thru the pinard Podcast
a conversational podcast with @Academic_Liz with midwives & other birth professionals about their studies/ research & how it's changing our practice globally - email thruthepinard@gmail.com
thru the pinard Podcast
Ep 92 Hannah Dahlen on the path of a feminist midwife championing change and a sustainable research future
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Ep 92 (http://ibit.ly/Re5V) Hannah Dahlen on the path of a feminist midwife championing change and a sustainable research future
@PhDMidwives #research #midwifery #education @westernsydneyu #bigdata #Yemen #sustainability #perinealwarmpacks #leadership
research link - ibit.ly/Y58ML
From seeing her first baby born as a child in Yemen to becoming a Professor of Midwifery at Western Sydney University, Hannah's journey illuminates the evolution of modern midwifery practice, research, and leadership in Australia.
Hannah's story begins in the clinics of Yemen where her mother practiced midwifery, instilling in her a powerful feminist perspective that has guided her entire career. After training in the UK, Hannah returned to Australia in 1991 to find a healthcare system dominated by medical authority where midwives struggled for autonomy. Rather than accepting this status quo, she channeled her experiences into advocacy, rising through the ranks of professional organizations while conducting groundbreaking research. Her world-renowned study on perineal warm packs transformed an "old wives' tale" into level-one evidence now recommended in clinical guidelines worldwide.
Throughout our conversation, Hannah weaves together personal experience with professional insights about leading change in healthcare. She shares wisdom about building movements rather than seeking individual recognition, the importance of mentoring future leaders, and how academic research has empowered midwifery's professional standing. Her recent work on birth trauma through the Birth Experience Study (BEST) has gathered responses from over 8,800 Australian women and is now being replicated in fourteen countries, challenging systemic issues in maternity care.
Perhaps most compelling is Hannah's reflection on sustainability in leadership and the personal costs of advocacy. As she approaches her sixtieth birthday, she speaks candidly about learning to say no, finding balance, and encouraging a new generation to move midwifery from "surviving to thriving to transformation." Listen for powerful insights on leadership, research, and creating change that lasts generations, not just moments.
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Thank you very much for joining me , as per usual . Can you introduce yourself , please ?
Speaker 2My name is Hannah Darling . I'm Professor of Midwifery in the School of Nursing and Midwifery at Western Sydney University , and I'm also the Associate Dean of Research in Higher Degree Research .
Speaker 1So let's go back to the very beginning . How did you get into midwifery ?
Speaker 2Well , I got into midwifery before I probably even
Hannah Darling's Introduction
Speaker 2remember that . I got into midwifery because I was . I was a child growing up in Yemen when my mother was a midwife out there , so cool . From the very earliest age I was in the clinics . My probably most of my earliest memories were being in a playpen while mum did the antenatal clinic and I sat there being gawked at and poked and giggled over because I was so white , blonde and that was a very unusual thing in the Middle East .
Speaker 2So , yeah , I mean I can't ever remember ever wanting to be anything other than a midwife maybe a brief stint of wanting to be an actress that I think everybody
Early Midwifery Foundations in Yemen
Speaker 2has in their young years . And then I saw my first birth at 10 . And I was because I'd been begging to get into a birth and I was , you know , just amazed . And then my best friend , who was my neighbor next door , her sister in-law was having a baby and I became very involved in that whole pregnancy and then I helped catch that little baby and they named that little baby after me and I was just shy of turning 12 years of age .
Speaker 1Oh wow , how delightful Did you actually stay in touch for long with that little child so I left Yemen at 15 .
Speaker 2The whole family came back to Australia . I went back when I was 23 um to catch up with people . I mean , obviously this was an era there was no phones , there was no letter , writing was , and I went back and I found the house and I knocked on the door and , um , I did meet little Hannah who at that point sadly looked probably like a seven-year-old girl . She was very , very tiny , had indications of vitamin D deficiency and had severe rickets and I doubt very much she's alive today because if she gave birth she would be one of those tragic stories of an obstructed labor and um , yeah , so , so little Hannah and my experiences in Yemen really for me , were the birth of feminist in me , in that everything I do comes from that really strong feminist point of view , which is that women , we need women .
Speaker 2You know , we hold up half the sky and I always say and we give birth to the other half , so we actually hold up more than half the sky and yet we are so disadvantaged , so often still , even in our incredibly privileged countries like Australia . And so for me , being a midwife , I always say to my students you can me being a midwife . I always say to my students you can't be a midwife without being a feminist and if you think that , then really I'd prefer you getting out of the profession right now because I don't think you'll be safe for women . So for me those two things merged . From my younger days of seeing the invisibility of women and on women's issues , when did you do your initial qualification ?
Speaker 1Now we used to call it training , but we're now trying to change that to education . So where did you do nursing first , then midwifery , or did you , were you able to kind of go through a midwifery based process ?
Speaker 2No . So I came back to Australia at 15 , having been homeschooled for the first 15 years of my life , and I walked into a high school with 1500 students and it was you know , it was an amazing culture shock for me , but all of that homeschooling and independent learning had really taught me to be very self-motivated and to to kind of get with it . I had also six . We had six siblings . I was the oldest of six , all born under the age of seven . So I kind of had to get on with it because my brothers , my naughty brothers , took up most of my mother's time . She
Feminism and Midwifery Connection
Speaker 2was teaching us . So when I came back to Australia I finished high school . I finished , I did two years in a real school in Australia and then I went to Hornsby Hospital and I I would say I did training actually , because I don't think it was education back then , it was training it was training back in the what 70s , 80s and even the 90s before it went into tertiary very much training .
