For NSW-based midwife Astra Joynt, her work is about much more than just caring for women giving birth. It’s about developing relationships with families, and setting up their first chapter of parenthood in the most positive way possible.

“I get a kick out of feeling like if I do my job well, then I'm making a real difference in people's lives”, Ms Joynt told HealthTimes.

“If somebody has a really good birth, it sets them up on their whole parenting journey and moves them into that space in a really positive and empowered way."
"And it’s a really pivotal time, especially for the first baby. It sort of sets you off into parenting feeling great and empowered, rather than feeling traumatized, and disempowered”.

In addition to her midwifery practice, Ms Joynt has also become a lactation consultant.

“I'm seeing more and more that lots of people are equally as traumatized by their breastfeeding experience as they are by their birth."

“Some may have a really great birth and then go on to have just an absolutely horrendous time with feeding their baby, and there's probably even less support for people after they have their baby than there is before. They kind of just get chucked out of the hospital and away they go."

"Often you find they haven't been given any really good, consistent, kind advice. Their confidence has been undermined. They feel like crap about themselves and feel like they can't do it, something as simple as feeding their babies."
“It’s a case of just sitting with them for an hour and a half and just giving really gentle, sound support, and then away they go and never see them again, but they're like, ‘thank you - everything changed after that and we’ll call you if we need you’”.

“I just get a kick out of  actually doing that one-on-one care, and providing really solid evidence-based information just turns people's whole experience around. It's really satisfying.”

Ms Joynt said there had been a couple of key moments in her youth that had directed her on a pathway towards midwifery.

“My youngest sister was born at home when I was 10. I didn't even really know what a midwife was, but the midwife used to come and visit my mum, and I was there for the birth. I remember thinking, ‘that was pretty interesting’”.

“Then I kind of stumbled across a book of birth photography in the library when I was about 17. I don't know how I found it. I just sort of flipped through that and was just really drawn to it. I was like, ‘that hat just looks really crazy, amazing, interesting world that I didn't even really know existed’”.

“It went from there, and then when I had my own baby when I was 24, that really cemented it for me.

“Ever since, I have really enjoyed the variety of what I do. If you work to the full scope of your practice across all areas, you're just doing something different every day, and I really enjoy the relationships that I build with the families that I work with.”

Ms Joynt said the long hours were one of the most challenging facets of her work, along with the politics and red tape that comes with being a midwife.
“There is a medical dominance of midwifery in Australia, whereas in other countries, we really work comprehensively alongside our medical colleagues. Here, it’s a very top down set up, dominated by medicine, which is not how we're trained."

”We're trained to be autonomous practitioners, but then the reality of how we work is in a very medicalized model for a lot of us.”

Another challenge for private midwives is that, despite their lobbying, they are still disadvantaged when it comes to accessing insurance.

“We’re the only health professionals who work with no insurance, and that's just really scary and not safe for us or our clients.”

“It's outrageous, and you know what's even more outrageous? There's one insurer that insures private midwives, and it's written into the government legislation because they're the only ones that would take us on. Yet, we still have to pay an insurance fee for birth, but we're not covered by that insurance fee."

“There's one tier of insurance for people who are providing pregnancy and post-birth care, and then there's another second payment that you have to pay, which is more than double the antenatal and postnatal fee, for people who are providing births.”

“That's great for those midwives who have access rights to hospitals. But for the rest of us, you're not covered for home birth, and you still have to pay the fee, which is around $2,000 a year at its base level on top of your other fee, to not be covered. I cannot believe that this is even allowed to happen.”

Working against the backdrop of a global pandemic has also thrown up a few curveballs for private midwives.

“It’s been absolutely hectic. All of us in this region found that we were crazy busy with home births. People who'd been teetering about what to do had really decided that they didn’t want to be in hospital.”

“A lot of it was because they just didn't want to be needlessly exposed to COVID if they didn't have to, and then there was a whole bunch of people who were kind of super alternative and a bit ‘conspiracy-theory’ about vaccination.”

“It was a lot to manage the workload and to take as many clients as we could, but also not burn out. I actually really did burn out, a few of us did. We also encountered thing we just didn't expect, like having clients asking me not to get vaccinated because of their personal beliefs, and then being fired by clients because I got vaccinated.”

Ms Joynt said that her biggest misconception about becoming a midwife was that her role would be akin to that of a doula.

“I thought it would mainly be about providing that emotional support and helping out at a birth.”

“But in reality, you're held to very high clinical standards. It's not for the faint-hearted. You have to be very strong. You have to really want to do it. You have to really care about women's health and birthing health – and you have to be prepared for the politics.”