What do you need to not only be a good midwife but to excel in your midwifery career? The key lies in getting back to partnerships with women and perhaps, most importantly, to take courage writes Karen Keast.


The word midwife is derived from Middle English and literally means with-woman (mid = with and wif = woman).

Australian College of Midwives spokesperson and Western Sydney University Professor Hannah Dahlen says getting back to the meaning of the word midwife and focusing on having a partnership with women can often mean the difference between what makes a good midwife and what makes a great midwife.

Professor Dahlen is a renowned advocate for midwives, one of Australia’s leading midwifery researchers, and a privately practising midwife with a small Sydney midwife group practice, where she has been pivotal to the delivery of more than 20 home birthed babies in the past two years.

“Make women your friend. I absolutely believe that this is the key,” she advises.

“Make women your friend – respect them and form partnerships with them.

“If we could just get that message through that we need relationships and they are the key to getting good outcomes to child birth. If we simply grasp that we could turn birth around overnight.”

That simple philosophy can often get lost in the demands of the clinical system but the gradual embracing of the continuity of care model is beginning to change the face of birth in Australia.

Under continuity of care or, as it is also known, caseload midwifery, women have the same midwife from early in their pregnancy through labour and birth until around six weeks after birth.

This model is increasingly becoming recognised for resulting in improved and ongoing health care benefits for women, their babies and their families.

“When you are working with someone for nine months and you know their hopes and their dreams, and about their partners and their children and their cat and dog and the things that have happened in their lives, you are there like with a friend or with a sister – you care, you advocate, you fight for them,” Professor Dahlen says.

“We are constantly taking women at the most intimate and amazing rite of passage in their lives, we take these women and we throw them in with a bunch of strangers and then we wonder what happened when it all goes pear-shaped.

“The biggest organ involved in child birth is the brain not the uterus. When you invest in the brain, the uterus works really well.”

Griffith University Professor Jenny Gamble, who is deputy head of School (Research and Higher Degrees by Research), says midwives need to be true to the partnership philosophy that lies at the core of midwifery.

“It’s about trust and it’s about communication. It’s the idea that you are not going to abandon the woman on any level if she makes choices you might disagree with,” she says.

“It’s not just about decision making; it’s that notion of working hand-in-hand with them.

“When you are in a partnership with a woman…you can see this event is important to her as a person, as a woman and as a mother.”

Professor Gamble says to be an outstanding midwife, it’s also essential to apply evidence in practice.

“Evidence is more than what model of care you do. I’m talking about evidence based on the big picture, not the procedural level,” she says.

Top performing midwives should also engage in political discussion and activity to help women access the sort of care that produces the best outcomes, Professor Gamble says.

Midwives have lobbied hard in recent years to secure changes to the way maternity services are provided in Australia, with eligible, privately practising midwives now able to provide certain Medicare-rebateable services and to prescribe PBS-listed medicines.

But Professor Gamble says there’s more work yet to be done.

“I think that midwives have done a good job but they have still got a whole lot more to do,” she says.

“Part of being a great midwife is that you have to participate politically.

“Advocate at the highest levels, through your associations – the Australian College of Midwives and Midwives Australia.”

Professor Gamble advises there are several other ways to improve your midwifery career – find a professional mentor, continue your education or professional development and, last but not least, to seek out and work in the continuity of care model.

“It changes a midwife. It’s the biggest professional thing that you will ever do,” she says.

“Midwifery is literally the best job in the world. It’s an amazing job. People who haven’t provided caseload midwifery care are missing out.”

Professor Dahlen agrees, especially after spending 24 years in fragmented care before moving into the continuity of care model.

“If you have always been scared to do continuity because you think it will put too many demands on you, give it a go,” she advises.

“Midwives who do it say they could never do anything else. The biggest risk that a midwife will face in continuity of care is she won’t be able to work in any other way.”

Perhaps the most important quality that makes a good midwife great is just one word you will never find in a midwifery textbook - courage.

“Don’t be frightened to stand up. I think we have learnt to be good girls for too long,” Professor Dahlen says.

“I have a magnet on my fridge that says ‘history does not remember well-behaved women’.

“I think midwives need to have courage and need to get more courage from forming partnerships with women.”