Speaker 1Part of the staff did not sit back , just repeated what you were doing .
Speaker 2Yep , absolutely , and those sisters that taught you were terrifying and Yep , Absolutely , and those sisters that taught you were terrifying and you literally wrote learn everything down . You wrote , learned it , you regurgitated it in examinations and so I did the hospital training . I wasn't in university when I did it . I was one of the last groups ever to go through the hospital , so we used to kind of call ourselves the last of the best , but of course I don't believe that anymore . I do believe being in university is extremely important and I literally only did nursing because I wanted to be a midwife and there was no other way in Australia at that time to do it . And as soon as I'd finished nursing I headed over to the UK and I then did my training in the UK , in Surrey .
Speaker 1I wasn't sure whether you that's the process or whether you'd gone to the UK and did it straight over there , because they were doing direct dentistry , I think at that stage .
Speaker 2Just starting , I still was one of the last group before it went into the university became predominantly . I kind of always was like on the edge of that significant change . So no , I did the 18 months post uh post nursing registration um midwifery training over there and it was .
Speaker 2It was phenomenal training and I have to say it was an experience of really feeling very autonomous , feeling that respect midwives had at that time . And um , as soon as I finished that training I came back to Australia and discovered a very different world of medical dominance and invisibility . Now midwives have always been called nurses . Midwifery just was in such a poor state when I came back . So I came back to Australia in 91 and um , yeah , it was . It was a shock and I constantly got in trouble because I was . I had not only been shaped as a feminist midwife as a child , but I'd been shaped as an autonomous practitioner in the UK . And yes , I did get often asked who , who the hell do I think I am ?
Speaker 1yeah , how
Educational Journey in Australia
Speaker 1did you keep going then , like the , the , the medical dominance at that time and I was nursing at that time it was very much shut up , stay in your corner , do as what the doctor says . It wasn't . You weren't encouraged to advocate for your patients at all , um , and as if you did step up , you got slapped down very , very fast . How did you keep the drive , though ? Because you've been in midwifery since then ? How did you keep going against that resistance ?
Speaker 2and I'd say we didn't just get slapped down by the doctors , we got slapped down by midwives by seniors , yeah seniors .
Speaker 2Um , it was a very much stay in your place and you know , yeah , who do you think you are ? And I think that for me I guess I grew up fighting . I grew up as a girl in a man's world . That was a very dangerous world . I grew up having to protect myself . I grew up knowing that if I didn't grow a loud voice , that I would be , you know , very badly hurt and damaged .
Speaker 2I grew up in a family of boys where I had to constantly tussle for my plays and I just think that at the heart of everything I do , I have such a a respect for , for women and I and I am a woman and very proud to be a woman , and so for me it's been always more than just a job , it's been a I mean , I don't like the word calling because I think that conjures up , you know , religious overtones , but for me it is a way of making the world a better place . And also for me . For me , the times when I was silent and of course I've had times where I've been deeply ashamed of my silence the destruction that wreaked on my soul was worth it .
Speaker 2And so I also then discovered that actually , you know , as I often describe it , you know , be brave enough to let the quavering voice out , as I often describe it . You know , be brave enough to let the quavering voice out and you know that really scared voice that you're so think , oh my God , what's going to happen to me ? You take a deep breath and you say you realize the world doesn't fall down , and after a while what you realize is people gravitate to you and then people get strength , and then you've got a movement on your hands and , you know it , you're changing things . And so for me , I think it was being brave enough to do that , speaking up and then realizing the world didn't fall down , and then realizing there's other people who thought the same as me , and then , wow , we were . You know I don't .
Speaker 2One of the big things I did is I I joined the of Midwives . So at that time we were the New South Wales Midwives Association and very early on I became like the secretary and then the media spokesperson , and I did that for many years and went on to become the vice president , the president of the college , and so I think that it really helped me , particularly being employed within a health system to have the voice of the college where they couldn't touch me , and it gave me an enormous , enormous power , enormous connections , and it helped me give courage to others . And and that was a wonderful way , because it can't be just leadership should never be about one person . Leadership has got to be about building a movement , because you know , one person gets old , they die , they fall over . Bang there goes your movement . If you don't build a movement , you're failing your fundamental I guess you know mission as a leader .
Speaker 1I think that's the power of being vocal is so many people think they are the only ones who think like that ? Because , and especially before social media , it was much more isotropy of knowing who else out there feels that way . So you get that one person and , yeah , you become that magnet of oh my goodness , somebody else feels the same way , oh , I need to go to go talk to them , I need to . And that strength and that builds that community , builds that kind of momentum that can make and does make changes .
Speaker 2Yes , and actually the leader is not as important as the first follower ?
Speaker 2Yeah , because then the first follower gives courage to others to stand up and , before you know it , you've got a movement on your hands .
Speaker 2So we pay a lot of tribute to leaders , um , and I think we need to look beyond those , those people , to what is being achieved here , and having courage is led by example in that , oh my god , that person stood up and said what they said and the world didn't fall down . Maybe I can do it too , but it also takes generosity of leaders to push other people forward , to give them the courage to say and I mean , the only reason I ended up as a leader in midwifery is Pat Brody , who is one of my absolute heroes in midwifery and she said to me Hannah , you are are a leader , you should take on this role in the college . And she mentored me and she , she stood behind me and she told me I was doing well , and she told me sometimes when I could improve things , but in a very beautiful and gentle way , and so she gave me the confidence to unlock something that was in me .
