 To introduce Hannah Darlin, she's a Professor of Midwifery at the University of Western Sydney. She's also the National Media Spokesperson for the Australian College of Midwives where she deals regularly with media on midwifery issues. Over to you Hannah. Thank you Jane and this is one I've only done on Midwife and I love Patricia because I can't stand technology. And I have a good set of hands and they always seem to work. So thanks everyone for being patient and if you didn't hear what I said before, Happy Midwives Day and I think this is a very exciting day and I'm going to tell you some statistics soon that will show how important this day is for getting the role of the midwife out into the public. So why do I think that we need more political midwives now than ever before? I don't know how much you caught of what I was saying before but so much is happening in the world today that affects midwives. So many good things and some things that are worrying and taking us back. It's really important that we're not apathetic with the good things and that we push them forward and it's really important that we don't give up and we don't fight the injustices that are also sometimes being leveled. So if you look at the definitions of... There are people here saying they can't hear. I hope that's working all right. If you look at the definition of politics, it's manoeuvring for power in a group and that's essentially what politics is. It's about manoeuvring for power in a group and you only have to watch children in a playground to realise we're hard-wired to manoeuvre for power in a group and midwives are no different. But in many ways we have a bigger job ahead. We have a bigger fight. We have a harder road because we are dealing with women's issues and we are predominantly women and we're dealing in a world where, unfortunately, childbirth and women in their facing society are often not given the importance that they should be given. So I want to begin by this concept that politics can be good, it can be bad and it can be downright ugly and politics can be used to take us into the future and that, of course, is the politics we all should subscribe to but politics can also be used to keep the status quo and we have to be very wary of the use of politics to hold things firm in order that there would be certain groups that would continue to have the power that they need and politics can also be used to take us back into the past and we also need to be very, very wary of that. One of the things that I am most concerned about is that midwives often feel a sense of giving up, a sense of helplessness, a sense that they can't do the work, change the world. Well, of course, alone we can't. But I love this quote from Mother Teresa, while we can't change the world alone we can cast the stone across the water to create many ripples. And the thing about casting stone across the water and creating ripples is you never know where those ripples land and what distant shore that has an impact. So I just really want to encourage midwives not to fill this up, not to give up. Remember, if you cast your stone and everybody else does, eventually those ripples will reach some distant shore. The other thing I think that's actually critical is that we often think about painting the world but nobody thinks about painting themselves, as Leo Tolstoy said. And that's very famously done. He said, we need to be the team. And I find it fascinating, and I've been doing a lot of research where we've been interviewing midwives and then actually observing their practice, their ethnographic work. And what I find fascinating is that midwives have what I call an international rhetoric. We all know what midwives should do. We all know the mantra. We all know how to answer the right way but what midwives say in an interview or in a focus group and what you then feel practice are very different things. And there is this sense that often midwives understand the right way to be and the right way to act and the right way to be critical. When they get into the huge machinery of the metallurgy system and all of the power play that goes on there, they revert very quickly to being part of that system. So doing the change takes an awful lot of time. It's like I had a wonderful paper on the importance of midwives being political. And he said that midwives' roles were diminished over the last century, not because of their failure as caregivers, but because of their failures to respond to the political challenges they face. And I think if we look back over the last 300 years of history where midwifery really lost the role and presence in maternity care, it wasn't because midwives weren't doing a good job. It was often because they were not educated, they were not connected, they didn't work together and frankly they'd never had to face this before. So responding to the political challenges that we face is absolutely essential. We are going to take this. The other thing that the clerk said is we need to recognize the importance of political awareness and activity. It's midwifery to survive and prosper. And one of my kind of things that I've learned during politics, particularly over the last 15 to 20 years, is every time you get a win, wait for the backlash and plan for it and be strategic. Often what happens in midwifery is we get a win and we celebrate, which is great and we should, but we do not think about what is going on in the background that could potentially be trying to destabilize that win. But always be prolific and aware and active. So I just briefly want to talk about a study idea that was published in birth. And I put the rest of this up earlier, but I will also put it up again just now so that you can get it if you want to read the full paper because I'm