ļ»æEpisode 45 - How to change the system
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host,
[0:03] Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. In each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:22] Welcome to today's episode of the Great Birth Rebellion podcast.
[0:27] I'm currently recording this podcast two days post convergence of the rebellious midwives conference which is a conference that I held in Sydney Australia over the weekend it was such an epic success everyone who came was on a high the feedback that we've had is insanely good and when I was planning the conference it was with love and compassion in mind for the really tough work that maternity care workers do every day and this is the talk that I presented at the conference to open the conference I've obviously only included parts of it for this podcast but I wanted to share it with you guys because so many people had the most beautiful feedback and said that it really resonated. And this talk is about how to change the system.
[1:21] Because the number one question that I get asked almost every week from people who know that something is wrong with the system and they want to know what they can do to change it. The answer I always give them is that you can't. You can't change the system. It's bigger than you. I tell them to stop trying to change the system or at least stop trying to change it on your own. There's nothing that you can singularly do on your own that's going to turn around the shortfalls what we have in the current maternity care system.
[1:57] Instead, I talk to them about what I know and what I've learned from the permaculture
[2:03] philosophy, believe it or not. And I'm going to take you on this journey. In permaculture, they talk about the way to generate change is to start where you are, use what you have and do what you can. And to aim for anything bigger would be an overwhelming and hopeless task that would burn you out before you made any change. And so my answer is always that you can't change the system, but we can change the system. And in this talk, I'm going to tell you how. As I record this now, I'm 40 years old. And for the last 22 years, I've been on a journey to understand what it means to live healthfully. My husband and I, we now have two children who were both born at home. We live on a five acre hobby farm in the Blue Mountains. where we have goats and chickens and veggies and free-range children. And we've adopted this lifestyle that would look quite odd to most people. Home-born and homeschooled children, both parents working at home, we're really swimming upstream from the rest of society in our food, lifestyle and health decisions.
[3:13] And we've really embraced what we call a retro-suburban lifestyle, which is rooted in permaculture principles. It would look quite odd to everybody on the outside and what this has to do with changing the system I'm going to tell you and the answer lies in this permaculture life that we're living, permaculture explains a formula of caring for the earth that enhances it and changes it for the better it uses a proven formula that creates self-sustaining food forest ecosystems that can sustain themselves because they have the nutrition and the soil and the ingredients they need to grow well.
[3:53] Food forest systems and bushlands represent a dynamic and resilient system that are capable of adapting to changing conditions. And only the plants that have their needs met will survive and the others will die and new plants will take their place. And the plants that survive will only thrive in the conditions that they're given. So on our farm, when we're planning and planting a food forest, we first think about what we want to grow and what we want to eat. And then we think about what support they need to stay healthy and what support our soil needs to stay healthy because the soil is what determines the health of the plants and so in permaculture we really focus on soil health, and then the rest is easy.
[4:43] So soil needs plants that will cover it so we will plant things like oregano and nasturtiums then it also needs nutrition plants that will deliver nutrients to the surface of the soil down from deep below like comfrey then you need plants that will add nitrogen like beans and other legumes and it needs animal droppings and compost and moisture and air and so we water it and we encourage worm activity to keep all the soil soft and fluffy and then you know you plant roots that break up the soil and keep it all soft and available for the health of the rest of the plants in that food forest.
[5:25] So this is how we do it because this is how nature does it. So if you look at a forest in nature it'll have these big canopy plants that provide cover for the understory plants and there will be plants and shrubs of all different sizes underneath the canopy and then the soil will cover itself because soil likes to be covered it's important for soil health that it's not exposed and then the soil is fed by the animal droppings of the animals that come around and eat all the the fruit of the plants and the dying plants that break down and return to soil and mushrooms will grow in the moisture and send nutrients through mycelium all under the forest floor and each of the plants is reliant on the other to have its basic needs met There's a balance and an ecosystem.
