LAURA NONEY

MIDWIFE

A true UAC Guide success story, Laura Noney is a Sydney-based
midwife working in the public health system. Her compassion and
care for others is palpable, as is her focus on patient-centred care, surely true for the new parents that are lucky enough to work with her.

Bringing babies into the world, balancing power dynamics
in an emotion-fuelled environment and the warning
signs of burnout – she shares it all.

Kick us off Laura, what’s your day job?

I’m a midwife. At the moment I’m doing home visits which are after the mums go home from the hospital. In the public health system, they only stay two to three nights, even if they've had a caesarean. We pick up where they left off in the hospital and make sure they are settling in and that the feeding is going well.

The day we come in is after their first night at home – generally when they’re freaking out from the night before. We give a lot of reassurance and see them for as long as they need.

Talk us through your process of becoming a midwife.

Well, I didn’t want to be a midwife, I wanted to be an architect. I got into interior architecture, did it for three weeks and hated it, then dropped out. I was like ‘Nup. This is fucked, I don't know why I wanted to do this.’ And I’d done fucking physics and stuff in high school to get into it… it was the worst.

Growing up we’ve always been taught to stick with
things and not quit – my parents said to stick it out,
but it was the first time in my life where I was like
‘No. I know that I hate this.’ So that was a good
lesson for me.

You know in high school when they give you that book with all the unis and the list of all the courses? It wasn’t until my younger sister was going through, just reading them all out – she was like ‘Midwife? How about that?’ 

A true UAC Guide success story! Every single one of us bought a copy!

I know! I don’t even think I looked at it in high school.

At the time it was one of the first [midwifery] courses; before that you had to do nursing for three years and then do a grad diploma in midwifery. I had looked into doing nursing, because there was a massive stigma around doing just straight midwifery. It was looked down upon because you didn’t have your nursing, you didn’t have your extra skills. Although, if you want to do rural midwifery, you need both nursing and midwifery. I remember a lot of friends doing nursing who were all being placed in nursing homes, and I knew from the get-go that I wasn't someone who had the personality for... I wasn’t very good with the older generation. I knew I wouldn't get through it.

And also… men. I was never interested in looking after male characters hahaha. Old people with penises just never interested me in the context of nursing.

I knew straight away that I was way more interested in looking after women. I went straight into applying and straight for the Bachelor of Midwifery. I didn’t get into any of the Sydney courses, so I went to Southern Cross University for the first year, which meant that I had to travel up to Coolangatta in Queensland.

I was very shy and anxious, very much a homebody, never thought I wanted to travel. So when I did that for a whole year, I knew that it was the right course.

I transferred to UTS for the second year and finished out my training there.

How hard is it to get a graduate position after you finish?

Easy. It’s kind of like getting into uni – you put down your top four or five preferences for which hospital you’d like to work at. You interview for your first preference, and if you don’t get that one it just goes down the list. It’s kind of like the HSC… you think getting
a graduate position is the be all and end all, but they hire first year midwives and give you the same support as if you were in a graduate program. 

You said you had a strong feeling you wanted to work with women, do you think that studying in a majority female cohort and being surrounded by so many women influenced that even more, and made you more passionate to work once you graduated?

I think so! I’ve always been drawn [to women], even just with the connections I make in my life. I always make stronger connections with women.

Have you worked with male midwives?

The majority [of male midwives] are the most amazing people I have ever come across. And the women LOVE them – they get so much out of male midwives. They bring a different kind of compassion. Women seem to connect with male midwives in a different way, for the better. The male midwives I have met are extraordinary.

It seems like you followed your intuition massively when picking your field!

Yeah, it definitely all clicked. It all fell into place once
I started. You start prac three months into the course, and I just knew straight away. I loved it. Being there, surrounded by women helping other women, being there for each other… it was where I was meant to be.

In your work in the hospital, what do you find beneficial in creating a productive and caring environment?

In the hospital system, just like anywhere, there are a lot of different personalities. Lots of different types of people, lots of different ethos and life values and ideas of how you best care for women. You find your little clique when you’re at uni, and then you go into
the workplace and there’s this big group of women who sometimes work well together and sometimes not so much. I think it’s really helpful to find the colleagues that you have the same ethics with on how you want to care for the women. You bounce off each other. You can talk about what you love in the workplace, but also what you get frustrated by as well, so that way you don't burn out as much when you are trying to push against the system.

People get burnt out, and they need to protect their
heart in whatever way they can. Some people have to
put up that wall or work in a certain way in order to
do this job.

I totally understand where that comes from, but it can be frustrating as well. Finding your little network of people and having debrief sessions is good – going out for dinner, away from the work environment.

What do you think people’s perception and understanding of what a midwife is versus what it actually involves?

Oh! Everyone has completely different ideas.

A lot of people think that we are just the support staff to the doctors. As midwives, we are actually the core staff. We do pretty much everything. All the antenatal care (which is leading up to the birth). We do all of the birth, the labour, the assessments, we are there
for the birth and the delivery of the baby. We support the mum through the labour, we help suture the mum after the baby is born,
we put cannulas in... we can do pretty much everything.