obviously not going to give you all of the dancing in the paper. But I did a study where I looked at what was said about midwives, midwifery and midwives, obstetricians and obstetrics and births over a one-year period on the Internet in web-based news reports. And I analyzed using a quantitative content analysis what was being pulled out there into the public about our profession. So I won't talk about the birth aspect, that was a massive one, but I'm going to talk about the study that was published one year on midwifery from 2006 to 2007. And in that time I ended up with over a thousand alerts that were to deal with midwifery and obstetrics. And I'm going to talk to you a little bit about the things that came out of that. But what I like so much about this slide, I don't know if you can spot what's going on and please type it in if you can spot it. But this shows the numbers of midwives and obstetrician alerts coming through for the different months. And the dark blue is the midwife and the light blue is the obstetrician. Do you notice something happening in May and what do you think might be actually happening there? So there is a big spike in midwives and you can see that the month of May is having huge impact. Now some people have written Mother's Day. Yes, Mother's Day has some impact, but remember I was looking for midwives and midwives and midwifery as the key. So this is IMD. This is midwives day. This is widely reported around the world and this is the impact that we have from this day. And what I found when I did the analysis is the most positive depictions and the most powerful language in the media reports came out in May. So having midwives day can add it because you have this massive impact. And as you can see, it's fairly similar to midwives and obstetricians in the different months in the 50s. If you look at the countries, I think this is really interesting. I wrote it down into the country for 1,000 media news reports and you can see some interesting trends going on here. Obviously the new apps have the largest. They are the inventors of the Internet after all and the most average users. So look at the contrast between the numbers of reports on midwives and obstetricians related to some of the countries. What else do you see here? You see in the U.S. a very big dominance of obstetrics in the media reports and much less midwives reports. And you see in the U.K. where midwives is very strong that the majority of the reports are around midwives. In Australia where we're getting stronger, we're starting to become neck and neck and we want to repeat this study and start to show how as midwifery changes in its power and presence, those are the numbers of reports. Canada, again you can see midwives now becoming very strong and leading ahead. New Zealand, where midwifery is very strong, absolutely midwives now lead. And I think this is fascinating because this also shows that the media both reflects and creates opinion and when midwifery is strong, midwives actually dominate in the media. The same things that came out of the study when I looked at the midwives, midwifery and midwives themes, where the largest theme that came out was mainstream midwives. This is on models of theft and the rise of midwifery stories. And 28% of the stories reported were that. And the next largest theme was what I call the Cinderella of maternity care. The workforce and industrial issues. And following that came a theme that I called the living and abiding with your hand time. These were funding issues, insurance and legislation. And then weighing down at 8% of the media reports came the theme after the experts. And I wanted to keep that 8% in your mind when we go and look at the obstetricians. And then at 10% we found out that midwives interestingly most of these came out on midwives deaths. And unsafe midwives... Hannah, Hannah, Hannah. Hannah, sorry to interrupt you. I'm still getting a few comments about the audio. So can I just ask you to turn your webcam off now and hopefully then we've done everything we can for the audio. Thank you. I think that's a part of the answer in here. Okay, that again. All right. So unsafe midwives was around 6% of the reports. And then the art of birth was around 2% and then other things that I really couldn't categorize. And so when you look at this and you actually look at the quantity of reports around the different things, you can see that there's a lot of emphasis here on midwives yet rising and articulating what they're doing, but also a huge amount on the fact that midwives have a huge workforce issue and that midwives have huge industrial and regulation and insurance restrictions. And then way down, much lower comes the expert midwife and recognizing midwives. If you look at what that all kind of came out of saying is that midwives are gaining acceptance of their seeking recognition. If we look at obstetricians, do you remember where midwives sat when we had the RC expert? Well, we sat at about 8%. It was the number one category for obstetricians after the expert. And these were midwives. These were reports around obstetricians who were doing lots of research and very much being consulted as the expert. The next was Dr. DeHiroz amongst us and this was an announcement and award. You might remember from midwives that was 7%. And then it was obstetric workforce. Then it was around reports of trending care and new technologies that obstetricians were engaging in and some of them were quite scary. They're disappearing obstetricians following now. So what I want to do now is just tell you how different that is to the midwives. If you think about where the midwives issues were most dominant in the media here, clearly the obstetricians are seen as the experts as heroes amongst us. And then followed