For many decades, midwives have been crucial to the Australian maternity care system and women nationwide. Offering support and advocating for women and their families, midwives play an important role that goes beyond the delivery room. However, the number of working midwives is rapidly declining. Data from the Department of Health and Aged Care shows the number of midwives employed in NSW has decreased every year with 555 fewer midwives in 2022 than in 2016. 

While there are several factors as to why this is the case, one of the more concerning reasons is that many Australian midwives don’t feel that the Australian maternity care system aligns with the essence of midwifery. According to a study in the Journal of the Australian College of Midwives, many midwives find it difficult to work within the Australian maternity care system’s approach to childbearing within most public hospitals, poor leadership and disjointed policy-driven medical models that force midwives to be more in-tune with the institution, rather than with the women they are working with.

Carly Facius, an Australian registered midwife, echoes this sentiment. She believes that it is becoming harder and harder for midwives in Australia to practice midwifery in the way that they know and have been trained.

“Midwifery care is about midwives supporting and advocating for women and their families… Many midwives are unable to support women in the way that they want or need because they are living in fear of retribution and constant scrutiny” says Carly.

“Many midwives are experiencing moral distress due to the emotional conflicts that come with wanting to practice in a way that is advocating for the birthing women against the constraints of the system. There are hospital policies and guidelines that are often not rooted in evidence-based research and midwives can feel trapped within these policies. It is incredibly frustrating when we know that midwives in other countries can practice without being restricted or medically dominated”.

The majority of midwives seek out the profession in the first place because they are passionate about helping women and families embark on the childbearing journey. Research shows that pregnant women working with a midwife during pregnancy and birth have lower rates of labour induction, reduced need for a Caesarion section, are at lower risk for an episiotomy and have a decreased rate of preterm birth and infant mortality. However, with anything that involves human life, there is risk and studies show that one-third of Australian women experience trauma during birth. Not only is this traumatic for the women, but midwives are suffering as a result, too.

“When midwives find themselves present at a ‘traumatic’ birth, they often themselves experience vicarious trauma or may even feel like they are a part of the trauma. Often, midwives say that they’ve seen things that can’t be undone and it can make it very difficult for them to continue practising midwifery” says Carly.

Without adequate mentoring and training, many midwives in senior and managerial positions are feeling the stress and midwives working ‘under’ them are feeling frustrated.

“There is limited mentoring for people who move into management or leadership roles (within midwifery) and often, people who end up in these positions don’t have the skillset for it. If there is someone in charge who doesn’t know how to manage people, this can impact the whole midwifery team. The work of midwives has become increasingly scrutinised and this has been very challenging for midwives who want to provide care that is truly with women. Many midwives are working and feeling fearful of being reported to bodies such as AHPRA (Australian Health Practitioner Regulation Agency) and not being able to practice what they believe is true midwifery”, Carly says.

NSW Nurses and Midwives Union Assistant General Secretary, Michael Whaites is also concerned about the lack of support and training for midwives in senior roles.

“They don’t have that skill and knowledge support around them. And that leads to them either leaving the industry or reducing their hours also” he says. “We’ve seen an absolute knock-on effect”.

Continuity of care, which is a model of care that sees the one midwife work with a woman and her family from conception, throughout pregnancy, to birth and the post-natal period has proven to work well for both the woman and the midwife.

“We have research to show that midwives who work in continuity of care experience a high level of job satisfaction and often report feeling that they’re working in a more supported environment,” says Carly. There has been a push for many years to roll out more continuity of care models across Australia and this has been very slow”.

In July of this year, an upper house select committee into preventing birth trauma in NSW was established, chaired by Animal Justice MLC, Emma Hurst. She said that a key focus would be midwifery continuity of care.

Figuring out what needs to change in the system and implementing those changes is crucial in encouraging midwives to stay in the game as well as for those interested in starting a career in midwifery. Until this is done, unfortunately, Australia may continue to see a decrease each year in the number of registered midwives around the country.