I first wrote this piece in April 2021, after attending the March for Justice and generally being fed up with the way women and mothers are treated in Australia. I looked for a place to have it published and didn’t find one, and so the idea of MGM was born.
In recent months, Australian women have called out the terrible treatment they experience at the hands of systems that abuse them, blame them and silence them. As a new mother, my peers and I have come up against systems that make us feel like failures. As a second time mum, I see now we aren’t failing, the systems are, and the statistics confirm it. Here I reflect on the many ways new mums are left without the support they need to thrive, despite evidence being available on how to improve outcomes for mothers, families and the wider community.
Plenty goes on before weeing on a stick. I won’t go into that here but there’s an unofficial rule, you don’t tell anyone you’re pregnant until after 12 weeks. In the first trimester, women make some of the most important decisions of their lives regarding care provision, often without knowledge of what their choices will mean for their birth outcomes. Little do they know that they could be in the one third of women who define their birth as traumatic. A percentage of these women saying the trauma resulted from how they were treated by healthcare professionals. Some experience post-traumatic stress disorder, leading to longer term morbidities for mothers and babies.
Suicide is one of the leading causes of maternal death in Australia.
Continuity of midwifery care has been shown to improve women’s physical outcomes, their feelings about their birth experience and the health of their baby. Yet this model of care is only available to 8% of Australian mothers, despite it being recommended in the National Strategic Approach to Maternity Services. The Australian documentary Birth Time, released this year, highlights our broken maternity system, citing high intervention rates and birth trauma. They urge birthing women and their allies to advocate for change.
There are also equally compelling campaigns from The Parenthood and Thrive by Five to address some of the other barriers women face, including inadequate paid parental leave and unaffordable childcare. But first there’s pregnancy and the postpartum period, often referred to as the “fourth trimester”.
The risk of losing a pregnancy is highest in the first trimester, therefore not telling is a risk management strategy of sorts. It means women experience pregnancy loss while at work, in court, on the shop floor, at their desk, and they don’t tell anyone, perhaps take some sick leave and move on as best they can.
This year New Zealand started to lift the silence, by passing laws to provide paid leave for miscarriage and stillbirth. This law allows employees to take up to three days bereavement leave if they or their partner experience a miscarriage or stillbirth. In Australia, no such leave is available. Furthermore, in Australian workplaces one in two mothers experience discrimination, while pregnant, on parental leave or upon their return to work. This fact only encourages women to remain silent.
Pregnancy is often when women see the system is stacked against them.
To access continuity of midwifery care in Adelaide, mothers can apply to the Midwifery Group Practice (MGP). MGP is offered at three public hospitals, Women’s and Children’s, Lyell McEwin and Flinders. In these programs, women are seen by the same midwife or members of their team, from their first antenatal appointment through to up to 6 weeks of postnatal support. There are also a limited number of private midwives in SA who can be engaged to attend homebirth and provide antenatal and postnatal care. Women with access to this model of care are less likely to need epidurals, to use other drugs for pain relief, be given episiotomy, an instrumental birth or caesarean. They are also more likely to feel in control during labour and birth, and commence breastfeeding earlier. This was my experience, when I was accepted into the MGP program for the birth of my second child in 2020, having had obstetric care for my first in 2016.
In MGP almost all my antenatal appointments were done at home, my pre-schooler looked forward to seeing our midwife arrive, and he got to listen to the baby’s heartbeat as I lay on our couch. Appointments allowed time to talk and build a relationship, my midwife reassured me as Covid restrictions increased, that she would be there for my homebirth no matter what. And she was, alongside her colleague and my doula, who was there to provide my husband and I with additional support. Postnatally my midwife visited daily, then weekly for 6 weeks. Meanwhile, women birthing in hospital were told they couldn’t have more than one support person, their older children couldn’t visit them, and they were worried about increased exposure risk, given most maternity wards are now largely part of bustling general hospitals, pregnancy and birth being grouped with the illness and injury of the wider population.
Currently many more women apply for MGP than can be accepted. Funding and access to this model of care is limited despite research proving that having a known midwife saves the health system money, as well as helps protect women from birth trauma. Instead, many women won’t know the people attending their labour and birth, one of the most intimate experiences of their life.
There are men who won’t do a poo in the office toilet due to privacy concerns, and yet women are expected to dilate to a level that facilitates the birth of their baby while strangers walk in and out.
What happens after birth impacts outcomes too, instead of feeling part of the community many women report feeling isolated when they become mothers. When my mother had her three children in 1980’s Adelaide, a lengthy hospital stay was mandatory following birth. During this time the midwives taught mums (and some dads) the basics of baby care, your breastmilk came in and you learnt to breastfeed with the assistance of midwives and alongside fellow mums. My mum made friends on the postnatal ward and continued those friendships throughout my childhood. Mum also visited the local Child and Family Health Service clinic, which now sits boarded up a few streets from my childhood home since these services have long been centralised, taking them out of local communities. Further rationalisation continues, the bustling Norwood clinic and most recently Sturt Street closed. The opportunity to meet local mums keeps diminishing, leaving many isolated and at risk.