on by the fact that there are some workforce woes. But again, very, very dominant was the fact that they were experts boarding news frontiers inventing technologies. So now as contrasts those with the midwifery scenes, but what really came out was obstetricians have both recognition and acceptance, whereas midwives increased and have not got that recognition yet. And then I contrasted those native scenes and you can see clearly the artsy expert obstetrics are seen as vastly more important and good to go to after expert advice. The workforce issues, midwives still outdrift obstetricians, but there was some similarity. But again, huge differences in public recognition. And what I found interesting is that what really showed how recognized doctors are is even if their daughter got married on the weekend and they got reported. And this is telling us that obstetricians are seeing as very important in society. Litigation was fascinating. Litigation was neck and neck. There was one report in both groups. However, what was absolutely fascinating was the way those reports were put forward. With midwives there were three that were serialized. Two of which were not midwives. They were non-midwives. But serialized and stationalized sometimes you felt you were reading a novel. With the doctors they were all individual cases. They were written very objectively and often ended with, well, he was a good doctor and he made a mistake. So even the language used to report these things have huge impact. And then you can see the massive issue going on with the recognition of midwifery with funding, insurance and legislation. And this is a lovely quote that comes from a Canadian study. And in this they talk about, the whole situation reminds me of a long hard labor like my first born. Midwifery has been in second stage for a long, long time. Midwives and consumers have been working really hard to support this birth. But everyone knows pushing is hard work. And that moving from acceptance to recognition is hard work. And for many midwives around the world I think we are in second stage and we now need to bring out all of our skills to get us through the birth, the profession and to move us from acceptance as we increasingly are to recognition. So I call this getting on with the birth or fighting the midwisitation of our profession. And there is an enormous amount of evidence that actually midwifery, one of the most ancient professions in the world has progressively through the last 300 years been demigrified. Demigrified. So even though this is not a word and you can't put it on your scrabble board it's my little kind of capturing of what I think is going on. So how do we fight the demigrification of the profession? And I think the first one is yes, moving into recognition is a key and how do we do that? So as a researcher, of proficient, of very much seen as the expert research is fundamental and as a researcher being able to ask questions that only midwives will ask is the only way we are going to show midwifery because of proficient I'm going to ask questions about how midwifery works and very much in the last decade, in two decades we have seen the rise of fantastic midwifery research getting to the media. We've seen it start to shape policy and it's in that says I can't speak more strongly about the need for midwives to get research active and to support research and to get involved. We need to reframe our profession. There's a lot of bad media and press that goes on. Unfortunately the media is very attached to the negative and we need to be very strategic about getting good stories out there and that's often the mistake we make. We need to show that midwifery is relevant. If you look at what goes on in the media it's either home birth and it's the disaster or it's the elective caesarean women requesting it and it's as though 98% of the population and what actually happens in maternity care is not even understood or reported and this makes women out there often think I wouldn't want a home birth so that's not relevant to me. Midwives are associated with that so midwives are either depicted as being associated with home birth and completely outside the system or very much subservient to the obstetrician in the system. So we have to be very careful to make sure that women understand and the public understands that every woman needs a midwife and some women need an obstetrician as well. Oh, how do we do it? Well, hanging on to what we know can only ever be a short-term strategy and I love this picture of the polar bear putting the iceberg that's quickly melting under them and as time changes and issues affect us we have to learn to adapt to midwives. We have to learn. We are so clever. You look at midwives in the birth room while they recognize a woman in a situation where she's blocked or mentally blocked or that position isn't working we're starting to wonder if we're so inventive we need to bring this out with politics and be flexible. And the question I'd ask today is do we believe in what we do? And I often say this to my students do you believe that you are in one of the most magnificent and fabulous professions on earth? Do you truly honestly in your heart believe it? I can honestly say that I do not think there's a greater profession on earth. There's nothing ever else that I've ever wanted to do. Do you believe that every day new changes change lives? Do you believe that you are important? Because if you believe that you'll go outside and you'll go into the world and you'll go into your care of women telling them. And I think the way many midwives practice and many of them attitude tells me that they actually do not believe that what they do is important. I love this quote from Henry Ford and he says, coming together is the