Afterwards, we are doing all the care as well. We’re helping with the recovery, the breastfeeding, the bottle feeding, the mother crafting skills. 

I think a lot of people think, just like with nursing, that you're there to do the temperature, change the dressing, give emotional support, and the doctor does the majority of the work.

The midwives are the primary health givers, and the doctors are there to support us.

Yeah I think that’s a massive misconception for sure – how involved you are and how much you are doing.

Yeah. The doctors are there for us to call on if something is deviating from normal, like if there needs to be an assisted delivery – forceps or vacuum, things like that. Or if there is a booked or emergency caesarean.

Does a midwife specialise? Or does it just depend on the day?

Every hospital is a little bit different. There’s antenatal care (before the baby is born), during the birth (delivery ward or birth unit), and then there's postnatal care, so that can be on the ward or home visits. Every hospital has an antenatal clinic so you can get positions there, you can get positions in the birth unit, the maternity ward or the home visits section.

Some hospitals you’ll apply for a job in a specific section and that's where you'll stay, others have a rotating system where every three months each midwife will rotate around to a different part of the hospital so that they keep their skills up. Every aspect of birth is very different, I suppose it's kinda personal, what aspects you like and resonate more with. You’ve got the option.

What have you been typically doing?

In the last five years I've been rotating around, doing a bit of everything. I would say that postnatal is where I feel like I can give a lot more.

I really love to see a mum's confidence grow after
she's had a baby. I love to help nourish that, help to
give her the confidence to realise that she can look
after her baby. That’s where my passion lies.

I do love the birth side of things as well, I just think with my personality I can't do it 24/7 because it's so fast paced and SO intense that
I need to have time away from it to kind of regroup myself so I have the capacity to give. Whereas a lot of the girls in that area… they can just give. Constantly. Without it affecting them. I’m amazed by them.

Have you experienced burnout?

Definitely. In my first 6 months.

It was just a combination of everything. It was my first time living away from home, my first time working full-time in shift work and my boyfriend had moved away. The girls would all be off every weekend and I was kind of like ‘I’m going to work’ at like 1pm on a Saturday. I thought I'd made the wrong decision – I was hating shift work, it was not good for my mental health at all and I was ready to quit then and there.

It was then that I learned you don’t have to just
do it one way, or the way that everyone tells
you you’re supposed to... like you just get out
of uni and go straight into shift work. That you
just suck it up and you do it.

I looked around and I found a position that was Monday to Friday in the special care nursery, and my main role was just looking after the feeding. It’s where I started my career in lactation consultancy, helping mums with expressing milk and, when the babies were ready, helping them with feeding.

When you look back at that time, were there warning signs of burnout coming?

Oh definitely. My mental health was horrible, my anxiety was the worst it had ever been. Halfway through shifts I’d be calling my boyfriend crying. That’s a pretty good warning sign haha.

I started seeing a psychologist and she was like ‘you should probably start on some medication’ and I was like ‘No, I think I just need to change my situation’. I know what the problem is – I just need to not stick to what society thinks I need to be doing to be doing this job. 

Giving and giving and giving!

Yep. That’s my lesson. I can find a way to do this because I love it, but I’ll find what works for me and do it that way. Because there’s no point otherwise! There’s no point in me going to work when I’m [feeling] like that. I’m not able to give to the women who need it.
I learned that very early on.

What do you find the most challenging part of your job now? What are you hoping to get better at?

I still struggle with the system side of things. Just like every system, it’s not individualised care focused on the individual.
It’s just ‘getting a job done’.

I guess because it is the public system, there’s also a certain degree of needing to churn through people, give them the care
and then discharge them because there is another mother coming in to give birth to her baby.

I see that everyday – people being pushed out of the hospital sooner than expected. But then, I definitely think it is more beneficial
for them to be outside the hospital, getting care in the community. I think [community care] is definitely the best kind of care. You’re going into a woman's home, you’re going into her environment. Whereas when she’s in the hospital, we are telling her what to do. [Home visits give] the power back to her. We are giving her autonomy, and it should be like that everywhere. When you are in a hospital, or any kind of system, there is just naturally a hierarchy.

Yeah, like a relinquishing of control.

Yeah. I think my biggest piece of advice for new mums and dads is that – you don't want them to give [all the power] over to the doctors and midwives. Which is hard because you want them to trust you. But just like your GP... you don’t want them to have complete control over you. You need to have some sort of understanding over what’s happening, so you can make an informed decision about your body and your baby’s body and the care that you receive.

You can get 100 different opinions, but in the end, you have to make the decision. Giving over complete control to the doctors and the midwives is not beneficial in this day and age. Especially with all the information that we can access. You can access all the policies online! 

Is that a difficult dynamic to navigate? Dealing with people who are really prepared – like, you’re the expert but also they’re
the expert of their own body and their own pregnancy?

Yeah, there are people who come in and are not prepared at all, and then there’s people who know too much and are constantly fighting the system, which is the other extreme.