Speaker 1The power of a leader who leads from beside , not from ignoring from in front , is so powerful .
Speaker 2Exactly . And the side , if you look at all of the people we admire in history , the ones that are kind of almost icons in our memories of leadership , they're often incredibly humble people , they're incredibly generous people , they're incredibly principled people . It's always about more
Building Leadership in Midwifery
Speaker 2than them . Yes , and you know , I think you know people like Gandhi and I think people like I mean there's so many , I don't want to F&A . You know , think you know people like Gandhi and I think people like um , I mean there's so many I don't want to . Yeah , if I name you know one or two , I you know I met Mother Teresa in Yemen as a young woman and that was phenomenal for me because I saw somebody who truly and utterly believed in what she did and really couldn't be bothered with all the fuss that was going on about her . And for me , these great examples are . They're the ones that stick around , that we remember forever in a positive light , not the ones that are some of them in the media currently that can't be leaders but are anything but yes .
Speaker 1So you're midwifery . You're working midwifery here , you come back to Australia . Where are you working ? In what model of care ?
Speaker 2so I come back to Australia and the world has changed about university and um , so I figure I may as well go and and get my bridging to get my degree in right , because there was no , there was no option of that in midwifery at this point . So I , I went um back to uni . Oh well , I went to uni . I had never and that was a whole , oh yes , explosion of um , a different way of thinking , and I , I really found that there was a part of my brain that had really always sought this and so I really came . I came alive and I did very well and they offered me an honours scholarship and at that point I wasn't incredibly , you know , informed about high degree research . So I thought , oh no , I'm going to go off and do a master's , because a master's is more important than an honours . And so I went up and did a master of Child and Family Health , really loved that . Then I thought , hmm , I think I'd really like to go on and of course , couldn't get into a PhD because of that . So then I went back and I did my honours . Then I ended up going into a PhD , but all this time clinically .
Speaker 2I came back and worked at Auburn Hospital first , and I became a clinical well , back then a nurse specialist , but very , very quickly within the first few months , with a lot of people saying who the hell does she think she is ? And then , within um a couple of years , I um got the educator post the the King George V Hospital , which is longer exists . It's now RPA . I became the birth um , the birth well , actually , labor ward , that's what it was called the labor ward um midwifery educator , uh , and I loved that role and I really realized that I loved my . I love stimulating my brain , but I loved watching the growth of our students . That was . There's something magic about watching those light bulbs come on , isn't it ?
Speaker 1when those connections are made , it just makes up for the rest of the crap that happens , but you sit there and go . Yes , you've something magic about watching those light bulbs come on , isn't it ? When those connections are made , it just makes up for the rest of the crap that happens , but you sit there and go . Yes , you've got it , which also is that building of confidence , that building of ability and watching somebody flourish is , oh , there's nothing better .
Speaker 2I totally agree and I thought look , one person can't change the world . Clearly at that point I'd had many , many battles and was making small changes . But if I get a flotilla of of people to go out and change the world , then we can change the world . So I really concentrated on my students at the same time I was doing finishing my honours . Then I did my PhD and then I became midwifery consultant and I was between two hospitals , rpa and Canterbury . I really loved that role . I , as part of that role I took on , I redesigned like things like the antenatal clinic so there was continuity of care there . I ran my own antenatal clinic for complex women . I kind of reformed the way that Muslim women were cared for so that it was much more culturally sensitive and safe for them . So I got the opportunity at CMC level to feel like I actually had a bit of power and respect .
Speaker 2Yeah , and then I finished my PhD and I was literally just the ink had barely dried on the on the um thesis and um . My wonderful college colleague , virginia Schmeid , um , was at a meeting and she said there's an associate professor job going at Western Sydney . Um , I really think you should apply for it . And I was like associate professor , like I'm literally not yet graduated , you know and she , she kept at me , she kept at me , and I had a fairly dim view of academia at that point . I love the thinking , I love the critical thinking , I love benefiting , but I kind of thought that they were all really wankers , sitting in their ivory towers and had no idea how the real world worked and you know , they needed to get on the wards and and see what it was really like . So I thought , oh well , um , I'll give it a go and I I'll give it 18 months and then I'll do something else . And and I thought I'd never get the job . But I got the job . And when that , when the dean rang me to offer it to me , I said you've got to be kidding . I started here , um , and I haven't left , and that's nearly 17 years . Oh wow .
Speaker 2I went on and got promoted to professor in about , I think about 2012 and 2012 . Yeah , it's pretty much where I've stayed and I'm now in a probably too busy space . So I need to get some quality and some balance back in my life . But I have the extraordinary privilege of doing my own research , supervising lots of PhD honours and master's students , teaching a bit , but , but not a huge amount all the sexy part of teaching not all of the course coordination and everything and governance , which enables me to lead research development and , you know , hdr development . So you know it's a really nice balance now of all those different factors .
