. This paper identifies and discusses 3 important legacies of Florence Nightingale, medicine, and technology

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Wright, A. (1998). Australian Midwifery: Past, present and future. ACMI Journal, December, 18-20.

ABSTRACT

‘Long before the butter churn and camp fire oven signalled the arrival of Western housewifery in Australia and while Europe was still guessing what lands lay below the equator, the dark thin-shanked aboriginal women lived and mated here, raised children, fed the fires, prepared food, performed family and tribal duties’ Pownall in Australian Pioneer Women in N.S.W. Midwives Association (RANF) 1984; for as was the tribal custom of the day around 1710, when a birth was imminent, a ‘nurse’ would be chosen to ‘help’ the labouring woman – perhaps some could argue, this was the true origin of Australian Midwifery. However, as the above quotation states, ‘Western Midwifery’ would have its roots founded in the traditions of Florence Nightingale.

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MASTERS AND DOCTORAL THESES

Beechey, D. (2003). Eureka! Women and birthing on the Ballarat goldfields in the 1850s (Masters thesis). Australian Catholic University, Ballarat.

ABSTRACT

The Ballarat goldfields were a raucous, noisy, exhilarating place that was a tent home for thousands of men, women and children in the 1850s. The Ballarat goldrush and the Eureka Rebellion are among the most significant events in the history of Australia. They set the scene for this study titled Eureka! Women and birthing on the Ballarat goldfields in the 1850s. This qualitative study utilised and historical research method informed by a feminist perspective.

This account reveals the story of women’s lives and their birthing at this time as found in historical documents. These documents revealed that the women birthed in their tents with a female friend, relative or lay midwife present. Trained midwives were rare and doctors were too expensive for the majority of poor diggers with no guarantee they were genuine. While most women birthed safely the appalling conditions, infection and birth complications all contributed to high rates of maternal and neonatal mortality and morbidity.

This study has implications for both women and midwives. Hearing voices through this story of their lives and birthing will expand the understanding of issues specific to women. The sharing of the story of birthing in the 1850s will raise awareness of the connections between midwifery history and the twenty-first century giving midwives an appreciation of the past along with different perspectives and greater understanding of women and birthing so their midwifery practice in the future will be enhanced.

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Brodie, P. (2003). The invisibility of midwifery: Will professional capital make a difference? (Doctoral thesis). University of Technology, Sydney.

ABSTRACT

Serious questions need to be asked about the current status of midwifery in Australia. This doctorate examines the lack of recognition of midwifery as an autonomous profession and its consequential invisibility in Australian maternity care.

Despite the significant amount of evidence that continues to accumulate to support the expansion of midwifery models of care, such changes have not been widespread in Australia. An examination of international, national and local health policy and strategic direction in maternity services, together with a critique of contemporary Australian midwifery and the role of the midwife within the public health system, provide the rationale and context for the study. The ‘case’ for introducing improved systems and models of maternity care is developed with regard to the evidence for increasing the utilisation of midwifery. The doctorate argues for greater visibility and recognition of midwifery in Australia with a focus on the role of midwifery leadership and its potential to improve collaboration.

A number of case studies report experiences and insights of leadership and collaboration across different contexts: clinical practice, organisation of health services and health policy leadership in maternity services. The result is a comprehensive understanding of the reasons for the lack of visibility of midwifery and the potential costs of such a situation continuing. The exploration of this situation highlights the barriers to recognising and acknowledging midwifery itself.

Attention is drawn to the continuing lack of voice and visible leadership in Australian midwifery, with midwives being absent from decision-making in situations where others, predominantly nurses and doctors, speak ‘for’ them.

This work examines the barriers to midwives forming alliances and working to influence government agendas at the social, organisational and political level. Exploration of the power structures and hierarchical constraints that exist reveals particular barriers and highlights what is needed to address the impending decline of the profession in Australia.

The enhanced capacity that midwives would experience if their work were to be understood, recognised and valued in the provision of maternity services in Australia, is postulated through the development of a construct called ‘professional capital’. Drawing on several theoretical perspectives, it is argued that the notion of ‘professional capital’ is dependent on a strategy of focused and deliberate leadership and collaboration within maternity services and the creation of positive social networks and affiliations amongst midwives.

Professional capital would enable greater visibility and recognition of midwifery and a more effective midwifery contribution to maternity services. It is suggested that improved professional and societal recognition will ultimately enhance the professional performance and self image of midwives. Such developments will enable new and effective ways of supporting and strengthening inter-professional relationships and systems of care that will, in the long term, improve the outcomes and experiences of women who access maternity services.

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Davies, R. (2003). ‘She did what she could…’ A history of the the regulation of midwifery practice in Queensland 1859-1912. (Doctoral thesis). Queensland University of Technology.

ABSTRACT

The role of midwife has been an integral part of the culture of childbirth in Queensland throughout its history, but it is a role that has been modified and reshaped over time. This thesis explores the factors that underpinned a crucial aspect of that modification and reshaping. Specifically, the thesis examines the factors that contributed to the statutory regulation of midwives that began in 1912 and argues that it was that event that etched the development of midwifery practice for the remainder of the twentieth century.