beginning fitting together is progress working together is success. And one of the greatest things I see midwives failing at is that we're not really good at all coming together and working as one. We're not good at trying to put aside some of our patterns that we will not be flexible on. We want it to be only our way and we want our issue to be listened to. Instead of coming together and working on the key things that are going to get us together. My great group, Plea with You would do. Yes, we need to come together and today we're doing that around the world. It's fantastic. We need to then keep together even when it's hard and issues sometimes divide us. But ultimately we will never ever change the profession in midwifery if we do not work together. We're not doing that because without women obviously none of this is ever going to happen. So while we're ready for the challenge because of course we've changed while we get new and exciting opportunities it also can destroy all we hold dear and learning to be flexible in politics learning to negotiate learning at times to compromise of how that is to do is the only way actually we will survive. Another quote from Dick Burke said while health reform influences midwifery there really is ever the focus of the debate and they run the danger of being victims of unintended consequences. And you only have to look at what's happened in Australia to realise that while yes there have been some health reforms that have been great for us there have also been some reforms that have had unintended consequences for us. And one of the consequences of unintended reform is of course around the world there has been an issue with insurance behind birth and decline. That has been a result of more global changes in how insurance is provided but also in what health registration bodies require and it's had the unintended consequence of impact seriously on private midwives and their insurance. So we must always be aware so every time a policy comes out in health every time something is at foot think about how does this impact midwifery? We don't rank highly on health agenda but we need to make sure that we are aware and we make our voice come out there and identify issues that are done also. It is really simple if you're negotiating with governments if you're trying to get a point across if you're trying to make a policy relevant argument think it's simple there's two things governments interested in money and votes and that's it. So everything we do, motherhood statements they're not going to help the government we should be thinking about how does midwifery save the government money and how does midwifery save its votes and the best way to do that with the voting is to make sure that consumers are the ones that are up front and working strongly and we need to make sure that we have data that documents the outcomes of midwifery care and we've got some very smart researchers who are now doing that we need to make sure that data is of interest to policymakers and we need to make sure the findings are communicated in a manner that the public can understand and these are things that I think midwives actually are very good at because we are good at taking very complex concepts in medical care and simplifying them and making them much more understandable to do this when we deal with government as well. So how can you as a midwife become more political? Well you need to have a voice and I cannot say more strongly you need to join your professional organization and get involved. So ICM as the national body that represents midwives every country if you don't have your own national association as part of ICM then please get one happening there is nothing more powerful than when a group of midwives get together get a name, get a position one of the greatest things is that you can do things like common in the media whereas an individual midwife in a hospital can't stand up and criticize what's going on within her organization. She has to have another person who is in a professional organization to be that voice. Get on to team committees. People often complain to me about policies and procedures and I say well get on to the same policies and procedures the only way to make it happen. Learn to network. Learn to communicate with models of midwives. Learn to get others on board. The ability to connect with women's groups with different organizations with obstetricians, with psychologists and social workers if we can bring everyone together around team issues will be much more powerful. Press releases we use a lot and they're very good at strategic strategies with getting out certain messages. One of the things I found most powerful is that how to get into journalists. So if you have an important message to come out on, you have a publication coming out get on to a good journalist give them the story the day before the publication comes out and target them and that way you will often end up with far more effect than waiting for a publication or a press release. Try to get the optimal moment knowing that you don't put out anything in the media on Friday because it will die over the weekend. Monday is a good day. Learning how to get your message out at optimal time. Local lobbying is really essential and this is something I think midwives are learning better skills at but making sure we have lobbyists making sure that we have got the skills and the people there who are placed to put out positions. I haven't got time to talk much about the media and my passions. I've spent the last 15 years being a media spokesperson and I can assure you that the media does care but a little for a short time. The good thing about our profession is mothers and babies lend themselves to media coverage. I often say I'm really