[6:16] So let's imagine that the maternity care system is like a forest and like a food forest each of the elements and layers coexist and rely on each other to function properly. In my presentation I had a slide up here of a forest it had all the different layers so the the canopy layer it represents the high level infrastructure and leadership so think of brick and mortar hospitals and politicians and big heavy hitters who make the big decisions that impact the rest of us down below. These are the big trees. These could be major services, major structures, major policies, all these things. Then we come to the middle layer of the forest. So it's not the huge big trees with the trunks. It's sort of more, you know, bushier, productive trees. They might be three, four, five meters high and in this middle layer we think about this as being hospitals and actual facilities and services. So this could include mainstream large-scale services like hospitals but also boutique and unique services like birth houses and birth centers, private midwives.
[7:31] Birthing on country services, private obstetric services. So those are the the next layer under the canopy. And then as we get closer to the forest floor, we get through to the plants within the forest that do the really hard work to support and maintain the health of the soil and the forest floor. And ultimately, all of these lower dwelling plants are responsible for the health of the larger trees and the middle layers.
[8:02] Because the lower level plants are the basis of any good garden and any healthy forest. And the health and well-being of those lower layers are essential in the long-term survival and outcome for the larger plants. So the support layer and the smaller trees and shrubs are, if you think of these as the midwives and the doctors and the pediatricians and student midwives. Then the next and most important layer within the forest are the women and their families. And these represent the ground floor layer, which includes the ground covers and the small shrubs and plants that are there for the purpose of maintaining soil health. What we know about forests is that if you remove this bottom layer the overall health of the forest diminishes and ultimately those bigger canopy trees and the lower productive shrubs so the big systems that are at play and the workers that are amongst it they become less productive and the trees lose their health and they die without the support and nourishment of the ground floor layer.
[9:15] Without a ground floor, the forest has a lot of trouble maintaining itself, replenishing itself, recovering from things that occur in the external environment. So it becomes less resilient and more susceptible to environmental stress. Because when you take away the underlayers, there's nothing feeding or protecting or supporting the soil. And soil quality is what impacts on growth and survival of trees. Or in this analogy, the system.
[9:45] So what does this have to do with changing the system? You've bared with me while I give you some obscure forest analogy.
[9:54] But firstly, if we see where we are in the forest system, you'll see that while we as midwives and maternity care workers have an important role.
[10:04] We can't change the whole forest ecosystem dramatically or instantly. And this is the same if you're at the bottom lower layer of the forest, if you're a woman or family using these services. Big, huge change happens when one of the big canopy trees falls over and opens up space for new plants and what we call pioneer species to grow. And these are the plants that now, when a big tree has fallen over and isn't taking up space in the forest has an opportunity to take the soil nourishment and use it to focus on its own growth and health. But if all the big trees and all the canopy fall over at the same time the understory becomes unprotected. It gets too much sun exposure, it dries out, the soil integrity is challenged and there's less food and shelter for the animals which feed the soil also and the ecosystem fails because it's out of balance and so when people say you know how can we change the system maybe we should just burn it down topple it all over start again if you started again and toppled everything over in a garden you would need to invest heavily in soil health and nourishment in order to keep those new trees alive it's a lot easier to change an established forest than it is to knock it all down and start again.
[11:33] So when I'm planting a food forest at home in my garden, I'll plant the tree that I want to grow and then I'll plant all of the support plants beneath it to give it the best possible chance to thrive.
[11:45] And this is exactly how you can create change in the maternity care system.
[11:51] You can either be or become involved in the big canopy layer as a big tree and enact change there, but that role is reserved for only a few people or a few big players. Not everyone can do that. Alternatively, you can be a support plant to a tree that you want to see thrive. So you are part of this ecosystem. and if we're starting where we are using what we have and doing what we can you can be of impact in your area of the forest and in the ecosystem in which you are planted.