When you get married, you prepare for that wedding day – you know what you’re going to experience. You have things planned out.
It should be the same for your pregnancy, labour, birth and after the baby is born. Have an idea of what you want and how you want it to go. Not a full on plan… but know your options, so that when you get into the system, it’s not the first time you are hearing terms like ‘induction of labour’, ‘forceps’, ‘vacuum’ or ‘cervix’. 
Do the readings!
Do the readings! Do the classes!

What would you change about the public health system if you could change one thing?

More one-on-one care. The research shows that the women who have the same midwife or care provider throughout their whole pregnancy – their labour, their birth and afterwards – have the best outcomes.

The thing that leads to a good outcome is trust in your care provider. If you can't have trust you are going to have fear, and if you have fear you are getting rid of all the love hormones that help to facilitate a good birth, bonding, breastfeeding and love. If the fear
is there, the cascade of intervention just starts from the beginning of the pregnancy.

So if you have one care provider from the start, and
you build that relationship, you could have a birth
that’s really full on and doesn’t go as planned, but the
women don't come out of it traumatised. They come
out empowered, because they’ve been prepared.

They know that you’re looking out for them every step of the way, with their best interest and what they want in mind.

Yes! They’re educating them through the whole process rather than just being like ‘ok this is what’s happening, now this is happening’.

Continuity of care.

Continuity of care! And then through that, it’s holistic care because they are looking after every aspect of your pregnancy – body, mind, heart, soul. Haha. Everything.

We need that continuity of care globally, across the entire healthcare system.

That’s definitely the route I'll be going when I have a baby. It also dramatically decreases the cost of the maternity system, because women have less instrumental births, less caesareans, less epidurals, less infections, less premature babies. All of this benefits the
cost of the hospital system.

This is speaking very generally and stereotypically, but people that are typically against a holistic way of looking at healthcare are also often the same people who are concerned about profits and where taxpayer’s dollars are going. If you are so worried about profit, you SHOULD be interested in holistic healthcare because it directly benefits the economy.

Yeah, the evidence is there, the studies are there, written on paper. I don't know why more funding isn’t put into it. You’ve also got to have the midwives who want to do it. Personally, at this stage in my life I am not ready to be on call 24/7. I just don’t think we’ve perfected the model yet, because we haven't had the funding to perfect the model. There will be a way to do it. but they are still
trying to figure it out. 

Revamps and overhauls of systems take serious coin.

But it’s happening! Pretty much all hospitals have continuity of care – a caseload midwife or MGP or midwifery group practice.

How many months are you with a woman from start to finish? Is it when a woman first comes into the hospital, you are assigned?

Everyone has a choice, in Australia. You have the choice to have your own midwife [in the public system], or go private and have
a private obstetrician. Or, you can go through the public hospital generally, which would be a different midwife every visit; when you come in for the delivery, you get the midwife who is on shift.

Say you fall pregnant, you go to your GP, you confirm the pregnancy at about 8–10 weeks, then you would go and book into a hospital. At the booking appointment, that’s when they give you your options for what kind of care you want. If you wanted to go private, you would ask the GP to refer you to a specific obstetrician.

If you want to do continuity of care through the public
system, you have to get into that pretty much as
soon as you pee on a stick. It’s that popular and that
under-resourced that they’re not keeping up
with the demand.

So if you get pregnant, let me know and I’ll get you on the program!
HAHA! You’ll be the first person I call! 

Can you spell out the difference between an obstetrician and a midwife? What do you get from an obstetrician as opposed to
a midwife?

An obstetrician is a doctor who has completed all their training, so now they are a consultant – the most senior you can be in that field. Then they can get their own clients who pay them, and they work through a private hospital that gets revenue from that payment.

Your private obstetrician would be in charge of all your care, organising your appointments, your ultrasounds, blood tests and your labour. They might not be there through the labour, but would definitely be there for the delivery of the baby. They would do the suturing afterwards, and they would do the caesarean.

Obstetricians I think are excellent for women who have known risk factors and know that they are going to need a private obstetrician throughout their birth and labour, for medical conditions that they already have.

Once you are in the postnatal ward at a private hospital, the midwives are going to be looking after you. Obstetricians don’t do post-care.

Looking forward, where do you want to take your career?

I really love helping with lactation and breastfeeding. I’ve got my certificate in lactation consultancy, so I’d really love to get that up and running as a private lactation consultant.

I’d love to open a clinic where we had all that extra postnatal support – lactation, infant sleep, infant massage, mums and bubs groups, exercise classes. Where mums can just get together. Just somewhere for them to have a space to come together and support each other and have services to access that support as well.

Amazing! A lot of women don’t have that, friends and family living nearby, someone to bounce things off…

Yep, and we are all having babies at such different times now. Because of technology, women can now wait longer [to have a baby] than they used to. We don’t schedule them around our age anymore because we don’t have to. Your friendship group is probably not going to be the group that you’re with when you have a baby.

I want to create that space.

Dive into the stellar midwifery-specific content Laura recommends –her go-to blog, clear educational resources and this poddy
that shares real stories of pregnancy and birth.
Or, if you’re thinking about becoming a midwife yourself,
click right here you delightful human!

Interview Haylee Poppi & Grace MacKenzie
Edit Grace MacKenzie
Image Declan Blackall