In 1859, when Queensland seceded from New South Wales, childbirth was very much a private event that took place predominantly in the home attended by a woman who acted as midwife. In the fifty-threeyears that followed, childbirth became a medical event that was the subject of scrutiny by the medical profession and the state. The thesis argues that, the year 1912 marks the point at which the practice of midwifery by midwives in Queensland began a transition from lay practice in the home to qualified status in the hospital. In 1912, through the combined efforts of the medical profession, senior nurses and the state, midwives in Queensland were brought under the jurisdiction of the Nurses’ Registration Board as “midwifery nurses”.

The Nurses’ Registration Board was established as part of the Health Act Amendment Act of 1911. The inclusion of midwives within a regulatory authority for nurses represented the beginning of the end of midwifery practice as a discrete occupational role and marked its redefinition as a nursing specialty. It was a redefinition that suited the three major stakeholders.

The medical profession perceived lay midwives to be a disjointed and uncoordinated body of women whose practice contributed to needless loss of life in childbirth. Further, lay midwives inhibited the generalist medical practitioners’ access to family practice. Trained nurses looked upon midwifery as an extension of nursing and one which offered them an area in which they might specialise in order to enhance their occupational status and career prospects. The state was keen to improve birth rates and to reduce infant mortality. It was prepared to accept that the regulation of midwives under the auspices of nursing was a reasonable and proper strategy and one that might assist it to meet its objectives. It was these separate, but complementary, agendas that prompted the medical profession and the state to debate the culture of childbirth, to examine the role of midwives within it, and to support the amalgamation of nursing and midwifery practice.

This thesis argues that the medical profession was the most active and persistent protagonist in the moves to limit the scope of midwives and to claim midwifery practice as a medical specialty. Through a campaign to defame midwives and to reduce their credibility as birth attendants, the medical profession enlisted the help of senior nurses and the state in order to redefine midwifery practice as a nursing role and to cultivate the notion of the midwife as a subordinate to the medical practitioner.

While this thesis contests the intervention of the medical profession in the reproductive lives of women and the occupational territory of midwives, it concedes that there was a need to initiate change. Drawing on evidence submitted at Inquests into deaths associated with childbirth, the thesis illuminates a childbirth culture that was characterised by anguish and suffering and it depicts the lay midwife as a further peril to an already hazardous event that helps to explain medical intervention in childbirth and, in part, to excuse it.

The strategies developed by the medical profession and the state to bring about the occupational transition of midwives from lay to qualified were based upon a conceptual unity between the work of midwives and nurses. That conceptualisation was reinforced by a practical training schedule that deployed midwives within the institution of the lying-in hospital in order to receive the formal instruction that underpinned their entitlement to inclusion on the Register of Midwifery Nurses held by the Nurses’ Registration Board.

The structure that was put in place in Queensland in 1912 to control and monitor the practice of midwives was consistent with the policies of other Australian states at that time. It was an arrangement that gained acceptance and strength over time so that by the end of the twentieth century, throughout Australia, the practice of midwifery by midwives was, generally, consequent upon prior qualification as a Registered Nurse. In Queensland, in the opening years of the twenty-first century, the role of midwife remains tied to that of the nurse but the balance of power has shifted from the medical profession to the nursing profession. At this time, with the exception of a small number of midwives who have acquired their qualification in midwifery from an overseas country that recognises midwifery practice as a discipline independent of nursing, the vast majority of midwives practising in Queensland do so on the basis of their registration as a nurse.

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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.

ABSTRACT

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. 

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Leap, N. (2005). Rhetoric and reality: Narrowing the gap in Australian Midwifery (Doctoral Thesis). University of Technology, Sydney.

ABSTRACT

This study draws on multiple modes of expression in texts that have been generated by my experience of midwifery development since I moved from England to Australia in early 1997.

The Professional Doctorate in Midwifery at the University of Technology, Sydney (UTS) has enabled me to produce and study my work as a midwifery practitioner, researcher, educator, writer and activist and to engage in a process of scholarship that both informs and is generated by practice. This has allowed me to analyse the complex issues that I, and other midwives in Australia, face as we strategise to narrow the gap between our ideals and the realities of the professional and political constraints that challenge midwifery. The study analyses the rhetorical communications I have employed as both carriers of ‘vision’ and ‘means of persuasion’ and the deliberate strategies to make changes that I believe will benefit childbearing women.

My portfolio challenges me and others, to explore how we are able to identify, enact, and convince others of the emancipatory potential of midwifery. Rhetorical innovations are therefore linked to the exposition of woman centred midwifery care; an overall goal being to enable situations in which women can experience the potential power that transforms lives, through their experiences of childbirth. In the process, I aim to produce new knowledge that will equip midwives to understand practice, policy and political situations and see new possibilities for responding and taking action.