glad I'm not a podiatrist and that in trying to sell a ham at home we have got cute babies and gorgeous mothers but the media can also crucify and sanctify midwives so be very aware. The media is not your friend you have to get very strategic at how you use it. Media relations take an enormous amount of persistence and sensitivity and to banquet is very interesting. And knowing that there's a time to talk and a time to shut up I once responded to everything I now learn not to respond to. Sometimes you actually do need to hunker down but you need to let it pass. In the olden days we say that today's news paper is tomorrow's fish wrapper but we of course can't say that anymore so those of us who are younger don't see the old fish and chips wrapped up in the news. But the thing about the media is the case in Spain is short and negative stories will pass and sometimes you need to learn when not to. I haven't left consumers to laugh because I don't think they're important. And none of the changes that have happened in Australia I know in New Zealand and in many other countries would have happened if we had not had powerful women jamming out further under their parliament house with their signs not being a parliamentarian. And so consumers are essential and I find it fascinating that the more oppressed midwife groups is within a nation often as strong as a consumer group but the easier it all is often the less prominent a consumer group. So my advice to you would be if it's good in your country and I know there are countries where it's good but the Netherlands is one but we know there have been a lot of changes there recently but don't ever let go of the importance of consumers because it will never remain good. There will always be forces that will try to make sure that midwifery does not have the power. So consumers are essential and midwives are going to need to work together. And if you're listening to this and saying well I'm not going to go into the media and I'm not really into politics and I don't do research on a clinical midwife well I think if anything can take away today is that the most powerful political act that occurs every day around the world is the way midwives are with you. There is nothing more powerful than the way you are with a woman whether it's in an anti-natal visit whether it's during the birth or whether it's in the postnatal period. We can change the birth world one birth at a time. When you hear women coming out of birth with serious trauma when you hear some of the things that midwives expect of them when you see some of the treatment from midwives it makes you feel terribly bad and ashamed of your profession at times. It also makes you realize that it takes one midwife down living one woman who then goes out and tells all her friends and relatives about that care to show that that is an incredibly strong political act. So if there's none of those other things you feel you can do remember that every time you're with a woman you have the opportunity to perform the most powerful political act in the world change the world one birth at a time. And I want to end there and with I guess the strongest message which is some of this lovely Kenyan proverb that sticks in a bundle are unbreakable. Now if we stick together and if we work together and I include women and midwives in that if we ask to teach it if we learn to take a deep breath when we want to laugh back or we want to defend our particular territory if we learn when to be public about what we agree on and private about what we don't agree on if we learn how to handle the media if we learn how to get the best people forward to do that if we learn how to make sure we support our researchers not criticize them or not make fun of research if we learn how to do that and all work together we are unbreakable we're a large number in the world we have the greatest impact on women's lives every day we have it all but sometimes they don't understand why we all dissipate and not support each other and not go ahead strongly together. So that's really all I had prepared and I want to leave them the opportunity obviously for questions now. Thanks. Thank you so much Hannah I think that's an amazing way to start the conference you know raising the profile of Midwifery getting the message out there getting politically active and sticking together what a fantastic message so I would like to ask if there are any questions from the room perhaps you could raise your hand if you would like to use the microphone or we can respond to typed messages as well so thank you very much for that I'll just put up that paper again for people if they wanted to read the whole thing that's now published in the but all the quotes are in there and that's really very interesting reading. I can't actually see any questions coming there but everyone's making wonderful comments about what you've said. Yeah somebody's made a comment here Lisa Kennedy, thanks sticking together we're not good at this it's our big downfall in Australia I agree I think you know in Australia we powerfully searched ahead a couple of years ago and it was the first time that so much fell into our land and the opportunity for me to really have that recognition and we worked brilliantly with consumers but sadly yes there were factions that you know within that group they didn't agree and I think in some ways we took the power out of our potential I don't think we've learned I know I'm a Polyana I'm a big believer that you know sometimes the tough times in life teach us the greatest lessons and I certainly am wiser in the result of that time but learning sometimes to be humble and learning to you know listen to each other and also talk to each other sometimes the conspiracy theories that arrive because we've heard