Speaker 2I mean , meanwhile , in the middle of that , I did go back into practice . So when the reforms came in , you know , in 2010 , I was the president of the college . I'd been through all of the you know , the rallies and the government and the Senate inquiries , and I'd been at the front of that , getting eligibility for midwives and I thought , wow , actually this is what I've probably always been meant for . Because , you know , go back to my way my mom practiced in Yemen and so I went out and I did the prescribing and ordering course , got my qualification , got my endorsement and I went into private practice for about eight years with a group practice alongside my academic role , which was absolutely soul food . But it also nearly killed me trying to juggle two competing roles and I got to the point . Then COVID hit and I got to the point where I thought I was , you know , in my mid-50s then , and I thought actually you are human .
Speaker 1I've just discovered that now in my mid-50s , and you don't kill yourself it takes a while to kind of have that reality sink in a little bit , absolutely one of the things that kind of rings in my mind .
Speaker 1I've seen you and I heard you talk at quite a few different events over the last several years , really ranging from local conferences , national conferences and I think even international conferences . And one of the things that is a very common thread through a lot of your talks is developing the sustainability and capacity of the future leaders and researchers and educators and kind of paying forward and bringing up the next generation . And it was really interesting at a recent midwifery professoriate forum that we had here that the ACM held for the first time and I'm excited it will be in Adelaide live next year is so many of what we would deem the leading professors of midwifery were saying the same thing . It's like yep , we've been here , we've done our time , but we're looking to retire , we are not going to be here for the long term . We need to start bringing people up . How do and we'll get back to your PhD in a minute how do you do that ? How do you bring up the next generation ?
Speaker 2Absolutely , and I think it's the test of our genuineness . If we are not doing that , it's the test of arrogance . If it's all about you , it's the test of do you honestly believe that you want a better world for women ? Because if you don't do that , you are failing . I mean , I've got two daughters now that
From Practice to Academia
Speaker 2are entering into that phase of going to have babies soon and and for me it's like you know , I need to give them a better world . So it's , it's also incredibly personal to me that that we , we improve things . So for me , I think the light went on with the students when I became an educator and I realized that you could light a spark and I've seen those sparks go on in many different areas to become great leaders . I think for me also , I realized that you know as as much as you know it may not be important the the word doctor in front of your name , the word professor in front of your name , gives you a certain avenue and a voice and people listen to you in a different way . So , okay , we'll go get the pieces of paper , we'll do the hard time , we'll earn the stripes , because if you can get a voice at a higher level out there , then let's do it . And then as an academic , yes , the research , the strategic research , the ability , the way that I worked very much with the media because I'd had 20 years working with the media as the college media spokesperson , getting a conversation article ready , talking to a key journalist , priming it all up so that they came out all together and you got huge media take up . So that enabled me to have a voice , because a lot of the work I was doing was clearly political in . It was about normal birth , it was about the implications of intervention in birth , it was about all of those things . So so I think that that was a really effective way of being able to use that voice . But I think the other thing that's given me probably the most satisfaction of anything has been my HDR students . So watching some of my bachelor , midwifery , graduate , diploma students going through honours and , yeah , phds then become ECRs , so early career , watching them take off and fly .
Speaker 2For me , you know , I gave this talk at the ACM conference a couple of years ago and I challenged everyone to create 20 . 20 . You are responsible for 20 people to let go out there , to mentor out there , to release into the world , to take forward what , what you're doing and um , I'm a great believer and I think , as I get closer to retirement , that urgency is really there , um to to get the next lot in place , because midwifery , it will always be a fighting profession , it will always struggle , it will always have the um attacks . It's a , it's a profession about women , it's a profession about reproductive rights . It's a profession that's always going to be in that struggle . So , in order to be prepared , we need smart , educated , competent , articulate and politically savvy midwives . And for me , when I mentor an ecr or mentor a student , I'm always mentoring them for their future role . I'm mentoring .
Speaker 2Okay , this is a great paper . Let's let's go pitch a conversation article . Let's see if we can do some media on this . You know , have you thought about this conference ? You need to go speak at this conference , get known , build yourself up . This is how you use social media . So it's more than just getting a qualification . Yes , it's being qualified to be a leader , and they're two different things .
Speaker 1Absolutely I agree , and I think I've worked out that I know of five generations of midwifery PhDs , so the first person , and starting in Australia with Leslie Page and I .
Speaker 1Leslie Barclay . Leslie Barclay , I've had the pleasure of speaking to them both for this podcast , so I'm kind of totally girl , kind of fanning when I did both of those interviews . So , starting with Lesley Barclay , in Australia I've been able to trace down five generations of PhD midwives that are supervising . Do you know how many of yours , generations below you , have now branched out and are doing that same , encouraging up from an academic sense ?
Speaker 2well , I'm the second generation because leslie was my supervisor . So leslie I always say leslie is the , the modern midwifery helen of troy . She launched flotilla , or a thousand faces of midwifery , because if you think of all the current leaders today , they were all leslie students . So we came from a time where when leslie supervised me , she didn't have a phd , she was still doing her own . So we came from a time when there would nobody with yes , yes and and look at us now .
Speaker 2It's just phenomenal how many midwifery academics are now out there with with phds and and doing incredible research . Caroline homer and I were were doing I was doing my honours while Caroline was doing her PhD . Then Caroline became my PhD supervisor . Leslie was my honours supervisor . You know Virginia , who I work with , was one of Leslie's students . She was doing her PhD when I was doing my honours . So there's so many connections in that role . So currently , if I were to look at all of the ones that have gone on , they've not all gone on to be academics , but some of them are now leaders or they're , you know , incredible leaders in private practice or they're working in government offices , but also quite a few who are academics now supervising and that's really lovely , and I suppose they're starting to graduate their first lot of students . So I guess , what am I up to about coming up to the third generation after me ? Yeah , which is lovely .
