‘…I gained a very deep understanding of the mammalian birth process and what it means to keep a silent watchful presence – to sit silently listening to the distinctive low bellowing of a wild cow giving birth – having taken herself away from the herd and sought the safety and privacy of a bank or a stand of trees. After leaving school I sailed off to see the world and didn’t return to Australia for nearly 30 years!
This month, MIDIRS stops to chat to Sally Tracy, Professor in Midwifery at the University of Sydney and conjoint Professor, School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales (UNSW).
Sally was educated as a midwife and a nurse in New Zealand and has over 30 years’ experience as a midwife in clinical and academic settings in Australia, New Zealand and the UK. Sally is also involved in several large research projects and recently led a major study, outlined in the medical journal, The Lancet, which found that care provided by a midwife who stays with the same mother-to-be throughout her pregnancy, during birth and postnatally at home is as safe as shared maternity care and significantly cheaper regardless of the complexity of the pregnancy care needed (Tracy S et al 2013).
MIDIRS: So Sally, you have a huge amount of experience of working with women and their families. Tell us a little bit about your background.
Sally: I was born in the outback of Australia on a cattle station 500 kms inland from the coast in the state of New South Wales. I had an exquisite childhood with all the freedom that is conferred on a bush kid – with free time to ride on horseback and explore the landscape. It was during this time I gained a very deep understanding of the mammalian birth process and what it means to keep a silent watchful presence – to sit silently listening to the distinctive low bellowing of a wild cow giving birth – having taken herself away from the herd and sought the safety and privacy of a bank or a stand of trees. After leaving school I sailed off to see the world and didn’t return to Australia for nearly 30 years!
MIDIRS: What made you decide to become a midwife?
Sally: I became a midwife after giving birth to my children and having been appalled at the way women were treated in childbirth! So right from day one I have to say I was a ‘midwifery activist’. I had just graduated in midwifery in New Zealand when Helen Clark the then Minister for Health in New Zealand made the most momentous changes, a quantum shift in fact, for midwifery in New Zealand with the amendment of the NZ Nurses Act 1990. Her words still inspire me. With the legislation she wrote:
‘The implementation of the Nurses Amendment Act 1990 should increase the choices available to women and their families in childbirth services. The Act restores autonomy to midwives, who were previously limited by legislation which allowed medical practitioners only to take full responsibility for the care of women. Statistics reflect the benefit of a commitment to natural childbirth, of continuity of care of the client and the rejection of unnecessary intervention. The majority of women have been socialised to perceive birth as an illness. The challenge of this legislation is to change that perception…’
This led the way for New Zealand midwives to enjoy equal status, higher pay, have more control over their working lives, carry caseloads and have visiting ‘privileges’ to public hospitals for referral and consultation with medical colleagues. Sadly we haven’t quite made it there in Australia I must confess.
MIDIRS: Which areas of maternity care or research interest you the most?
Sally: My research for the past 20 years has been about making the system better for women. My studies are usually concerned with the ‘cascade of interventions’ and unnecessary interference in birth, and more recently have been concerned with changing the way midwives work in the system. My feeling is that we must move into the 21st Century and take ourselves out of the ward based roster system and really respond to the rhythm of women and their special needs during pregnancy and birth – in the way many New Zealand midwives work today. My other major project has been the text book written for New Zealand and Australian midwives that focuses from the community in – rather than starting with hospital care. My latest project (which hasn’t been written up yet – we’ve only just started it) involves measuring amniotic fluid lactate during labour as a possible marker of uterine muscle exhaustion.
MIDIRS: Can you tell us a little bit more about your work as Professor of Midwifery at the University of Sydney?
Sally: I am based in my own little research unit based at the Royal Hospital for Women in Sydney- the Midwifery and Women’s Health Research Unit. Here I have the opportunity to share ideas and work with a whole multidisciplinary team of midwives, nurses, obstetricians and others, not forgetting the new mother. Being embedded in the practice area is absolutely integral to my research.
MIDIRS: You recently led a major maternity study which established that case-load midwifery is as safe and cost-effective as standard maternity care. This must have been a fascinating project to work on. Can you tell us how the study came about and your own involvement in it?
Sally: Well the M@NGO trial is the culmination of 20 years work! I designed the first iteration of the trial in my thesis while I was a master’s student at Queen Charlotte’s (later the TVU masters course) in the 1990s. Of course I was heavily influenced at the time by wise women such as Lesley Page and Sheila Kitzinger. These were the ‘heady’ days of Changing Childbirth. It took the next 20 years moving backwards and forwards between the UK, New Zealand and back to Australia, and two more children, to finally win a competitive national funding grant (after many unsuccessful attempts), to help set up the caseload midwifery group practices, to oversee the study and finally have the work published last week.
MIDIRS: Which of MIDIRS services do you find of most benefit in your role of midwife?
Sally: I love the pink publication from cover to cover
MIDIRS: When you are away from work, how do you spend your time relaxing?
Sally: I play the Viola da Gamba, and I am a gardener. I grow my own veggies and I live in the Blue Mountains out of Sydney where I walk on a bush track every morning early with my three dogs. And I am a mother of four and grandmother to Charlie and Max.
MIDIRS: And finally, if you could give one word of advice to newly graduated midwives, what would it be?
Sally: It is a most wonderful word of advice given to our class of post grad midwives years ago in London by Caroline Flint: Always be armed with research to back up your practice! Caroline used to carry around a shopping bag with relevant research papers in it. Today it is very handy to have a little file on your laptop where you keep the pivotal papers that support your practice. Make sure they’re in easy reach. And I should like to finish with this sentence from a public health report tabled in the UK House of Commons in 2001 which says:
‘Midwives are often passed over by public health strategists because they are usually employed and managed by the acute sector, which is not at the forefront of the public health agenda, but in fact they have an important public health role’ (Paragraph 75).
Tracy SK, Hartz DL, Tracy MB et al (2013). Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. The Lancet 17 September [online version ahead of print].