something and we haven't actually gone and addressed it with time so one of the greatest lessons I look at places like the U.S. and in their Humber Summit that they ran a couple of years ago and what they did is they came into a room which is phenomenal for the U.S. when you think of if there is a nation with more politics going on around maternity care it's that one but they got all of the people all of the stakeholders in a room and they said let not debate whether or not Humber says let not debate the statistics let's talk about how we're going to make it happen safely well it's totally changing gender so rather than fighting rather than that public animosity that sort of came out they came up with a fantastic statement and got that read into their their senate that said well we can live with this and I think as midwives we need to do a lot more of that there's a question there Hanna about whether midwives should be members of the maternity coalition your advice on that well I am I love the maternity coalition I think it's fantastic I guess there is a level in me that's cautious too because I do I do see the value of consumer led and consumer only groups I do think there's a value in that because I think unfortunately sometimes consumer groups are dismissed because they are seen to be ingratiated with midwives and therefore following a political agenda I think that the way that the organisation in the UK in particular the National Salvers trust the NCT has done it is brilliant I think that the way they have strategically got people on all of their committees involved in all of the policy decisions is wonderful but at the same time there needs to be a forum for midwives and women to work together I still like to think of consumer only organisations but I think there's also a place for being able to think I've just given the microphone to Denise she wants to ask a question so Denise you can sleep now I don't think her microphone can be working if anyone else has any questions raise your hands or type them hello is it working now yes it is absolutely I didn't have a question I just wanted to share with people about the maternity manifesto in New Zealand which is a combined effort with maternity service consumer council people and others to try and put some maternity issues on the political agenda here and we've created the maternity manifesto where people can come and sign up as individual and group supporters and we have something like services to support including the college of midwives and then maternity service consumer council and others are taking this to the politicians in fact next week on the 20th we have an appointment with the labour health spokesperson and we've talked to the Greens and we've talked to Maori Party a little harder to get to the National Party at the moment but anyway thank you thank you for sharing that excellent it's wonderful I just want to make a comment on New Zealand you know I really do think that if we have a microcosm of excellence in New Zealand today and I think many of us can take important lessons from that yes definitely agree we just have a couple of minutes left until 10.2 if there are any other questions Alcora I'll give you the microphone coming from Australia you know I thought New Zealand was a microcosm of excellence and it is in that women have access and so forth but if you see the maternity manifesto you'll see that 70 odd percent of the women what would you recommend people do where they locally live as far as becoming more politically involved do you recommend that people write their local I think we've got a question I'll answer the last one because it was we had certain cases in Australia where people ran for Parliament and ran for the Senate and I think it was fantastic particularly when the media got hold of it they got quite a lot of attention around women's issues and midwifery issues and they also got noticed when they started to negotiate with politicians about selling their seats because they didn't get a number to get a seat themselves so I think we have to go at many many levels we have to tack at many levels going into Parliament and negotiating and then there are those that are still fantastic at telling themselves for the gates of Parliament and I actually think there's a place for it all where I think we fall down is when we who are in Parliament get criticised by those who are coming to the gates and when those come to the gates criticise and then we divide so let's see a place for all of that and everybody with their individual skills they have to then be politically active and I think there's absolutely a place for midwife to get into official politics in Government Okay we'll just take one last question from Beth Ann I'll just give you the microphone so you have the microphone now okay we're unable to hear the question there and we've been told by the organisers that we need to finish up now so once again thank you Hannah have you got any parting words there's a comment here that says midwives are terrified of politics I agree I don't understand that midwives are also terrified of feminism and yet we're here to cover it so I think we just encourage each other that it's actually not that harm it's really exciting and the way that I get over my nerves in dealing with some of these things is I think of it as a giant test game that's all it is and if you're getting knocked out at one point well you need to be strategic about staying in and another so just think of it as a giant test game and when all of that fails just remember what it's like to be in the room with a woman sitting there is nothing more powerful nothing more worthwhile fun than that and it'll give you the strength Thank you very much thank you and thank you everyone for listening