Episode 50 - The State of the Midwifery Workforce
Mel:
[0:00] This episode has been generously sponsored by Poppy Child, who's a childbirth educator, doula, and creator of the Birth Box and the Oxytocin Bubble. Both of these things are strategic tools used to help you get ready for labour and birth. Historically, Poppy has offered Great Birth Rebellion listeners 25% off the Birth Box, and now Poppy is also offering the Oxytocin Bubble, which is included in the Birth Box. But she's offering the Oxytocin Bubble as a standalone offer for 25% off for Great Birth Rebellion listeners. Now, the birth box gives tools to help you navigate labour and birth, and the Oxytocin Bubble is a soundtrack that accompanies those tools to help you sink into a calm and gentle space as you navigate labour and birth. If you want to access your 25% off offer, check in the show notes below and you'll see the link.
Welcome to the Great Birth Rebellion podcast. I'm your host, Dr Melanie Jackson. I'm a clinical and research midwife with my PhD and 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.
Mel:
[1:22] Welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and today I've invited my good friend, Lynnelle Moran. She's not only my friend, but she's also a midwife, university lecturer, and researcher.
Mel:
[1:38] And today we're talking about sustainable midwifery careers. Lynnelle just recently joined us at the Convergence of Rebellious Midwives. And during the Convergence, which happens every year, it's the conference that I run every year. During the Convergence this year, we had a panel on stage and collectively the panel had.
Mel:
[1:58] Over 280 years of midwifery and obstetric experience as care providers and as clinicians and as academics. And a question that I asked them is how do you get to a point in your career where you can have a sustainable career that lasts a long time and that you love and that you relish in. And that's what Lanell and I are going to talk about today is long, sustainable careers in midwifery, in healthcare, maternity care. And in a time where midwifery careers are becoming shorter and shorter and more difficult, today we're going to talk about how to improve your chances of having a long career in maternity care. And we're looking at Lynnelle's researched around midwifery sustainability. I love this. We look epic.
Mel:
[2:52] Welcome to the Great Birth Rebellion podcast, Lynnelle, in your epic, I'm loving this family shared jacket that you're wearing. If anyone's watching on video, Lynnelle's just, it looks like vintage Adidas.
Lynnelle:
[3:06] There's plenty of vintage Adidas in this household though.
Mel:
[3:09] Incredible. Well, Welcome, Linnell. We're going to talk about more than fashion today. Linnell, we just spent the weekend together at the Convergence as well. And I was really reflecting at that event today. About longevity and midwifery and this is the topic of your research and your passion. So I'm really going to talk to you today about midwifery sustainability but before we start that can you give us an overview of what you are doing with
Mel:
[3:39] your midwifery career? Introduce yourself.
Lynnelle:
[3:41] Of course, thank you Mel, thanks for having me and yeah currently I'm teaching midwifery so I'm a lecturer at acu in melbourne and i'm working predominantly with second and third years at the moment it's just a total honor might sound cheesy but it's just so true it's so true to work with students and to work with such passionate students who know that their their future lies with being a midwife so clearly so i absolutely adore that prior to that i worked clinically as a midwife I began my career working in a busy tertiary hospital, working in a core sort of framework, so rotating across all areas of midwifery. I found at that time, like a couple of years into my midwifery, I was really struggling to feel connected to the work and to feel connected to my midwifery colleagues. And I was seeing a lot of an exodus from the profession of people who I really admired and hoped to learn from and continue to learn from. So that was concerning to me. I also knew for my own sustainability, I wanted to work in continuity of care models. So I was able to move into a publicly funded home birth program and MGP program at the same hospital and service. And I continued working there for a number of years, which I absolutely adored. Then I started working casually in academia and I also knew that to
Lynnelle:
[5:08] Effect change the way I wanted to do I really wanted to research relationships in amongst midwives and the importance of those relationships because I knew that that was something that was central to my own midwifery and I wanted to learn from other midwives and develop those communities for midwives and you know from that 10 years ago I set up the Vaginal Club
Lynnelle:
[5:33] Which is a midwifery I would say it's a collective it's a space that we gather regularly as midwives to discuss midwifery research and we look and discuss that research in ways that how we can you know support each other and integrate it into our advocacy and our care integrate it into our community building and mobilizing a practice strengthening our midwifery community and so So we've done that in Melbourne for 10 years and the community has grown and grown. Mel, you and I now for, well, how many, a year and a half have we, maybe nearly two years.
Mel:
[6:11] Probably nearly two years now had Vaginal Club as part of the assembly, the first online Vaginal Club chapter.
Lynnelle:
[6:19] Yes, that's so beautiful. So we meet monthly online and now there are six other chapters around Australia of Vaginal Club and it's just phenomenal to see the community growing and to see us strengthening the profession in this way. It's a grassroots movement.
