At the start of 2020 I was looking forward to the year in which we would celebrate the role of our nurses and midwives. Remember, the World Health Organisation had designated 2020 the Year of the Nurse and the Midwife in recognition of the vital importance of a strong, enabled and skilled nursing and midwifery workforce to the provision of universal health coverage across the globe.
As the lead midwife in Victoria, I know the work, impact and influence of midwives is seen and experienced everywhere. Every day more than two hundred babies are born in our state, in public and private services including hospitals, community services and homes. Some services care for more than ten thousand women each year and others care for fewer than fifty. This care is provided by a committed multi-professional workforce. Some women and babies need care from a few and others need care from many—but every woman and every baby receives care from a midwife.
When COVID hit, the rapidly imposed public health measures to stop its spread significantly impacted women and their pregnancy, birth and after-birth experiences more than I ever imagined. Women and families anticipating and experiencing one of the most exciting times of their lives were thrown into an unknown landscape. Fear, anxiety and loneliness replaced the usual joy of being pregnant and having a baby.
Pregnancy classes ceased or were delivered virtually. Women couldn’t see the faces of their midwives behind masks and face shields. Media coverage about hospital visitor restrictions began causing angst about whether partners and supporters could be present at births. What was previously so normal became a ‘risk’ and usual practices were stopped overnight. No-one had time to come to terms with these changes.
On top of the concern faced by women and families, we midwives didn’t know what was coming next. We were anxious and scared too. Would we still be able to provide the best care to women and babies? Providing woman-centred care, something we did with ease before COVID, was now hindered by an array of day-by-day—and at times hour-by-hour—challenges.
Our midwives were frustrated. They told me they couldn’t keep up with the overwhelming amount of information and policy changes coming at them. While I was thinking about the statewide impacts and those two hundred women birthing every day, the impact on midwives’ day-to-day interactions was profound. These midwife-to-woman interactions are what matters most for our profession, and our midwives saw the impacts of the policy changes on the faces of the women they were caring for every day.
Policies and plans made with the best intentions didn’t always work in practice. They often created more fear and uncertainty and took away from the unique joy of planning for and bringing new life into the world. Women needed the care of midwives more than ever and midwives needed to be able to care for women safely. Finding a balance wasn’t always easy and often a win-win situation wasn’t possible.
But maternity and neonatal services collaborated and were willing to adopt new and innovative ways of working. Our health services formed local clusters to share information and resources so they could continue to provide care across Victoria that was both COVID-safe and accessible. We embraced new ways of meeting, the virtual world becoming our new norm. While we all missed face-to-face contact, we appreciated the efficiency of having our meetings only a few mouse clicks away. A core group of us met regularly, at times talking many times throughout any given day, as we continued to navigate the changes, asking: ‘What’s next and what advice should we collectively provide to our sector?’
During the peak of our response, we also had a weekly catch-up with services across the state to hear what was working and what wasn’t and to find out about their concerns, worries and challenges. We were making each new decision through our collective experience, knowing that the impacts on women and families would be massive. We were very mindful that we were making rapid decisions and were unable to test them out with consumers. Things we didn’t think would be an issue at times became newspaper headlines.
In my role over these last three years, I have been privileged to see midwives step up, make rapid changes to their work, and pivot and adjust to ensure women, babies and families remain at the centre of care—all with kindness and compassion. As midwives, we know that women may not always remember our names, but we know they will always remember the professionalism we bring and the way we made them feel—and that is such a privilege for us.
Being a midwife leader during a once-in-a- lifetime global pandemic was never on my to do list, and 2020, without a doubt, was the toughest year of my professional career. There were many days that started and ended with tears: tears for what we couldn’t do; tears because I knew the impact of our decisions would be felt by women, their families and our communities; tears for our midwives; tears of exhaustion; tears for being separated from my kids and my family; tears for what we did achieve and how we supported each other near and far.
But at the end of each day, in the quiet darkness after the sun had gone down, I reminded myself that the sun would rise again and we would all be back at it—making the best decisions we could, with the best intentions—because midwifery is a career for life.