Speaker 1And I think that was what Lesley was saying that her proudest achievement is the fact that so many of her former students are now professors of midwifery in Australia and internationally and that she was able to help that professionalisation of midwifery , evidence and academia from that setting , which is a fabulous legacy to be able to still see living and growing .
Speaker 2And the other thing that I often say when I'm doing talks on this , just to really drive it home how young midwifery is as an academic profession compared to medicine . The first professors of midwifery in Australia are alive and well . Yep , the first professors of obstetrics have been long time buried . Yes and well , the first professors of obstetrics have been long time buried , yes . So if you , if you look at how long an academic history obstetric now has compared to midwifery , what we've managed to achieve in I guess we're up to about 30 , 30 , 30 years what we've achieved in 30 years is unprecedented . And not only that . We have achieved a Nurses and Midwives Board . I mean , I was part of that lobbying for a Midwives Board . You know we got a Nurses and Midwives Board . We've achieved a Nurses and Midwives , you know , and MAP . We've got a Nurses and Midwives Federation . We've got midwives being called midwives . They're being called midwifery unit managers now mums instead of numbs . So this has all happened in the past 30 years and at the forefront of a lot of that advocacy have been academic midwives , people like Pat Brodie , you know Caroline Homer . You know like Pat Brodie , you know Caroline Homer , you know Nikki Lee , really smart , not only intellectually smart but politically smart and very compassionate and genuine people .
Speaker 2And really for me I mean for me , I had the huge honour and benefit of having two fantastic supervisors . So I had Leslie Barclay for my honours and I had the huge honour and benefit of having two fantastic supervisors . So I had Leslie Barclay for my honours and I had Caroline Homer for my PhD . Now , you know , I had the creme de la creme and the way they supervised me is how I now supervise . So Leslie began group supervision .
Speaker 2So when I was doing my honours , we would meet once a month , we'd all get together , there would be group supervision . So when I was doing my honors , we would meet once a month , we'd all get together , there would be group supervision going on . And we now we we've run group supervision here since for 17 years in in western sydney and then we've we've formed a template for now nursing is starting to to follow some of that pattern as well . So , yeah , I mean , those leaders are phenomenal in shaping . I've also seen people who've had terrible supervisors . Yes , and it's very much taken a lot of their confidence away , maybe formed some bad habits , and they've had to relearn a different way of supervising .
Speaker 1Yeah , Did you do the same topic for your honours and then your PhD and roll through ? You did two different topics I couldn't have done anything more different , in fact .
Speaker 2So for my honours I did a grounded theory , um , because Leslie Barclay was very big on grounded theory . I did a grounded theory analysis looking at first time mother's birth experiences and it was called the novice birthing uh published about , I think , about four papers in the end out of that , that honours thesis , and I interviewed women who had home births , hospital births and birth center births , um . And then I went on and did a randomized controlled trial for my PhD okay , yeah , just slightly different .
Speaker 2I really crossed the paradigms . I've never been happy just to sit in one space . I always go . I want to try and challenge myself so I led um the one of the world's biggest uh , randomized controlled trials on the perineal warm pack trial , which now is recommended all around the world and level one evidence in Cochrane and by Quality Safety Commission , putting warm packs on a woman's perineum in second stage during the birth .
Speaker 1So how does it feel that that
The Perineal Warm Pack Trial
Speaker 1is now an international practice ?
Speaker 2birth . So how does it feel that that is now an international practice ? Well , it , it feels funny because it's an ancient practice . The reason I did the trial is because when I was in England , um on about my number 10th birth , the lovely community midwife hours . We'd left the room , terrified the life out of me because I thought she wasn't coming back . And she waddled back in with a bowl of steaming water . She wrung her face cloth out and she slapped it on the woman's perineum . And this woman just went , ah and birthed a baby . And I thought she put something magical in the water . I asked her what was in the water ? She said ah no . She says oh no d the water . She said ah no left . She says oh no , ducky , I'm just soothing the ring of fire . She was scottish and I started slapping warm packs on everybody because you know well , that's all the evidence you needed , didn't you ? You know , and so , regardless of consent or not , I was using warm packs .
Speaker 2Came back to australia , went to auburn hospital we were using lots of warm packs , was all great went to rpa to king george the v , walked down the corridor of the labor ward with my steaming bowl of water and you would have thought I sacrificed a goat on the linoleum . They said to me what the hell are you doing ? And I said I'm putting warm pack on , warm sparingly , and it was like I had just done something absolutely dreadful . And they said what about the you know , the infection control ? And what about the occ , health and safety ? And what about this ? What about that ? And then they said the most brilliant thing to me , which is well , where's your evidence ? And of course that was the point , yep . And so I just said , well , okay , I was someone who wouldn't be told no , I'm going to launch the world's largest randomized control trial on my own steam .
Speaker 2I went to J&J and Johnson Johnson and I asked them for $1,500 to translate the survey , the , the questionnaires , into multiple languages and um . I led this RCT of 717 women by minutes , with six week and three month follow-up on all of them , um on 1500 , and it took seven years to do . And halfway through it , when caroline homer said to me what are you doing ? Why are you not getting a phd ? So halfway through my rc , I did what no one ever should do anyone listening don't ever do this . I went and did my confirmation of candidature and got into a PhD , yeah , so I'm very grateful to Caroline , because you know , obviously I now have a PhD .