Mel:
[6:35] You know, Vaginal Club is what it sounds like. It's midwives and is other health professionals as well or exclusively for midwives?
Lynnelle:
[6:44] It's exclusively for midwives and, you know, that has been a point where people occasionally have said, oh, we'd like to broaden it out. But the reason, you know, as we'll talk about, Mel, you know, there is obviously a need for us to strengthen relationships in multidisciplinary relationships. But from my research has become a clear need that we need to strengthen our connections within the profession. And really, you know, in order to run, we need to walk and role. And I just feel like we need to focus on this profession and to re-establishing our connection within the profession. And from that, great strength can come.
Mel:
[7:24] Absolutely. I absolutely agree with you. And this is something that I talk to midwives about when they ask me, oh my gosh, how am I going to keep going? And I keep coming back to, you've got to find your people because if you don't have people around you the job can become unbearable, and they are the ones who are going to get you through your mentors your colleagues, people who just have your back so this is part of what we're going to talk about today you've made it happen through the Va Journal Club you're raising up the next little midwives into the profession and making sure there's sustainability from that you know we're all doing a little bit the convergence is a part of that. The Great Birth Rebellion is a part of that. Together, collectively, we can strengthen midwifery. So let's talk about what are the current challenges for midwives in midwifery at the moment. Hang on a minute. I have a perfectly timed cup of tea. That's what I do have. I have a perfectly timed cup of tea. Thank you, Dan. Oh, my gosh. Beautiful. He's amazing. So, Lynnelle, we'll talk about what the problems are for midwives first and for midwifery first because then we want to heavily focus on the solutions. We don't just want this to be a big, sad story.
Lynnelle:
[8:48] Yeah.
Mel:
[8:49] Actually something that you midwives, if you're listening to, can take away and have some actual practical things that you can apply to your work to make sure that your career is sustainable.
Mel:
[9:01] But, Linnell, I picked out direct quotes from two of your papers that have already been published in your 2023 paper. It says that internationally, the midwifery workforce is facing a professional crisis due to numerous organisational and individual factors that have led to midwives leaving the profession. These factors include high levels of workplace stress, systematic barriers to providing woman-centred care, trauma and burnout. That's the 2023 paper. The 2024.
Mel:
[9:37] One quotes, and these are the first lines of your paper. The 2024 paper says, significant attrition and projected workforce shortages within the midwifery profession are global issues. Extensive research has identified that high level of workplace adversity, chronic stress and increasing rates of vicarious trauma and moral injury experienced by midwives underpin this situation. So, those are the opening lines of your paper. Can you fill us in on the story of what's happening for midwives within the maternity care system at the moment, both here in Australia and globally? Because this is not an isolated problem.
Lynnelle:
[10:22] Yes, and it's a really big question, Mel. So, you know, it does feel like a grim place to start, but it is essential that we face it in an honest and realistic way and not... I think we just need to face the reality that that's where we currently are at. And also, we recognize the solution to the problem doesn't fall on the shoulders of midwives. That this is, it's a problem for us all. It's not just a problem for midwives. So we need to really look systematically at a political level, at a societal level, at a system level and at an individual level and realize that
Lynnelle:
[11:09] This is like an ecosystem that is enabling this threat to midwifery or the creation of environments that are not sustaining midwifery to flourish. And we want to really challenge and dismantle all of that. So there are definitely modifiable things that we can do. But just to go back to the current issues facing midwifery is that we have a deficit in workforce currently and also in the projections. That's Australian, but also global. And so there's a lot of research modelling around workforce. And part of that is around an ageing workforce that we'll see people who have a strong intention when we survey and consult with existing midwives in the current profession, there's a strong intention to leave. So in Australia, we have a third of midwives who express their desire to leave the workforce prior to retirement age.
Lynnelle:
[12:08] So that's concerning. That's reflected globally as well. We've got high levels of medicalisation, which are dominating the maternity care landscape and clipping the wings of the midwives being able to practice to their full scope and to practice to their philosophy of care. And it is contrary to the evidence. And we all know that was spoken about it so extensively and exhaustively about we know the evidence of midwifery-led care is, you know, optimal for women and people and babies and communities. So it's this exasperation and, I guess, disillusionment that exists for many midwives who are working. And I think there's also, we have the early career midwife cohorts, so they're coming into the workforce and finding themselves in a very turbulent environment. They're reporting low levels of support, relationships within that context. They're feeling isolated. They're feeling they're not supported to support. Develop their skills. They're definitely not supported to access models of care where they have aspirations to work within. So, there are a lot of barriers to access models of care like continuity models or private practice. There are a lot of systemic barriers to prevent them to move into those supported models. So,
Lynnelle:
[13:37] The early career midwifery cohort is also highly vulnerable in this context. The staffing mix. So we see there's a strong reporting of poor staffing mix. So a highly junior workforce. And that means that based on deficits, that workforce is being asked to step into leadership positions that they don't have the experience to fulfill. They don't have the training or support to fulfill. And it's a high-risk situation. And those midwives then are also, that early career cohort, are being asked to perform double shifts. So we've got this, we're pushing and pushing and pushing in terms of what we're asking of midwives. Additionally, one of the issues is that there is not appropriate access to supports and services for midwives. So you'll see in other professions, there are regular, it's embedded into their model of employment that they have clinical supervision. I'm thinking of the social workers and paramedics.
