Episode 3 - Different Roles of Obstectrican's, Midwives & Doula's
We interview Jan Ireland, Midwife veteran and legend, and founder of MAMA Melbourne. Jan helps us to understand the different roles of an Obstetrician, midwife and doula, so as to help you choose the optimal birth care team. She also talks about the changes to pre and postpartum care during the COVID19 crisis.
You can find Jan and her wonderful team at:
[00:00:00] Welcome to the Mama Matters podcast, whether you're expecting you've recently given birth, or you’ve just chatting along your fertility journey, it’s time to get down to the nitty gritty and sort fact from fiction. I'm your host, Rosie Dumbrell, physiotherapist and pregnancy expert. Mama Matters aims to provide an easily digestible, up to date and evidence-based approach to pregnancy, birth and motherhood with a side dose of humour along the way. With interviews from the industry's leading experts and experience of my own adventures as a mother to three gorgeous boys under four, I want to share the stuff that helps to bring confidence throughout motherhood. Mama Matters is a podcast by Lenny Rose Active, and this is what you can expect to hear in upcoming episodes.
[00:00:40] I like the word ‘undisturbed” birth. This is nothing about not making noise, it’s about the woman feeling free to do what she has to do to pick up her baby at the end. It's waiting, waiting and then waiting.
Welcome back. Welcome to Episode 3. I can't believe we are out there already, but I really hope you found the information in our first couple of episodes supportive of your journey throughout this time. We are chatting today about ante and perinatal care and there is still a small flavour of COVID19 and how antenatal care is affected in the current situation.
[00:01:23] But really the M.O. behind this episode was to really help you to understand all of the different roles of the caregivers that are available to you throughout the pregnancy to birthing journey. And it really is my mission to help provide the most up to date and relevant information for women throughout the pregnancy to motherhood journey. So I really hope that this episode contributes to that for you. One of the most amazing things that I did through all my pregnancies was to have the support of a midwife.
[00:01:52] And we also had an obstetrician, the amazing guy Skinner, who you can hear from in the first episode. Not everyone is lucky enough to be able to choose to have both in the private setting. And so regardless of whether or not you are private or public with your care. I wanted to encourage you to understand the different caregivers that are available to you, their roles and also to shed some light on how the support roles and level of care is affected with the current pandemic situation. I interviewed the legendary Jan Ireland, founder of Midwives and Mothers Australia, a veteran midwife and devoted mother and grandmother.
[00:02:31] Thank you so much, Jan, for joining us today on the podcast. And probably your biggest fan in life. I'm so happy you are here, And yes, I really, really appreciate you taking the time to chat to us today.
“Total pleasure, Rosie.”
[00:02:47] I just am like, do I have to have the fourth baby so that I could hang out with you more?
[00:02:52] Or do I just start a podcast ?
Thankyou for you including me, not sure you should have a fourth baby just to see me.
[00:03:04] Well, you know, I have conceded it's not off the cards! So I would love you just for our listeners to explain the role of the midwife and how that differs from the role of an obstetrician. And perhaps also to touch on the role of a doula. I think that women often do sort of maybe, you know, go into a model of care that, you know, mimics what their best friend is done or, you know, that perhaps, you know, just kind of think that's the way they should go. But they might not have explored options and understand the different and discreet roles that are available to us along the journey.
[00:03:36] So I think that the obstetrician, the midwife and the doula, they have closely related roles really. And I think the informed choice of educated women often does consider her roles today. And it's interesting, those different professional people anyway. First of all, I'll talk to you about the obstetrician and the doula and then about an obstetrician. An Obstetrician, by their own admission - they've become a doctor and medical person and then that becomes a surgeon. Just like you would expect the chef to be able to cook a good meal, you'd expect a surgeon to be able to do a good operation. And when someone goes to an obstetrician for the birth, it sort of puts a flavour that birth is a medical problem. Hmm. And obstetricians, mostly wonderful people, but they will solve a lot of problems to do with birth by surgery. That's just a plan and I understand that, as a midwife, I understand that if I had surgical skills I'd damn well sometimes use them, especially women were asking me to. I think this explains what an obstetrician is. It's a doctor who specializes in women's health, gynecological and obstetrics. Yes. So his a role in normal birth, probably is to stand back and let the midwives and their family and work out what's happening and be called in if there’s a problem. And all over the world, that’s what obstetricians do. In Australia, obstetric practice has become the norm, but 80 per cent of people who go to obstetricians are anticipating normal bursts.
[00:05:39] So Australia's got a bit of a monopoly on obstetricians being the people you go to for births, which in practice would be great if obstetricians and midwives and doulas or worked in a little team. And you only got whichever one you needed. I have great respect for them, and I use them a lot.
[00:05:57] A doula is a person who is very interested in being a companion and a help and support to pregnant women. So it's a very broad term.