Speaker 2And then that , when that came out , I then discovered the birth centre always the birth centre on the ground floor , which was we were on floor five . They were on the ground , they were putting warm packs on everybody , but there wasn't know , it was as though nobody was talking about that , because nobody , all of the cultures , differences . So , yeah , so then when that came out , my , my study came out and it showed a reduction in pain . It showed a reduction in third and fourth degree tears and then , um , several more have been done and that's led to level one , evidence of the benefit , but part of my phd . One of my favorite chapters in my phd is called from social to surgical , where I trace the history of parallel chaos throughout the ages , from hip-hop to modern day , and I published a paper with nikki leap on it and , um , warm packs are as ancient as ancient time itself . So I , I didn't do anything . I didn't do anything . That was actually , you know , innovative . I just literally evaluated that it had an effect but that's that .
Speaker 1I'm not going to say justifying or validating , but it almost is validating that traditional women's knowledge , absolutely From experience .
Speaker 2Yeah , and I often call I do a talk on this on how I kind of ended up where I am called from old wives' tales to level one evidence and it is there's so much women's knowledge . That's brilliant knowledge , but we haven't , we haven't , we haven't actually gone out and scientifically evaluated . Now we have . I mean you , look at continuity of midwifery care . Yeah , we all know it works , we all know women love it , we all know that . But now we've got this incredible evidence of benefit , it's now , you know , changing , changing things around the world .
Speaker 1So , looking at your PhD , it's now kind of several . We'll be polite and say , several years later now , what still sticks in your mind as something that surprised you the most , either during the PhD process or the results of doing it .
Speaker 2What surprised me the most ? That's a really good question . It's a lot of work , yeah , yep . It was much easier to design a trial and and continue on my merry way and not have to write an entire thesis on it and and then reflect on my findings in a critical way . So I took seven years to do my PhD . I had several babies in the middle of it , worked . I did what so many women do juggled caring responsibilities along with working and studying and you know , I just think women are amazing what they juggle .
Speaker 2And I got to the end and I was literally running out of time .
Speaker 2I was one of those students that was like you know , this is your day and date and you , you know and I'm working myself back to the day that I'll submit on that end date . And Caroline very kindly said to me Hannah , what you need to do is you need to lock yourself away from for a couple of months and get this thing done . And I was almost doubting my ability then to do to write because I had no concentrated time . She basically paid me for two months and I wrote my thesis within about six weeks . Oh , wow , well done . And I was just like , oh my gosh , and maybe there is a little bit of a brain in there given the chance to just do not and I literally would get up in the morning and I would look up and it would be dark and the whole day was gone . And so I think it was discovering yes , I did have the capacity . And it was also discovering that anyone who gets a PhD , they really earn that PhD .
Speaker 1Yeah , how did you keep your sanity ? Because it is hard work . It has its ups and downs . I kind of refer to it as a multi-dimensional game of snakes and ladders , that you're going up and then a supervisor says something or asks you a question . Then you end up going down the ladder again , but you don't never go back to the same point . You're always kind of advancing , but it is up and down . How did you not rock in the corner ? Or did you rock in the corner ?
Speaker 2Rocked in the corner , but I never saw that as not completing
Advancing Midwifery Research
Speaker 2. I always thought I will complete this , because I just don't ever not complete things . That's one thing about me is I'm a completer , so I always had the confidence that I would get there . When it was hard , I looked after myself . Sometimes it took time out . I did stuff that I enjoyed . I would , you know , walk and read and , you know , really try to kind of nurture myself back to a point where I could do it again . I think I just got inspired by women and by people around me , knowing it was important , it was going to make a difference to the world , and I think I also knew that I was going to get easily bored in my life , that I needed that stimulation . It probably eventually was going to come in academia to give me that outlet , so that I needed this piece of paper in order to get there .
Speaker 1So you said already that you were juggling with a family , with young kids and with study . How did you balance your study then ? Were you one of these people who got up early before the kids , and then , when they went to bed at night , or when they were in school or depending on what age they were , how ? Did you balance that .
Speaker 2So I'm not an early morning person , love walking and and that , but I'm not . I don't do lots of work early morning . I'm a late night person . That's when I sort of come alive .
Speaker 2so I'd probably think a lot in the early morning while I'm getting them all ready , and then I would yeah , I would work more at night when they've they've gone to bed , I also had a study right in the middle of a big , open , planned family area , um , so that I was always and I had a little window through to the sitting room so I could see what my kids were up to , I could see what was cooking on the stove , um , but I also had my own space and I think that was a really good way of them feeling like I was there but me feeling like I could get on with it .
Speaker 2And my husband was really , you know , I had an incredibly supportive husband who , you know , always believed that I could do it and was always 100% behind me and was very involved in taking the kids off and doing sports and all those other things that I could , because I hate sport . I absolutely like you know , I can't even fake pretending I like sport and he loves it . And so it was great Saturday was I had the house to myself and I could get into things .
Speaker 1The lovely division of care there , kind of like yep off , you go , go outside play sport and I'm going to do my stuff . How did you celebrate when you finished it , when it was all official , it's all confirmed , you've graduated you know , there's a funny thing about finishing a PhD .