Lynnelle:
[14:45] Those professions have recognised the emotional load that those professions carry and the need for us to have regular clinical supervision. And so despite the evidence, again, about the value of that for midwives, It's not something that we see routinely available or made accessible. So a lot of midwives are having to seek out that support at their own volition and expense. And that's a big problem. It's not accessible.
Mel:
[15:13] It sounds like in this initial framing of what's happening is that, nobody really is caring about the experience of a midwife as they're caring for women, as they're working in the system, that midwives seem to be expected to get on with it, and tolerate substandard working conditions. Would you say that midwives' well-being is not being considered?
Lynnelle:
[15:44] I would say in a lot of environments that's the case. I think there are exemplars and we need to look to those places where midwives are being supported to flourish and thrive and where well-being is prioritised. But I would say that instead of that aspirational idea of midwives' well-being being prioritised, what we see is midwives being supported. Pushed to their pin, being asked to prioritise the care of others and over the care of themselves. And I think these deeply entrenched expectations of resilience upon midwives is something that just urgently needs to be challenged and dismantled. It's not sustainable. We know it. The evidence and the figures and the statistics say that it's not sustainable. So we need a radical rethink. And I think from the reports that are coming out and the modelling that are coming out, you know, all the solutions point to increasing student intake, increasing number of graduates, increasing workforce, asking midwives to increase their hours worked.
Lynnelle:
[17:00] It's looking at career pathways. It is looking at some positive things, but there is so little focus on workplace and work team cultures. And it is fundamental to retention strategies and well-being strategies. And workplaces are obligated to provide safe places of work. And yet in health and in midwifery, so often it's overlooked. And it just, it makes no sense. We just have to start to value the need for professional, respectful relationships in the workplace, for promoting feelings of belonging and safety, psychological safety of midwives and employees. And just creating environments that support people to thrive and support people
Lynnelle:
[17:56] to feel safe and to feel like they have a sense of satisfaction in their work.
Mel:
[18:05] The part I really am curious about is the idea of psychological and emotional, mental safety for midwives. And in your papers, you talk about vicarious trauma and moral distress. These terminologies can be really helpful as we understand what leads to midwives, leaving because it's one thing to flood the midwifery profession with new graduates and focus on intake but if there's a massive hole in the bucket, and midwives are just leaving and this is what we know the current you know a lot of midwives aren't even they're studying longer than they're staying in midwifery, three to five years is the average attrition rate. So why are midwives leaving?
Lynnelle:
[18:54] Well, they're leaving for a number of reasons. They're leaving because of a lack of professional satisfaction. They're leaving because of burnout and stress, as you say, Mel. They're leaving because they don't get to practice to their philosophy of midwifery. They're feeling complicit in the harm that is being caused to birthing women and people. They're feeling their professional autonomy isn't respected. And like I said about the wings being clipped, I hear that so often, Mel. Like it's not even about advanced practice. It's about practicing to scope.
Lynnelle:
[19:31] You know, yes, there are things that we can do, but I feel like advanced practice is being applied to things that exist within our midwifery scope. And so not being able to find someone to supervise them to get their sutures you know supervise their suturing or their cannulation or their water births so they're just they come in with these aspirations of the midwife they want to be and that isn't able to be realized because the system can't support it to be realized like it's almost like a self-fulfilling you know the serpent eat in its tail, it's the self-fulfilling prophecy that if we don't resource the system with the adequate staffing and the adequate culture that supports growth, the realization of the capacity of midwives in this early phase that is going to continue to strengthen them as they move through their career to have sustainable and nourishing and enriching, enduring careers, we will never realize that because we've clipped those wings so early
Mel:
[20:39] And the number of stories I've heard from students who work hard through their student years, and if you're a student listening to this, I do feel like your hardest years as a midwife are the student years. So if you're already thinking, oh my gosh, if I can't do this, how can I do midwifery? It does actually get easier, is my first thing that I want to say. But these midwives come out with plans to work to their full scope. They want to work in MGP models. They want to work in home birth models they want to enter into leadership and academia and all these things and they've got high hopes and bushy tails and they're super keen and then I hear from them over and over again oh no, that yes they're hiring for MGP positions but they won't accept new grads or I desperately want to work in MGP there are spaces in MGP and I can't get that job for whatever reason, and there's just so many barriers to them entering into a job that lights them up and that they're qualified for they're kind, of almost forced through this initiation of the fragmented system of like first if you can survive this gauntlet we will give you the, opportunity to work in the capacity that you truly want to work in as a midwife, but then the midwives burn out before they get an opportunity to fully realise their career dreams.