One in seven new mothers experience mental health issues. Without local networks they can and do fall through the gaps.
Once I got home from hospital with my first son, there was next to no professional support. If I wanted to access services, I needed to take my bleeding body and my constantly feeding baby somewhere to get it. I didn’t see my obstetrician again until my 6-week check-up and then I was only really asked whether I needed contraception advice. This is standard postnatal care, even for those who have had a c-section. If a footballer injures their knee, they are offered extensive follow up and a rehabilitation plan.
Despite the feats women’s bodies undertake in pregnancy and birth, women’s health physiotherapy isn’t covered by Medicare and if you’ve seen a physiotherapist during pregnancy, it’s likely your private health insurance visits have run out postnatally. In France, women are automatically referred to government subsidised pelvic floor rehabilitation programs. There have been campaigns in Australia for our system to offer similar support, so far to no avail.
Breastfeeding has become a loaded term these days, despite it being the biologically normal way to feed a human baby. The benefits to mum and baby are numerous including less infections for baby, and reduced cancer risk for mums. Our most recent statistics, from the 2010 Australian National Infant Feeding Survey results, indicate that 96% of mothers initiate breastfeeding. However, at 3 months, less than half of babies are still being exclusively breastfed and less than one quarter at 6 months. Despite the long awaited 2019 Australian National Breastfeeding Strategy proposing a national monitoring system for breastfeeding rates, we don’t track rates in Australia and many strategies to increase rates remain unfunded or underfunded. We know breastfed babies save the health system money and are better for the environment, yet still there is limited support. Without the assistance of my husband, midwifes, my GP/lactation consultant, the Australian Breastfeeding Association and paid parental leave, I would not have been able to reach my breastfeeding goals. For me breastfeeding has been the hardest and most rewarding part of early parenting, and it would have been impossible without support.
We all need to acknowledge that improving birth outcomes, and breastfeeding rates, is not the responsibility of individual women. It is a public health challenge shown to be worth investing in.
Paid parental leave is one of the policies that supports increased breastfeeding rates, and better overall health outcomes for parents, yet Australia has one of the least adequate statutory paid parental leave policies of OECD nations. The Parenthood have outlined a strategy to make Australia the best place in the world to be a parent. Amongst their priorities is a call on government to fund one year of paid parental leave, equally shared between parents. This would bring Australia more in line with some of the best performing countries for parents and children, like Germany and Norway. Additionally, flexible work is being championed.
One of the perks of birthing during a pandemic, was that working from home became the new norm. When my first son was born, my husband was regularly travelling overseas for work and was denied access to regular work from home days when he requested it. This time having him home to hold the baby for a couple of hours a day while he worked, made a world of difference to my recovery. Care patterns are established in the first year, therefore it’s important that flexible work and paid leave be made available for both partners so parents can share care. Otherwise, gendered care patterns continue to perpetuate.
Another factor that keeps women from returning to paid work is the cost of childcare. In 2020 parents of Australia experienced the utopia that was free childcare. The fact it took a global pandemic to prompt this change is unfortunate. The research regarding investment in childcare and early education is clear, it helps kids, mothers and the economy. Australia has the fourth highest out-of-pocket childcare costs for families among OECD nations. Expensive childcare is a barrier for women’s workforce participation, as is an undervalued and underpaid childcare and early education workforce. Advocacy organisations including The Parenthood and our former Premier Jay Weatherill’s new gig, Thrive By Five, call for action. In Victoria, the state government have responded by investing almost $5 billion over the decade to fund care for three years olds. No such commitments have been made in SA. The 2021 Federal budget has increased investment in early childhood but not anywhere near the levels needed to make structural change. Additionally, the benefits don’t begin until July 2022, which isn’t much help to the many parents reeling from the impact of Covid.
New mothers don’t need to be told to lean in, we don’t need a summit or an inquiry to tell us what we already know, the research is done and it’s clear. We need action.
Here is a starting point…
(1) Funding to improve access to continuous midwifery care, preferably a system like New Zealand which bundles funding, enabling women to fund their chosen model of care and provider.
(2) Medicare funded pelvic floor rehabilitation.
(3) Investment in breastfeeding support, starting with full implementation of the National Breastfeeding Strategy.
(4) Investment in one year of paid parental leave to be shared between parents, and policy to mandate flexible work for both parents.
(5) Universal free childcare and early education, as well as adequate remuneration for early childhood professionals.
While we’re at it, let’s keep women and families out of poverty by adequately raising the rate of social security.
The title of this post is inspired by Pregnant Then Screwed, an amazing UK organisation working to end the motherhood penalty. They campaign on the issues that impact pregnant women and working mums, offering free advice while working for meaningful change.