Speaker 2It's almost an anti-climax , but I don't mean that in a negative way . It's you've been working so hard on this one thing for so long and it's been the pinnacle , and you get there and you hand it in , and then you have to wait , you know anywhere from three to six months to get a result and it's sort of like , oh , okay , all of it comes down to this you know , a few people's opinion , well , a few hundred pages between two leather-bound covers , and , yeah , a couple of people's opinion . So , and then you start again , because then you become an ECR and then you have realized you got so much to learn . So I think it's quite humbling . I did , I don't remember celebrating , okay , no , I actually don't remember . There was definitely not a party or a . I mean , my family came to my graduation , that was nice , but no , there was no . You know I'm throwing a party for 100 people or anything . It was just like well , thank god , that's over , okay , what's next ?
Speaker 1yep , yep , which is actually very good and a perfect segue . What happened after then ? Like after you've kind of you've stayed in academia , you have worked across a myriad of areas to enhance midwifery . What have been some of the ones that are most special to you Because you have covered so much over the last couple of decades ?
Speaker 2As in the research areas . Yeah Look , I went on to do a lot more work around perineal care and I had some students who looked at it as well and that was really good . I was able to be on some major committees that developed guidelines . I was on the recent third and fourth degree clinical care standard for Australia with the Clinical Safety Commission and that was really great to see all of it coming in and see it in print . You know recommend warm packs . Number one Felt like you know , coming home so I've enjoyed that . But I guess in line with my underpinning reasons for doing the warm pack trial , which was to improve outcomes and make births , you know , safe and satisfying for women , I've gone on very much within that line . You know , safe and satisfying for women . I've gone on very much within that line .
Speaker 2Um done a lot of work using big , big data sets . Um linked data , worked with some wonderful international colleagues who are brilliant statisticians , like lily and peters , charlene thornton , who you would know as well from flinders I do and I published lots of linked data . Okay , so we showed , for example , the high rates of intervention in private hospitals coming to public with low-risk women . We've gone on to show the ongoing implications for babies and women of intervention in childbirth . That had some big hits in the media and that's probably been a really important area of work . And then , um , you know , multiple students doing different things . I guess my free birth work was another big area and , um , of course , we published a book in 2020 . Just as literally was the last event was the launch of the book . And then very timely yes was on um birthing outside the system the canary in the coal mine . That came from a collection of about eight of my students work in this . Why do women avoid our system ? What's driving them ? What's what's underpinning the trauma that you know is creating this , along with lots of international people , so that that was another big body of work . And then really , my , you know , I guess my how do we reduce physical and psychological trauma for women has kind of all merged down now into the best study which , um , I've after .
Speaker 2Just a segue into birth time , the movie birth time , which I was involved in . That was fabulous , yeah , it was good . Um , joe hunter kind of contacted me and said do you think you could whip up a survey ? We've got all these women who are telling us all about the trauma . We need to survey them . And I was like you do not ask an academic to whip anything up , you do not know what this is involved . And I was .
Speaker 2I had just finished leading well , I was in the midst of leading , actually , the birth in the time of covid study , which was massive longitudinal study going
Birth Trauma and Respectful Care
Speaker 2on , and I thought , aha , hazel keitel just finished phd , with me champing at the bit brilliant , brilliant future leaders , yeah , current leader already actually and I said to her hazel , I've got the ecr project for you , let's work on this together . And the best survey came out of of that and we used a lot of the questions that came out of the birth in the time of covid survey . We had some validated tools from sarah speedham , from um , from the birth lab in canada , and also from hazel's um , her phd on on v-back and we we almost in research terms , whipped that survey up because we had all of this other work that could build into it and we co-designed it with all of the consumer groups . And then , at this point , the social media and the media contacts came absolutely to the front and we used social media pretty much to recruit and we got over 8,800 women in .
Speaker 2Australia which was the biggest amount of responses to a survey today , and that led to some really interesting findings around obstetric violence and birth trauma . That , of course , along with all the consumer advocacy and activism , led to the New South Wales birth trauma inquiry , uh , which , you know , is kind of where we are now with . Okay , we've got a problem on our hands , now let's fix it . So our next thing we're looking at is how can we support health care providers to provide respectful care and look after themselves . You know we do a lot of attacking health care providers .
Speaker 2It's jolly hard yeah it's so hard for midwives out there , they it's not their fault that the system's set up almost to make them dehumanized . This problems the system . So how do we fix the system ? How do we stop our midwives being crushed ? How do we create models of care that enable that empowerment ? And how do we turn this juggernaut around ? Because health is a juggernaut hurtling down a highway and the first thing you've got to do is put the brakes on , and once you've screeched it to a halt , you've then got to turn the jolly big thing around and head in another direction , and so it is not an overnight solution . And I think if I've learned one thing in my career , I began with great impatience of this . All has to change tomorrow . I now measure progress in decades , not days , and you have to look back over 10-year periods , not over one-year periods , or you give up and you know , never go on .
Speaker 1I remember talking to Franca Kidde doing her interview for this podcast , I think in 2020 or in 2021 .
Speaker 1And we were talking about how 2020 was meant to be the international year of the nurse and midwife and ultimately did become .
Speaker 1But then we repeated it the following year and we were talking about midwifery research and she said it's the decade of midwifery research , being this decade of the 20s and the changes , the research that's being increasingly driven by midwives that is going to change practice , that is going to be listened to , because we are getting more and more midwives at the table where decisions are being made and are able to articulate in the language of the people at that table which goes back to what you were saying before and that by the end of this decade , midwifery is going to be in a much different place , which was really , at that time when we were talking , was just fabulously hopeful , but it is coming true . Especially within Australia , we've had so many different looking at scope and practice of midwifery . Your best study is now being rolled out in the uk as well , and other countries 14 countries , 14 countries . So there's going to be this unarguable amount of information that is going to encourage that change and to help make that changing direction a little bit easier .