Lynnelle:
[22:06] That absolutely came through in this research, Mel, and also it's what I hear all the time through Vaginal Club. It is so important and I feel that if we're asking midwives to train in a fractured system, In preparation for working in continuity, are we really giving them the skills they need to work in continuity? Are we giving them skills that they are going to need to really, you know, unpack and unlearn to work in that model? And I would like to see it, you know, if we better resourced all aspects, all models of care and actually built in scaffolded, supported pathways to practice into all models and all aspects of the childbirth in continuum, then we would be able to better support people transitioning into practice. Yes.
Mel:
[22:57] And it's also really, really possible. You know, a lot of people are like, oh, that's a big job. But actually, if there's anything we learned from COVID times, it's that entire systems and entire countries can pivot within a day or within a week towards a unified goal. I do believe that if we had the intention of improving the maternity care system for both midwives and women, that we are completely capable because we saw it in action. We saw immediate and sweeping change happen in the face of a crisis, yet in the face of a midwifery crisis or a birth trauma crisis or, you know, an over-medicalisation crisis, there seems to be reluctance to change the system. Linnell, do you feel like you've adequately captured the landscape and the current issues that are happening in midwifery and maternity care at the moment.
Lynnelle:
[23:52] What would I add to that? I think the experience of midwives moving into the dominant systems at the moment find that the hierarchical structures are very challenging and so that they feel, you know, we've spoken so often about The care that midwives provide and having that autonomy to practice to our professional standards, to know when it is time to, you know, what are the points within the care that trigger consultation and collabouration. And so the respect, I guess, the mutual respect that we need to practice to our full scope, that's missing currently from the landscape. And so I feel like those multidisciplinary relationships are a big factor of why people are also leaving. They're not being able to realize those to their full capacity. And it's working against midwifery rather than how it is designed to work, how it should work, I believe, you know, to enhance the care that people receive rather than continue to or enhance the fractured nature of the care that's received.
Mel:
[25:06] Have you come across a global example of where, of a system that's doing it well that, you know, that we could literally look to and model off?
Lynnelle:
[25:15] Basically, those, interestingly, often came from smaller services or smaller work teams where the midwives got to enjoy a flatter hierarchy, got to know the medical team, the obstetrician or doctors that they were working with and that were supporting that team and the midwives were supporting. So there was this very beautiful intersectional dynamic, a valuing of each other, a valuing of each other's roles, a respect, acceptance and acknowledgement of those roles and of that scope, and a really sense of dependence and value that existed amongst them. It was strong midwifery leadership in those services. And so there was a real sense that the midwifery leadership was there to advocate for them, that there was an open door, you know, that they had access to the supports that they need. They had regular clinical reflection. And I think clinical supervision and reflection can be a scary term for some people. And they think, oh, it sounds like, you know, we're being governed or we're being surveilled. It's, you know, when you read and understand what that is and experience it, that's when it's offered in a very safe way.
Lynnelle:
[26:33] It's recognising what went well in our care and what's going well for us in our midwifery or what isn't and how can we bridge that gap and how can we get the resources we need, you know, to develop that skill or that insight and knowledge. So it's about growth and not blame.
Lynnelle:
[26:54] Again, the things that made those workplaces and work teams function so well, there was a culture of growth and not of blame or fear. So the team felt that they could talk about their weaknesses or talk about things that they felt that didn't go well in a very safe way and that everyone could gain from that sharing. So, yeah, I feel like it's so clear what works. And I think what also works is having those strong midwifery networks. So, not only interdisciplinary, but interdisciplinary and being able, they were supported to practice to their full scope and had trust. Trust and respect was massive. And I feel like the midwives I've spoken to that that midwives will leave if they don't have that they might leave the profession but they will leave the service or the team and they seek it out and when they find it there's this sense of I'm one of the lucky ones and that's so sad Mel it shouldn't be the exception it should be the rule but midwives are just feeling that when they find it they cling to it yeah and that there was something that was very sad about that I mean I was happy they found it and but it's just well this this has to change because this needs to become the rule and not the exception
Mel:
[28:19] Well let's talk about your research then because this is what you were trying to focus on you saw this problem of the workforce problems and the issues for midwives and tell us about your research, We know what inspired it, I guess. The problem is always what inspires us, the research. Yes. And then you wanted to find workable solutions to these issues, and you were focusing on midwifery sustainability. So tell us about your research,
Mel:
[28:49] what you found, because you found solutions.
