Ask the expert: Carolyn Hastie on continuity of midwifery care

With four decades of experience as a midwife, researcher, birthing service manager and educator, Carolyn Hastie has plenty of examples of how continuity of care benefits women. Carolyn shared with Pregnancy Birth and Beyond the physiological benefits of the safety and trust created by having one midwife throughout pregnancy and birth.

Ask the expert: Carolyn Hastie on continuity of midwifery care

What are some of the most important outcomes of continuity of midwifery care for mothers and babies?

I think that it’s really clear that relationship-based care is awesome. Women emerge from those relationships feeling valued. They feel listened to. Their wants and needs, desires and perceptions are all respected.

The majority of the time, things go really well at birth. They go according to the women’s plan because their physiology can work optimally. Because they’re not under siege, they’re not feeling threatened.

For those times when decisions need to be made because something else needs to be done, women emerge from that experience feeling good about themselves because they actually made the decisions.

There’s a wonderful obstetrician at the Royal Hospital for Women Sydney, Andrew Bisits. I remember one day having a corridor conversation with him. He said, “You know what, however, the birth goes, if the woman makes the decision, she always feels better about it than if it’s forced on her.”

What would you like to see happen at a political level to give more women access to continuity of midwifery care – because it’s not widely available at the moment, is it?

No, it’s ridiculous. We have this evidence that there’s less premature birth, less psychological trauma, less perineal trauma, and fewer stillbirths [with continuity of midwifery care].

It’s about the physiology working well and women feeling calm, relaxed and supported.

Could you imagine if something that powerful was available in a pill? How that would be promoted by pharmacies, and how everybody would order that because it’s a fantastic intervention?

But it [continuity of care] is the best kind of intervention because it’s a social intervention. Mind you, midwives also have fantastic skills, and they can see when things are going off track and women do need some kind of intervention.

I just think it’s unconscionable really that the government doesn’t take this more seriously. All women deserve that kind of relationship-based care. If they need obstetric care that goes along with that, for women with complications or some sort of medical condition, absolutely. We can work together very nicely and it’s just glorious when it works like that.

It’s so much cheaper as well.

You wouldn’t have anywhere near the need for neonatal intensive care that you have now, for example. You wouldn’t have the cost of all the operating theatre shenanigans.

Plus, home birth is one of the most carbon-neutral types of birth you can have. Also, if you look at the long-term trajectory of mental health benefits for the mother and baby of relationship-based care, you’re looking at long-term cost savings. We know that what happens during pregnancy and in the first few weeks after sets the stage for the baby’s long-term health and wellbeing. The trajectory is huge.

There are examples of where continuity of midwifery care is working well. There’s Belmont Birthing Service, which I set up, and the maternity and child health hubs at Logan. Both of these were community-driven. It’s just about political will.

For me, it’s about people getting in touch with their local members, both state and federal, and talking to the opposition and the people in government. I think consumers can do a lot of good using their power, to help people understand why this model is important.

Caring for child birthing women would have to be society’s most important job. Making sure that women are well looked after, and they emerge from that experience, bringing forward the next generation. That they feel good about themselves and the children are born healthy and well should be right up there. That care is not just important on the birth day but during pregnancy and in the first weeks after birth as well, so that they’re ready to parent and to parent well.

Ask the expert: Carolyn Hastie on continuity of midwifery care

Is there something else that women really need to know about the continuity of midwifery care?

I don’t know that women who haven’t come across it understand what it means. Some people might not think midwives can manage complications. But the good thing is that with continuity of midwifery care, complications are so rare! Also, midwives are certainly well trained to deal with complications if they arise unexpectedly.

Having that relationship means being able to pick up when things aren’t going in a straightforward way. Understanding the power of the relationship and trust and what that does for us physiologically is probably the key to understanding.

When you feel safe with someone and know that person and that person knows you, you don’t have to keep telling your story. They understand what’s important to you. It makes a world of difference. It is about women understanding their physiological need to be supported. They need to feel happy and safe, and then everything works well.

Two examples of innovative, community-driven health services offering midwifery continuity of care:

  1. Belmont Midwifery Group Practice, Newcastle, NSW
  2. Logan Maternity and Child Health Hubs, Qld

Carolyn Hastie is a New South Wales midwife, Griffith University researcher and midwifery educator. She has four decades of experience providing and advancing continuity of care.

Published 28th June 2022

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About the Author

Louise Wedgwood is a freelance health and parenting writer, working with magazines, online publications and businesses. She has a background in health science, and enjoys helping parents make evidence-based choices. Her own children have shown her making the right decisions is never black-and-white.

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