[12:31] And some of these big trees are these big juggernaut hospitals and obstetric-led medical birth units but let's say for example that one of these trees is the Waminda service that provides Indigenous women with culturally appropriate care and birthing on country and one of them is a politician lobbying for change like we've seen through the birth trauma inquiry here in Australia and in the UK and maybe one of these lower trees is a boutique birth unit like the birth house in Tasmania and another is the Australian College of Midwives and another is the research team like in the best study that Hazel Keedel and Hannah Darlan are currently working on. Or maybe they're a publicly funded home birth service or a thriving MGP program. You can either become part of these services enacting change in their area of work or you can rally under them and around them to nourish the soil in which they are planted.
[13:31] You can grow and contribute directly around and under their shade to give them the best chance of surviving and thriving. And what does that look like? That looks like following them on social media, donating money to their causes, going to their events, listening to their podcasts, telling other people about them, working for them, signing all the petitions that they put out. And when they express a need, doing what you can to meet a need. You don't have to be the big tree, but you can support it by hanging out in the understory and feeding the tree, making sure that the trees that you want to see thrive in this maternity care ecosystem have the support and nourishment that they need from the understory. And that means moving yourself away from services and maternity care options that you don't believe are properly serving women.
[14:25] And instead, investing your personal energy and influence into the soil that will feed something that you believe in more.
[14:33] And you'll see here that where the women are the very, very understory, and I told you earlier that although it's closest to the forest ground, it sustains the whole system. So imagine if women stopped supporting the obstetric-led units and invested
[14:51] their efforts and time into nourishing women-centered services. By using them instead or if they made lots of noise and put in collective effort to enact change within their own local services if they stopped hiring the private obstetrician that had the highest intervention rates and if every woman asked the government for more mgp publicly funded home birth programs and birth centers this symbolizes a movement of the understory from away from the trees that they don't want to see survive and towards the trees in the forest that they want to see thriving and we've seen examples of this in consumer activism where they put their time into lobbying and where women invest their money into paying for private midwives for example if you uproot from around something that you don't believe in and root yourself around maternity maternity services that you do believe in then this is where change happens and this is the same for midwives and staff working in these big units.
[15:57] Midwives and maternity care staff who nourish and support a birth unit, for example, that they don't believe in, are ultimately nourishing and supporting it to grow and sustain itself and nothing will ever change. If you want to create change, you have to look at which big trees you're supporting and which ones you're nourishing. And if it doesn't align with your beliefs and doesn't provide women with the care that they want then make an effort to invest yourself elsewhere.
[16:30] You're already putting effort into staying where you are, it's a personal effort and a personal cost and an emotional cost to yourself in order to invest into this system that you don't believe in. As long as you're bolstering up and giving your energy and sustenance to soil around trees that don't serve the forest you're nurturing a system that you don't believe in but if the understory uprooted itself and supported only the trees that genuinely served women those trees would thrive and the others would be starved and they'd be forced like in any
[17:06] forest to drop branches and ultimately die and fall over and then a new canopy would rise up. This is how change happens in nature and this is how we can enact change in the maternity care system. By putting yourself and your time and your energy into activities and roles that support the services that you want to see thrive, the natural consequence is that other services won't survive.
[17:36] This takes energy and effort but it also takes energy and effort to serve in a role that leaves you distressed day after day.
[17:44] And there's a saying in permaculture that we use when we feel overwhelmed by a huge job ahead. And when we look at the work in our garden and we think, whoa, there's so much to do, I don't know where to start. The answer is always the same. If you don't know what to do next, or you can't face the big jobs that are out there in the forest. The rule in permaculture is to start at your doorstep. Step outside and look at the first two meters in front of you and start there. You go for the low-hanging fruit to start with. Start where you are, use what you have, do what you can. So if you want to change the system, you can either do something to be a really big tree, but you'll only get there if you can recruit followers and support plants to nourish you. If you can't be a really big tree, be a follower of a really big tree. Root yourself around them and see what you can do to help them flourish.
[18:49] If you can't be either of these things, at least be paying attention so when the tipping point happens and momentum happens that you're there to follow it. So start where you are, use what you have and do what you can and together and slowly we will grow big beautiful trees that we want to see thrive and the other trees will die and feed the new forest canopy.
[19:16] That is how you change the system. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com. And to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
Ā©2025 Melanie The Midwife