Lynnelle:
[28:51] Well, solutions are still being versed, Mel, But my research, I was so lucky also to find the most phenomenal team of supervisors who have supported me to explore this question. So my question is, how do professional connections and relationships impact midwives' well-being and career sustainability? It's a grounded theory study. And so I'm supported by Professor Sarah Bayes, who is a grounded theory expert, an amazing midwife.
Lynnelle:
[29:25] Sarah is one of those midwives. She lifts people up. She just brings the most amazing, aspiring midwives to her, and she does this beautiful mentorship with them. I just read a paper the other day about intentions to stay in the profession, and Sarah was a co-author. I wrote to her and said, this is such a beautiful piece. She said, oh, yeah, this is by one of my PhD students and, you know, she's just doing such phenomenal things. So Sarah is one of those amazing advocates in the profession. I'm also supported by Professor Kim Foster, who is a mental health wellbeing expert and resilience topic expert. She's phenomenal. And Amanda Singleton, who is the CEO of the Nursing and Midwifery Program, Victoria. So a support service for midwives. So feel very lucky to be supported by them across this journey and to go so deeply into this topic where I got to speak with 32 midwives across Australia working in all models of care in lots of different practice settings. And I looked at that, their experience and looked at it across their career stage. So I looked at early career midwives, mid-career midwives and late career midwives and looked at their significance of relationship to them as it spanned across their career. And I wanted to do that because I wanted to understand the
Lynnelle:
[30:53] What the differences were for those midwives and what the vulnerabilities were for those midwives in those particular sort of points of their career. And I wasn't sure if there were differences, but as it turned out, there were significant differences. Many categories came from this research and many understandings that some things
Lynnelle:
[31:17] were affirming what we already knew, but they were definitely novel key findings. And one of them, you know, we know there in midwifery there's a tribalism that occurs and there can be a very strong us and them mentality between midwives and obstetricians. But this research really got deeper into that and it unearthed the existence of that tribalism and what is defined as toxic tribalism, not only between doctors and midwives, but looking at it also within the profession of midwifery. There was a very pronounced dissonance that could occur and existed between core midwives, so hospital-based midwives and continuity midwives, or hospital midwives and privately practicing midwives.
Lynnelle:
[32:07] Also looked at that within places, you know, the areas of focus. So birth suite midwives to postnatal midwives or antenatal midwives feeling very estranged from all aspects of the care that's being provided. And one of the participants who was a private practicing midwife who had worked in all many different models in their career, but was now working as a privately practicing midwife had this beautiful reflection when she looked back she said it's only when we're separate that we lose our power and she talked about the othering that occurs in midwifery and it was like okay we have a strong identity but when that strong identity is causing harm to the profession we need to recognize that and we need to look to solutions and look at ways to find connection with each other find appreciation find respect and all the things that frustrate us about dissonance in relationships and things that impede our care we also need to reflect as a profession and go oh actually are we doing that to ourselves and how are we disempowering the profession if we're not appreciating the work of each other and finding connection
Mel:
[33:26] Yeah i wondered if that terminology of toxic tribalism, was something that was generated through your research or are there other references to this sort of culture of tribalism or what you've discovered to be toxic tribalism where, you know, I guess midwifery cliques get formed. It sounds like a relationally hostile situation.
Lynnelle:
[33:52] Yeah. It's not unique to my research, but it's been amplified by my research. And this is something that, I mean, from the UK, you know, when we look to the recent reports from the UK, there was a really powerful piece just published, I think, last week about the
Lynnelle:
[34:13] Dysfunction of tribalism and factionalism within midwifery as a key finding of those reports that have come from the Okunen. And I must report. So, it's really prevalent and it's been recognised as a key issue in workforce culture and translates to the provision of care and adverse outcomes. So, it will be a much greater focus going forward, I believe. And I think that our research contributes to that. But I think what is unique to our research is it's focusing on the intra-professional dissonance as well as the multidisciplinary dissonance that would occur and the impacts of that. But the term toxic tribalism, I first saw it referenced in an editorial piece and haven't seen it referenced much since, but it was by an author, Wilkinson, who wrote this amazing piece about cliques and, you know, how
Lynnelle:
[35:17] These can be protective as well. And it's a very human quality. We know it's well-researched that we always, we seek to belong to communities and that's a very human quality and trait and attribute. So it can be highly protective and it is in other aspects of my research. It looks at the protective aspects of those communities and networks. But in this particular category, it's seen more to be something that interrupts They experience our feelings of belonging.
Mel:
[35:53] I mean, I've experienced it. Even as a private midwife, I think all midwifery cultures and contexts have an element of tribalism, which in itself might be, as you said, protective, and it becomes unproductive and unhelpful when it becomes toxic, which, again, I've witnessed the full array even within the home birth community, and in the private midwifery community. But even as a student, I was literally told face-to-face, by a midwife. Oh, by the way, midwives eat their young.