[00:06:11] So I don't know one might be interested in the culinary skills with a pregnant family. One might be interested in a breastfeeding part of it. And one woman might be interested in the education of the woman for normal birth, of appearing for whatever happens. But basically they're very nice people who want to be with women during labour and birth and before and beyond and picking up whichever skill set they like. There isn't any that I know of in Australia, any registration or formal organization of doulas education wise. So it's very important to me to do that and make sure that your needs and hers are on the same page. I would like to think that a midwife has a bit of doula in her. I work with doulas, and they are heavily involved in just caring for the women to do with preparing for postpartum with nutrition and exercise and being their companion during the whole process.
[00:07:19] I think that a midwife has a lot of doula in her. But as a midwife, there are alot of organizations telling her what to do. She can't always do that. So midwives, it's a person who has trained often as a nurse and then as a midwife and to be a practitioner to look after someone through the normal process of pregnancy, birth and beyond. So a midwife should be able to have look after her own group of women who come to her and birth them wherever they want to be births. My dream would be that a woman would say, yes, I want an obstetrician or I wanted midwife and I want to have my baby at home. I want to have my baby in a private hospital. I want to have my baby wherever I want to have it. And my midwife can come with me. So that can happen in some countries. And in Australia, we're moving closer to that. So the mum and midwife are now getting bed rights at the women's hospital and rights and all the other hospitals still. I think that the place of birth isn't encouraged. What do you think, Rosie?
[00:08:40] Do you mean in choosing to birth at home?
I feel like when you choose an obstetrician, you you're choosing hospital birth. And when you choose a midwife, you perhaps have your options opened up to quite a lot more. That's kind of how I understand it to be. And I find I feel like it's a little bit sad that we don't have more birth centres and places like that, that are midwife led in Australia, because, you know, for the normal birth, you know, is there a need for obstetric intervention? But I think one thing that I'm really glad that my beautiful friend Megan recommended me to your services throughout my first pregnancy and obviously you’ve then been there by my side for all three pregnancies. But I think a lot of women don't understand that person that they have as a support person is a very different role to their primary carer, if the primary carer is an obstetrician. If that person is an obstetrician, so they're not necessarily going to sit there and hold your hand and rub your back, but they are obviously, you know, trained to help through the delivery process. But, you know, it's really, really important to have that person who can support you emotionally and a midwife, I guess, can do both of those things. That's one of the most important support structures you can have in place during birth.
[00:10:00] I think (the midwife is) the person that you know and you knows you and that's what you want. It's really important to have with you. I don't think that the midwife does very much except be there with a woman and hold space for what she actually wants. And you know, and the midwife knows what she wants and she also knows about normal births. So I would be happy to say that I know what normal birth is. I like the word undisturbed birth and undisturbed births. It's nothing about quietness or anything like that. It's about the woman feeling free to do what she has to do to pick her baby up. And part of that is waiting, waiting and then waiting, and part of medical care is checking, taking an action, producing something, quickening it up or doing something to get at a healthy, normal baby the best way and quickest way. Possible sometimes and sometimes timing has to be key to that because they're very busy. But if I say what it means to us; what my job as a midwife is, is I get to be very close to my clients and I love them to bits. I just want to be with them when they're having their babies and just making sure that they're okay.
[00:11:17] Yeah. So amazing.
[00:11:20] So amazing. I'm not sure how anyone has ever birthed a baby without you by their side.
[00:11:26] Well, I do, but I think my life as a midwife hasn't been that successful, really, because I think it's all focused on being just a midwife. I think I am a midwife. I'm defined as a midwife myself. And I think my family could give you a few points about that. And I'm sorry about that. I love to work with my young midwives at my practice and love to make sure that they're spending a sort of a balanced life.
[00:11:59] Yes. Because you really have devoted your entire life to this amazing profession. This Segways really well into the next question, which is, what is it that drives you to work so tirelessly with women? You know, you're now into your early 70s and you give everything to this profession and to the women that you work with. Then, you know, can you sort of explain where that comes from?
[00:12:24] I think I can, because in my life as a person, it's the one time when I wasn't in charge of myself or able to cope at all was when I was a very small child. When my mother wasn't around sometime then when she came, I was fine. I grew as a woman. I was very confident, very naughty and very risqué.
[00:12:52] And then the time when I was back being that very small child and unable to cope without my mother figure was when I was having my first child. And it was horrific. And I lost myself completely. I didn't know who I was. And I ended up having psychiatric care. My marriage broke up. It was shocking. And so no one actually stood up for me. Noone said, hey, let me look after you. I always meant that I will never not be there for someone. And I think it's a unhealthy passion. But it's me.
[00:13:28] Sometimes it's those sort of beginnings that drive us, you know, to be really successful and really passionate about things. So I'm sure there are a lot of women that are grateful for that.
[00:13:38] Anyway, for the psychiatric health of my clients, really, I seriously don’t mind if one of my clients had a C section, or forceps, episiotomy, all those things, if that's what they want and that's what they need. I'm not disappointed. I'm disappointed they've got postpartum depression. Or if don't reflect on their birth as having some aspects of beauty. Yeah. And I think women all through their lives are so grateful for their beautiful children that they don't talk about their feelings enough.
