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Midwife Gayle Gugerly tells us how her role as a midwife in Oz differs to her employment experiences of UK healthcare
Before I begin I should point out that I am currently working in a private hospital so this covers my experience there.
Working as a midwife in Australia is different in a number of ways. Obviously, women need the same kind of care and support throughout pregnancy, labour and postnatal so it is not difficult to transfer the skills.
In the unit that I worked in in the UK, an Obstetric-led unit, the midwives had far more autonomy than they do here in Oz. They were the lead health professional and women generally only saw the doctors if there was a deviation from the norm or a problem, actual or perceived. Otherwise, the midwife would provide the majority, if not all, of the care, perhaps with some consultation with the doctors.
Here, however, the midwives have less control and tend to work under the instructions of the doctor. Midwifery is more 'medicalised' here than in the UK and the rates of caesarean sections, epidurals and instrumental births are much higher. The care pathways in Australia are very standardised and do not really encourage individualised care nor encourage midwives to use their skills and training in many areas, particularly in assessment and decision making, to the degree that they are required in the UK. Here, the obstetrician is the lead professional and they appear to dictate what happens at each step. For example, all women stay in hospital for four nights for a normal birth and five nights for a caesarean section (CS). If they want to be discharged with their baby before that time, this has to be signed off by the obstetrician and the paediatrician.
In my unit in the UK, midwives could discharge women who had had normal births without consultation with the obstetrician and the baby's paediatric check could be done by the woman's GP. For CS births, the woman was usually seen by the obstetrician the day following the birth and, providing they had no concerns, the woman could be discharged at the midwife's discretion in the next three days. During labour here, the midwife gives the majority of care under the direction (usually by phone) of the doctor but the obstetrician generally arrives to deliver the baby. In my UK hospital, the doctor only attended the birth when there was a potential problem. Midwives in the UK check the baby over when it is born, and some are trained to do the paediatric checks. Here, all the checks are done by the paediatrician.
There are areas here, however, such as breastfeeding, where there is much better support of women than in the UK, particularly with the existence of lactation consultants on the wards, giving individual support as well as running daily drop in sessions for in-patients. As a result, the rate of breastfeeding in Australia is far superior to that of the UK, since the midwives are able to support the women 24 hours a day as inpatients, whereas the women would have been discharged much earlier in the UK, with limited community midwife support.
The working hours are similar with some midwives choosing to work 12-hour shifts rather than eight hours. Midwives can request to work in different areas, including the special care baby unit. Induction to the job is brief, lasting only two or three shifts although in the hospital where I work, all staff have been very helpful and supportive in helping me to settle and adapt. There appears to be a good team spirit on the ward and relationships between doctors and midwives/nurses seem to be effective and relaxed for the most part.
Although, just as in the UK, there are staff shortages here, there is generally a better staff/patient ratio than in the UK and more willingness to arrange agency staff if required (although this could be because I work in a private hospital and therefore funds are available). There is mandatory training to fulfil registration and employment requirements; however, this does not include some of the obstetric emergencies that are mandatory in the UK and a midwife needs to be quite proactive in ensuring she is given the opportunity to attend training that she feels she needs.
During the interview, I was told that the hospital has a good fund for any relevant training that employees may wish to apply for (again, probably a benefit of working for a private hospital). I have had problems in finding suitable childcare (in other words, available for the extended hours needed to do shift work) and I have found my hospital to be quite flexible in respect of this. There is no midwifery supervision in Australia as in the UK so any practice/training concerns, problems, etcetera, would be taken to the nursing unit manager (NUM), out of hours manager or midwifery educator.
All in all, my job is quite different from my one in the UK and I would say that I feel more like an obstetric nurse than a midwife. However, I am sure this would vary from unit to unit and between public and private hospitals.
To find out about working as a nurse in Australia, New Zealand, Canada or America, pick up a May 2009 issue of Emigrate magazine – available at many good newsagents and retail outlets.
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