Speaker 2And also when women find their voice which they have tried for years and they have done so incredibly successfully in our country midwives also find their voice . When midwives find their voice , women find their voice louder , and so we've got to all work together in order to make this change happen , and and then you know , we all end up with the courage to to keep on going , absolutely so what else are you doing ?
Speaker 1what are you excited about for the next few years ? What's kind of got your your spider senses going ? Oh , I'm excited to be involved in this .
Speaker 2Look , watching , you know , the growth of the best study is brilliant . Continuing on doing some of this leaked data work , because our data sets are getting better and better , supporting my students to become the future leaders in the world they're all really exciting options . Seeing Australia in a caravan is you know , I'm not all serious . I love to read , I love to listen to podcasts , I love music , I love walking and I love travel , and so I do think another thing leaders have to do is to show the human side , because sometimes people look at you and go I'll never be able to be like that , but they actually don't know
Balancing Life and Leadership
Speaker 2what you're like . Yeah , they don't know that . You have times when you just think is it all worth it ? Have I done the wrong thing ? Should I just shut up and go away ? They don't see that you do like to watch you know Netflix movies and you're obsessed with .
Speaker 2You know Swedish crime drama . They don't see that side and they don't and and it's important that we tell them then that and it's important we say to them you need balance and it .
Speaker 2You know , midwifery is really important , but it isn't the most important thing to me , and my family is the most important thing to me and and I know I'm the most important thing to them , and therefore I need to be healthy and well , and if I'm healthy and well , then my family benefit and midwifery benefits . Um , so it's , we've got to keep the balance and I think I would say I haven't been good at that and I'm now , as I approach 60 this year oh cool , I'm really really saying right time to look after you , time to say no . So I'm saying no to a lot of things now and it's very liberating . First there's guilt and then there's liberation because you know you can just end up a husk of yourself and then nobody really is going to want to hear you because you're bitter and twisted it's very much that human being and not human doing yes is that and we kind of talk about holistic midwifery care that we need to give to ourselves .
Speaker 1And I see it with the students and I think that's one of my , obviously , where I work with undergraduate students more so my , my focus is making sure they're not going into a career burnt out already , that they are able to find that balance to a survive the through the training or the education course that they're doing , but then to actually thrive afterwards , which is really hard in the system that we currently have , which is not friendly to healthcare workers or to the people who are using the services .
Speaker 2No . And if you look at the national , global , the international global women and children and adolescent strategy for 2030 , you know I love the term that we need to survive . We need to move from surviving , yeah , to thriving , but what comes beyond thriving is transformation , yeah . So how do we move ? Move midwifery from survival , where I think many ways we are , I think we're emerging into the thriving , but I think we're also surviving . So we're in this teetering position between survival and thriving . How do we move it into transformation ? And to do that , we need , well , midwives . And I'm always saying to my colleagues midwifery is not a religion .
Speaker 1Yeah .
Speaker 2It's a profession , yeah , and you are the most important person , and to sacrifice yourself on the altar of the religion of midwifery will benefit absolutely nobody , least of all yourself .
Speaker 1And that goes back to feminism and the fact that midwifery is majority a female profession and that's a very female trait is to put others first before oneself .
Speaker 2Yeah , and you know , as the oldest child of you know a family of six children that I had on my hip almost before I could walk myself I feel like , yeah , my whole life has been looking after other people and you get into habits of it and we do need to stop and go right . What about you ? How do you look after you ? What is it that makes ? And the other thing I often talk to my students about is you need to find out what is it that gives you the out time , what gives you the down time , what gives you the soul food ? You need to find your secret song .
Speaker 2Yes , yes , yes , that replenishes you and and it's different for everyone , it's not the same for everyone and everyone needs to find what that is and they need to know when they need to go to it . So I think one thing about getting older is because you've been through , you know , almost burnout several times in your life , you start to recognize the signs early and you start to take action . So , um , and I think , as you get older , you know you're more vulnerable and you just don't have the stamina and the capacity that you had when you were younger , and you also know burning yourself out when you're older . It's not going to be good for your longevity and your health . So we become wiser as we get older , which is good which is good .
Speaker 2It's just a pity we don't have that wisdom sometimes when we're younger and have less aches and pains as we're getting older but our job as mentors and leaders is to spot our younger colleagues and and mentees doing that , and I'm always having words with them saying , okay , I think you're saying yes to too much . Okay , you can say no to that . Stop . Stop .
Speaker 1Stop , look after yourself , it's always that risk of oh , but this is an opportunity . It might not come up in the future . It might not be the same opportunity , but something different and possibly better may come up in the future as well , Exactly . Thank you so much for saying yes to this , though .
Speaker 2Well , it's a pleasure , liz . It's good to have these talks because we do need to really look after our leaders and academics out there , because we need them desperately and I I am so . I mean , it may seem like I've said some negative things today , but I am so excited about where midwifery is right now . Yes , I'm right on the edge of taking in ourselves into transformation . So we now need the survival to be absolutely done . Yeah , we surviving , we need the thriving to be absolutely embedded and the transformation is just around the corner . Thank you very much pleasure .