[00:14:12] Yeah. Yeah, it's great. Yeah. I think one of the great things that you guys do as well is carry through a woman into that postpartum period, which is so important as well.
[00:14:21] Oh, very much so. So for me, this is a very challenge, big challenge for me to sit here. My little unit here overlooking my beautiful part and not be able to go out. I have lots of my clients go past away that meet the window and say my babies want to give you a hug, but they can’t at the moment.
[00:14:44] Yes. Yeah. It's obviously for your protection.. Well, into our next question, which is, how is the COVID19 pandemic affecting antenatal care in Australia in terms of service delivery during pregnancy and then also during the birth?
[00:15:03] It's affected greatly when you're a young mother and her partner isolated from the extended family. That's enormous. So at a time when nature gives you such a joy as pregnancy, a newborn baby, the village comes to help you and you need that village to help try to it in the early stages. And mother law or that someone who comes to help you, maybe its just bringing a hot meal. And now that everyone's isolated from each other. I was talking to someone today and their dad's got cancer, and her mums looking after dad and can't come near the pregnant woman and they are selected as their support in antenatal care. Well, what we're doing is we're talking to all our clients for about forty minutes on the phone and then within 15 minute face to face with them without my gloves and a gown on. And in my clinic, there's only one pregnant woman and my midwife at the time. So, yeah, that minimizing infection, of course, is a lot of people wanting a home birth. I have to prioritize my midwives getting enough rest and also me not working the client. We already have half of our hospital births to home births now.
‘ which ordinarily b probably jumping for joy about. But it also places a lot more stress on you guys.’
[00:16:38] One of the biggest ways its (COVID19) affected things, is that independent midwives and doulas can't go in with people to hospital. There's only one person in that delivery room. Yes. We’ve quickly addressed that, now I've got two wonderful doulas who are making up an education course, and we're putting it online next week for women to be able to access to help train and supports Dads and partners. dads. So what the partners to give them some clues about what to do to support with and midwives do to help women labouring in hospitals.
[00:17:16] That's amazing. And you know, what So you say one of your clients goes into labour in hospital, but you’re not able to be there physically with them. Is there any other ways that you know. I was thinking like, could you zoom in or face time?
[00:17:32] So yes we've already done that. So yesterday I was able to send around my practice manager to someone while she's waiting for the midwives to come and then also to talk to a woman straight after the birth. But Marita, my beautiful Marita Howard midwife. She spent a day and a half at home with someone getting them into established labour, then the woman went into the hospital and she was on the phone to her most of the night and day. So the family were so grateful.
[00:18:05] I think just having that person to talk to, I think could make a huge difference even if you're not there physically in person. But at least that's one way that you can still sort of, you know, be there during the birth process to support a woman, which is really good.
[00:18:24] Well, thank you so much for sharing that. And so with the online course that you mentioned. Is there a way that we can share access?
[00:18:38] You on the website and be that need to be advertised probably on Friday and will be happening in about 10 days.
Head to the Mama Melbourne website:
[00:18:48] So you have to sort of try to teach their partners some things that the independent midwives would be doing if they could be there.
[00:18:56] That's awesome. Okay. Well, thank you so much, Jan, and I'll pop the link in the show notes to that. (see above)
[00:19:02] What an absolute wealth of knowledge Jan is and just one of the most humble, caring and devoted humans going around. So, so grateful to have been able to grab a snippet of her time, especially in amongst everything that's going on at the moment. And while she's scrambling to provide the best level of support at her and her team can, given the current support restrictions. So just such a pleasure and so much gratitude, obviously there is a lot more to be discussed around service provision in terms of the public versus private debate, what is available to you based on your geographical location. And also, obviously, one of the biggest things that will impact your service provision decisions will be around your financial capacity. So definitely we'll be delving into these in upcoming episodes. With less people at birth, helping your partner to be able to support you in the best way possible through your birth is just one of the best things that you can do for yourself.
[00:20:15] And one of the other things we'll be discussing in an upcoming episode is around hypnobirthing and I cannot recommend hypnobirthing highly enough, I have used it in all three of my pregnancies and births. And one of the biggest premises is around just really developing and building faith and confidence in our bodies innate ability to grow and to birth a baby and also around knowledge. Knowledge is confidence. And with knowledge we can empower ourselves to be able to ask the right questions and to ask for that which we need. And so not only that, but hypnobirthing also encourages us to surrender and to go with the flow. And, you know, this is now probably more pertinent than ever. We really need to be able to do this. So stay tuned for that in an upcoming episode. As always, you can contact us via our social handles
And please, if you're enjoying our episodes, please shouts out on social media using the #mamammatters. Can't wait to catch up with you soon. And stay safe. Ladies, bye.
[00:21:34] This episode is brought to you by Lenny Rose, active Australian owned three times mum and physiotherapist, designed luxe active and technical wear for the pregnancy to motherhood journey.