Mel:
[36:27] It was kind of like an FYI, just so you know, this is not going to be easy for you. And it feels very much like being back at school. It's like the schoolyard culture has entered the workplace. And sometimes that comes from leadership. Sometimes that comes from this pool of other clinical midwives. It sounds like this is what your research has highlighted, that this does exist. And what's comforting to me is that you've named it because there's a collection of midwives who just can't quite put their finger on, like, what's wrong with me? Why is this so hard for me? And the other terminology that you've brought out in your research too, you know, the element of moral distress, but again, the impact of toxic tribalism as potential reasons why you might not be coping with the work of midwifery is not because of midwifery. It's because of this damaging and hostile context.
Lynnelle:
[37:34] Absolutely. I think one of the other key things that it unearthed was the underutilisation and undervaluing of the elder midwife. And I feel that this is something that when I spoke to the early career midwives,
Lynnelle:
[37:53] It was something that was so pronounced for them because they were witnessing what was happening and the treatment of the senior career midwives in their workforce and their workplaces. And there were cultures where these revered midwives in their space were sort of, they described it as being sent out the tradesman entrance or the tradies entrance. And it was so heartbreaking. They said, you know, they were there and then they weren't. There was no recognition of their service. There was no celebration of their service, you know, from the institution or from the service itself. You know, and they said, why would I give my years to this place if that's how you're treated at the end of your career or after 40 years? So it was this real modeling that was signaling to them, our work is not valued. And that was a big red flag. That was just very stark to hear.
Lynnelle:
[38:54] And I really, you know, wanted to capture that. And I was grateful to capture that within, you know, that these midwives were felt that they shared that aspect of their observations and their experience and what it meant for them in their profession. And certainly, you know, the mid-career midwives I spoke to as well, that was something that came up persistently for them. And, you know, when we...
Lynnelle:
[39:24] Are experiencing such a deficit in mentorship and such a deficit in being supported to practice to our scope and to honour the midwifery, to not utilise these skills and this knowledge is just so, it's such a missed opportunity. And so that came up again and again in the stories and experiences and observations across all cohorts. it sounds like
Mel:
[39:51] The midwives were like desperate for the knowledge that like the wisdom that, experienced midwives had but there was no pathway to access it and then it was clear that the workplace didn't value those midwives skill and knowledge in the same way that the early career midwives did I mean this is society too though I feel like, our respect and honoring of, wisdom that like the wisdom of years is being lost that we actually, are having trouble as a community and as a society digesting the quality of information that comes from experience, but that way of communicating and that kind of knowledge I feel like it can't be shared in like a 15-minute seminar of like top 10 things to do for this we have to slow down and sit and listen and fully understand, the quality of like words from from wise people like long career midwives and I always feel like as a society, we've lost the ability to like listen for a bit longer, that could be me Yeah, I'm just on my high horse here about the value of ancient wisdom, you know, that we're almost losing the capacity to even grasp it.
Lynnelle:
[41:15] So I think you're right, Mel, but I also think it's bi-directional, right? So what the early career and new midwives, student midwives and new career midwives have to gain from elders, the elders also have to gain, you know, have a lot to gain in terms of from those coming into the profession, because it's just bi-directional. It's like this beautiful organic exchange. And that's something that I see. I saw it at the Convergence, I see it in the journal all the time. One of the recent journals we had, there was a new graduate who had just been a grad. She was two months into her grad year and they found themselves sitting next to a midwife who was 47 years into their career and it was so beautiful. It was just like it would so rarely happen that they would find themselves next to each
Lynnelle:
[42:13] Yeah, I just feel like that cross-pollination is really important. And I think that it's sort of energy-giving, you know, when we find out what we each need to sustain. You know, it's not the same for everyone. And we just put all our things into a pool and we can all draw from that pool and be energised by one another. And I just think that's really important. Otherwise, we get into our echo chambers, don't we? And if we're locked into just, if our community just mirrors each other, it's stagnant. It's stagnant in a way.
Mel:
[42:52] So what did you discover then? If we can give us five, I'm just about to get you to summarize your years of wisdom into a few short minutes. What is the solution then? We know that we've heard the problems. What is the solution to the issue of midwifery sustainability, like the lack of midwifery sustainability? How do we sustain ourselves as midwives, to keep going, but also like to actually love the work?
