Second wave feminism had an impact on midwifery and birth in Australia.
By the mid-1970s consumer and political pressure for birthing alternatives began to mount in Australia. Homebirth continued to be strenuously opposed by the medical profession. Until the 1990s the only non-medicalised option for women in Australia was a homebirth with a privately practicing midwife [PPM]. Unfortunately, this option was not available for a lot of women as cost, access and availability of PPMs were prohibitive factors.
Birth centres were another option. The centres are usually attached to hospitals, thus enabling quick access to the ‘safety’ of the hospital and the supervision of the doctors. In 1989, The Alternative Birthing Services Program (ABSP), a Commonwealth government initiative, aimed to provide funding to develop alternative birth choices for women including birth centres and homebirth. Many planned programs across Australia were not implemented and ones that were did not continue once the ABSP funding ran out. In WA, two alternative birth services were implemented, the Family Birth Centre (FBC) and the Community Midwives Program (CMP). The FBC opened in 1992 and was the first government funded birth centre in WA. The Community Midwives Program (CMP) was the result of many years of lobbying by midwives providing homebirth services to women privately and was the first government funded homebirth program in Australia. (1)
In her article Midwifery: Women, History and Politics (below) Carolyn Hastie suggested that the issues confronting women and those confronting midwives were on a ‘parallel course’. Midwifery has struggled by being subsumed into nursing as well as being seen as a subordinate profession by medicine. An example of the control of midwifery by nursing was evidenced by the review of the NSW Nurses Act in 1991 when midwifery lost its’ own separate register. It took until 2004 for the Nurses’ and Midwives’ Registration Board in NSW to be legislated.
In 1986 Lesley Barclay provided a comprehensive historical analysis of midwifery education in Australia. She identified a lack of definition of the role of the midwife or standards of education in most states. Regulation was inconsistent and often rendered invisible by nursing leaders who made decisions on behalf of midwifery. She found that for a midwife to be promoted there was often a pre-requisite to be a qualified nurse. Midwifery skills were not fully utilised and there were few opportunities for midwives to practice autonomously. She recommended that ‘direct entry’ be re-examined in the light of international developments and the inefficient current system of midwifery education.
It may seem surprising to know that not all midwives were nurses in the early years of midwifery education in Australia. King Edward Memorial Hospital, Perth, opened on 4 July 1916 as the first women’s hospital in WA. Students paid a fee of ten pounds to study midwifery, which was 6 months for qualified nurses and 12 months those without a nursing qualification. The last original direct entry hospital-based midwifery students graduated from Crown Street Hospital in Sydney in 1970.
Midwifery became a post registration nursing qualification, based in hospitals using an apprenticeship model. The major focus of practice remained with the biomedical model that reflects an illness approach to care. Midwifery education gradually moved away from hospital-based courses to the tertiary sector as either graduate diplomas or master’s degrees continuing as a post-nursing qualification.
An international move towards a model that recognised the definition of a midwife and a philosophy of practice that was ‘with woman’ resulted in renewed interest in educating midwives without the need for a nursing qualification. In 1999, Flinders University and the University of South Australia were considering starting a 3-year Bachelor of Midwifery course however believed that it was best to wait until other universities could commence courses at the same time to maximise support for this option. This led to the creation of the ACMI Bachelor of Midwifery National Taskforce with a commitment to develop national Standards for the Accreditation of a Bachelor of Midwifery that could be used as a framework for use across Australia.
The Australian Midwifery Action Project (AMAP) commenced in 2001 (read the reports below). The two main aims of the research project were to investigate the service delivery, educational, policy and regulatory environments affecting midwifery in Australia; and to analyse and facilitate collaboration, planning and communication across these sectors. This project, funded by the Australian Research Council in association with industry partners, supported the work of the ACMI Taskforce and recommended that national research should investigate, monitor and evaluate the introduction of the Bachelor of Midwifery, and compare and standardise outcomes with a strengthened and improved national approach and standards for the midwifery education of nurses. It was not until 2002 that ‘new’ direct entry programs recommenced in South Australia, New South Wales and Victoria.
(1) Thorogood, “Politics and the Professions: Homebirth in Western Australia.” provides an in-depth review of the ABSP.