I have analysed and explained my work using a framework appropriated from rhetorical theory and drawing on a range of feminist perspectives. This involves identifying and critiquing the rhetorical innovations that I have used when trying to create possibilities and persuade others of the value of midwifery and the need to make changes happen in practice, education and regulation. My study analyses the rhetorical nature of my own work as presented in my portfolio in a range of carefully selected texts that I have authored during my candidature. These include journal and newsletter articles, conference papers, research activities, policy submissions, education and training materials, the development of midwifery standards, formal and informal communications, and other documents, all aimed in one way or another at the rhetorical strategy of stimulating interest and action. The portfolio texts that arise from this work form the empirical data that is studied.

However, in varying ways these texts elicit understandings about the rhetoric and reality of Australian midwifery and the deliberate strategies that are employed by midwives to make changes that will benefit childbearing women. They therefore stand in their own right as contributions to the thesis with their own discursive and epistemological intent.

The reflexive process employed in this thesis highlights comparisons between what is being positioned as the potential of midwifery with what is also presented as the reality played out in contemporary Australian maternity service provision and in midwifery education and regulation.

The thesis weaves its way around the portfolio documents, attempting to bring to life and discuss the culture in which rhetorical innovations and intentional strategies are aimed at narrowing the gap between ‘rhetoric and reality’.

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McGuinness, B. (1997). Women’s ways of birthing in Ballarat in the 1940s. (Masters Thesis). Flinders University, South Australia.

ABSTRACT

Birth, like death is a human event surrounded by mystery, myth and intrigue. Birthing is afforded a place of austere aesthetic reverence, but women’s experiences of birthing are often dislodged by birthing’s mystified position. The history of birthing has escaped attention, or has been ignored since modern times. Evolutionary modes in society, and specifically the women’s movement, have been associated with a return of women’s voices to numerous aspects of social life, birthing being one. This oral history research study, guided by feminist principles, raises the voices of women. This study presents the stories of women who gave birth during the 1940s, a time which felt the effects of war and post-war reconstruction.

Birthing stories of the 1940s, retold in the 1990s, capture a multiplicity of women’s ways of birthing, revealing commonality, disparity and contradiction. The ordinariness of birthing is overwhelmingly evident in women’s stories herein. Women said ordinariness was the ‘way’ they birthed; they ‘took it in their stride.’ This retelling of birthing as ordinary is unique. Underlying this ordinariness and promoting the concept, is a certain self-trust and confidence. Three other storylines, evident in women’s stories are emphasised in this study. These storylines or ‘ways’ of birthing include the amnesiac experience of ‘twilight sleep’, the importance of women and family and the contradiction of silence, taboo and magic. The relevance of 1940s birthing stories for midwives in practice today is considered.

Women’s ways of birthing in the past may reveal connections and conflicts with ways of birthing in the 1990s. This study contends that midwives of today will be rewarded by hearing women’s voices and stories of their past experiences. Encouraging women and midwives to recall past, and also present stories, can enhance birthing experiences and thus midwifery practice. The future of midwifery practice and the security of women’s ways of birthing is reliant on the empowerment of women and to a lesser extent, collaborative partnerships between midwives and women. Most importantly, uncovering women’s past stories will afford value to these stories and illuminate women’s voices.

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Summers, A. (1995). ‘For I have ever so much faith in her ability as a nurse’: The eclipse of the community midwife in South Australia 1836-1942 (Doctoral Thesis). Flinders University, South Australia.

ABSTRACT

The aim of this thesis is to examine the factors which led to the marginalisation of the community midwife in South Australia and the effects that these factors had upon the lives of women in midwifery practice at the time of the implementation of the Nurses Registration Act of South Australia 1920. In pursuing this enquiry, the normal provision of midwifery care in South Australia from 1836 to the 1942 is also identified. This thesis is concerned to show in narrative form, how one kind of social change can affect certain individuals and groups, in order to evaluate the cost of that change to one section of society, the community midwife.

By using primary documentary sources of diaries, letters, official correspondence and minute books, this thesis examines the provision of midwifery care from the settlement of British people in South Australia in 1836 until 1942, and investigates the gradual movement of childbirthing from the home to the hospital. This movement had its embryonic beginnings in the development of the lying-in home of the Destitute Asylum from the 1850s to the 1880s. It was enhanced by the establishment of the Queen’s Home in 1902, the first formal training school for midwives in South Australia, and found its strength in the proliferation of community and country hospitals in the 1920s. The thesis establishes this context to explore the relationship between the community midwife and the local medical practitioner. It shows the importance of this relationship made in the resistance to changes to midwifery care in South Australia. By using medical and nursing journals this research examines the pathway of the professionalisation of nursing, its relationship to medicine and its subsequent effect on the practice of the community midwife.

This thesis argues that the eclipse of the community midwife can be attributed to three factors: the professionalisation of nursing and its relationship to medicine; the persuasive medical discourse on the dangers of childbirth in the light of medical knowledge; and the gradual changes in responsibility for the childbirthing woman from the household to the public sphere.

Ultimately it was legislation for the registration of nurses and midwives in South Australia, in the rise of the professionalisation of nursing, which proved to be the deciding factor in the eclipse of the community midwife.

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