Lynnelle:
[43:23] Mm-hmm. Okay. First of all, I'm going to say we have to develop these solutions with midwives. So by midwives, for midwives, we need to speak to midwives across all career stages and ask what they need. And respond accordingly. And so that co-design is so important. Next, I would say workplace cultures and work team cultures The emphasis has to be placed on creating environments where midwives are safe and midwives can flourish and practice midwifery. That is not easy and that's going to take a lot of work around, you know, at a government level, at a policy level, political level, at a system level, an institutional level. It's about
Lynnelle:
[44:15] Pre-registration, midwifery training, starting to talk to midwives about what to expect in the workplace and how to advocate within the workplace. It's about workplaces providing environments and leadership that cultivate professional relationships and cultivate safe work environments. And that comes from the top down. It has to be modelled, it has to be supported and it can't happen overnight i understand it's it's slow change is going to be slow it's looking to what works well in other not not only health settings look to what is so often known about the value and importance of interpersonal relationships in a workplace to productivity and to all of those things this is not new knowledge but it's just so often not applied in a health context. So we need to start prioritizing professional relationships and connectivity within the workplace. And that is a workplace cultural issue. We need to look, support midwifery leadership.
Lynnelle:
[45:24] And so that's supported pathways in midwifery leadership. And that's strengthening midwifery leadership through training, through mentorship, through, you know, ongoing reflection and supervision. We need to recognize and utilize late career midwives. And there's many ways that can be done. Lots of the things that aren't working are modifiable.
Mel:
[45:47] Yeah.
Lynnelle:
[45:48] Looking at ways midwives are working. Midwives are wanting continuity of work teams. They want to go into workplaces and not be moved at the last minute. So just these basic frameworks that can provide certainty and stability for midwives working. They want to know who they're working with, who their relationships are, who their work teams are, and have continuities they can develop relationships with those work teams. And obviously, that's going to strengthen their ability to perform their role. If there is respect, trust and acknowledgement for their role, that is going to also infiltrate into the standard of care and the experiences of care that women and people experience.
Mel:
[46:34] I'm hearing a lot of like, yes, absolutely great ideas and great solutions. But unfortunately, they rely on other people making, changes that impact us as individual midwives so I mean one of my and I hope and maybe you'll get to it in a second, but one of my I'm hoping please Linnell tell us what we could do on an individual level because there's going to be midwives listening going oh I'm not sure that all of that change that needs to happen is going to happen within my career so now we're still looking down the barrel of how do we survive this scenario yeah do you have some, individual options for each midwife i.
Lynnelle:
[47:17] Do but i also you know as i said at the start mel you know the solution is to the problem it so often falls on the shoulders of midwives and so that's why i will get to it. And I do have strategies to support midwives, individual midwives, and also, you know, those entering the profession, those studying the profession. But I would just say the emphasis really needs to be on system change. And we can be part of that system change by advocating and demanding for that system change. So that's why I want to emphasize those institutional changes and priorities
Lynnelle:
[48:03] that should exist, and I hope will exist. From an individual level, I think for us, I think this research amplifies the fact that relationships are central to our sustainability. Our connections between midwives is essential for our sustainability. So I would say
Lynnelle:
[48:26] Developing your midwifery network is critical and i would encourage people to not just create that network that is like i said mirroring yourself to throw the net wide and to try and you know gather
Lynnelle:
[48:43] Midwives that you respect that you see something in their practice that you you want to glean from you know that that you resonate with um that you aspire you know towards and and try and form a relationship with them it's really difficult when the time pressures exist there are so many barriers but if we just reach out to one another and to try and seek communities that exist already so look at what is happening with the Australian College of Midwives in your area or the professional peak body that exists within your area. What are community midwifery networks? A virginal club, a convergence of rebellious midwives. So find existing communities and see if you can connect with them. You know, I mean, social media is amazing in terms of identifying networks and seeing if there are online meetups that you can be part of. You know, the student communities, we speak to our students all the time about this is you're already you know surrounded by very you know there are like-minded midwives around you you know build your your support network now it starts today yeah
Mel:
[49:57] So essentially you're saying make a wide network of friends who are also midwives, and find them anywhere. They don't have to be in your actual workplace or on your actual ward. They need to be in your orbit. But I think that's an individual action that we can all take, even if nothing changes around you. To recognize that you need something that is going to sustain you, that that sustainability is not inbuilt into the system. And if you want to survive, you've got to make good friends within the community. And like you said, the Va Journal Club is an opportunity. The assembly is an opportunity. The convergence is a place to kind of find people. Yeah, there's lots of different branches, community groups, Home Birth Australia, the maternity community, consumer groups. There's lots of pockets of people who are doing the things that feed the system positively. So, yeah, doing that collectively. If you take nothing else away from this conversation, it's that point.
Lynnelle:
[51:08] But also, you know, extending that a little bit and going, okay, you know, we've got this community. What can we do about it? And having that solution focus. So then you start to mobilize and then you start to write your letters, you know, or meet your MPs or meet with a unit manager. What do you need in your workplace to make it a better workplace for you? And I think once that traction starts, it's like it has to come from midwives who are in the environment realizing the midwives know the solutions. And so actually advocating for that change within your workplace will make it a, you know, the more the merrier as well. So if you can mobilize and galvanize to meet with unit managers, meet with midwifery leaderships, meet with directors of the service, advocate for the change from within.
Mel:
[52:04] And if you see someone, this is the other thing is if you see someone doing amazing work, you don't have to do the amazing work. But if you get behind them, all of a sudden you can amplify the amazing work that they're already doing. And that's a really meaningful contribution to make. So even if you're that person that says, mate, that policy that you wrote or that thing that you did, that was epic and, you know, I'm behind you. That's a simple thing to do. The other thing that's the flip side is to not be a contributor to the problem. So if you've identified and reflected on your own behaviours or maybe the behaviours of your tribe is are you contributing somehow to a toxic workplace? Are you, you know, speaking badly about people or leaving somebody out? Or is there something that you're doing that could be very quickly and easily modified that if upon self-reflection you're like, hmm, maybe I'm part of, some of the problems that you're talking about, I think could also be a really effective way of enacting,
Mel:
[53:12] more systematic change as well.
Lynnelle:
[53:14] I totally agree. And I just feel like one of the other things I'd just like to end with, Mel, was from the late career cohort that I spoke to, what I noticed from them was this, you know, one of the categories that emerged from that was flourishing politicism. Like so there was this fire and they had engineered their career pathway not out of trying to move out of clinical to escape from the hours they had engineered their career pathway to fight for the profession of midwifery to protect and preserve it they were phenomenal right so there was this politicism that was a deep desire from the early career midwives i spoke to but they didn't feel like they had the community or the networks to be politically or to agitate for change. And so...
Lynnelle:
[54:05] There was a direct correlation with the strength of your midwifery network to your feeling that you could affect change. The stronger the network, the more powerful you felt to change and improve things for midwifery, which is a problem when the early career midwives are feeling really isolated and disengaged and disassociated from the profession. So what we need to do is build that community around our early career midwifery workforce. So that we can strengthen their ability to affect change and really elevate their voices because we need to bring them into the next phase of their career journey. And that will ultimately strengthen and benefit the profession as a whole. It's just essential. It's a self-fulfilling prophecy that we need to do that.
Mel:
[55:00] Well, it plugs the hole in the bucket, doesn't it?
Lynnelle:
[55:02] Yeah.
Mel:
[55:04] It means that they stay. It means that they can stay in the career that they, you know, midwives want to love their work. What I've seen over and over again is they desperately want to love it and be sustained in it.
Lynnelle:
[55:17] And yeah, it's, it benefits everyone. I was just going to say, could we put some links to some beautiful resources?
Mel:
[55:26] Is there more, before we go there, is there more that you want to say about,
Mel:
[55:32] midwifery sustainability that you've learned from your research?
Lynnelle:
[55:35] The grounded theory that came from my research is that, let me just have a look at it. It's connection, relationships and community, sustaining midwives, sustaining midwifery. That is, it just sums it up, beautiful one. I mean, our relationships with one another are central to our sustainability and we can't emphasize that enough in terms of preserving that, cultivating that and really looking at the generativity that exists within that across career stages, you know, from students to those transitioning into practice and to the elder midwives as well. We all need each other.
Mel:
[56:20] That is the golden nugget for anybody who's unaware of grounded theory research, because my PhD was grounded theory. Basically, you gather together all of this knowledge through interviews and, other range, depending on how you're gathering information. And once you've looked at it all in detail through all these little different techniques, you come up with an overarching theory that's grounded in the data that you collected. So, Linnell, you're – and then you do, you try and bring it into this one sentence, which you have. So, Linnell, just for everybody listening, this is the golden nugget about midwifery sustainability. Can you give us your grounded theory one more time?
Lynnelle:
[57:03] Connection, relationships and community, sustaining midwives, sustaining midwifery.
Mel:
[57:10] Amazing. Thank you, beautiful. Oh, my gosh. Yes. We just have to find community groups, build relationships, and it's the key to sustainable midwifery. It's what will filter through to the rest of the solutions. And we have, as with every episode, we've, a resource list for this podcast episode and i have put Lynnelle's papers some of the background papers as well in any links Lynnelle that you want to share, will you can put them in the resource folder so if you want to get access to that it's you just click the button on my website at melaniethemidwife.com to join the podcast mailing list and then you get access to the podcast resource folder which is a treasure trove of research and resources from every single episode including this one.
Lynnelle:
[58:00] Beautiful thanks so much mel
Mel:
[58:02] Thank you for speaking to us about this such an important issue because without midwives there's not midwifery and there's not mid maternity care and everybody suffers so we have to look after midwives and that's what your work, is about academically but also so practically and clinically Lynelle thank you for being a gift to the midwifery profession and you are part of my network we are going to keep each other going yeah Yeah.
Lynnelle:
[58:28] Thanks, Mel. Likewise.
Mel:
[58:30] Thank you, everybody, for joining us on today's episode of The Great Birth Rebellion podcast, and we will see you in the next episode. 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.
©2026 Melanie The Midwife
