 So, it is my great pleasure to now introduce Karen Gilliland, who is the Chief Executive of the New Zealand College of Midwives, with 50 years midwifery and nursing experience, including teaching, research, governance and management. She's represented midwifery on numerous fora, such as the Nursing Council, Pharmac Board, was a Canterbury District Health Board member for six years, and a member of the International Confederation of Midwives ICM Board for 20 years. Karen also chaired the ICM Scientific Planning and Programming Committee, and currently co-chairs the ICM Regulation Standing Committee. Karen co-authored the midwifery partnership, a model for practice, and women's business. The history of the New Zealand College of Midwives, and is the author of numerous published papers, articles and books. Karen was made a member of the New Zealand Order of Merit for services to New Zealand and midwifery and women's health in 2000. She leads the High Court action on pay equity on behalf of the New Zealand College of Midwives. Welcome Karen. Sorry, thank you Gene for that. Can you hear me? Yes, I can. Okay, thank you. Sarah, thanks very much for running through the history as well. I can remember the first time I did something and it sort of terrified me because I'm not particularly IT literate. So to see the progress is pretty amazing and for me to be sitting here and able to use it is even more amazing. Hello and good morning everybody from New Zealand. Kia ora, tātou, kia ora. Today I was really, really reflecting on the last couple of years we've had in New Zealand where the power of women's voices have actually made sure that midwives voices have been heard and I wanted to talk about that a little bit. How do I get, oh here we go. Yes, oh it's magic. Despite actually being an age-old profession, we still face major prejudice and predetermined bias and this bias is as you all know is a gendered one. And it's not only directed at us, it's directed at women and children. And the fact that our name is always associated with women, wise women, earth mother, mother of light means that we can't bypass how the world sees midwifery. But we also can't bypass how midwives actually, you know, the part that we pay in giving women voice, voice and choice as well. The relationships that we have with women and families is actually the key to progress and good relationships and public support rely on good midwifery. So everything is a catch-22 if we don't practice midwifery in a way that women want, then women don't want us. But advocacy and support is a daily feature of midwifery's lifestyle. And many New Zealand midwives have gone further to take part in political roles and governance roles. We have midwives who are mayors of cities, we have midwives who are MPs, we have midwives on hospital boards. All these things that midwives want to actually take part in a humane society and make a contribution to the way in which women and midwives are seen in society. And so, you know, when I talk to midwives about, you know, what makes us so political and so proud? And most of them talk about what it is to actually be a midwife, that actually being a midwife is very endearing. And the sort of things that they talk about, I've just, you know, put down here and all of you will be aware of them. But at the top, I think, is the relationship one. And here in New Zealand, the partnership model is what dictates how we practice. But, I mean, before, you know, underlying all that is the fact that midwives, you know, they have autonomy to be a midwife, to be a proud and woman, to, you know, make sure that the way in which we work with women helps women to also be proud and confident. The partnership model here is in New Zealand, you know, what we say is that it's mutually empowering, that there's as much in it for midwives as there is for women. And the underlying principles of that, of course, are about, you know, the way in which the midwife and the woman negotiate what it is they want, that they both feel that they're on equal grounds to say what they want when they want. They share the responsibility of the decisions they make, and it's all based on informed choice and consent. And that, of course, relies on, that relies on midwives being good at what they do and good at relationships. So, when I talked to midwives recently, because we've been, you know, very conscious in the last few years here in New Zealand, that we've somehow got to educate the public more about what it is we do. And we said to them, well, what makes you a good midwife? And I just thought I'd give you a couple of examples of what midwives say. And they think, I think that they sort of should really resonate throughout the world where we are and whatever your model of care is. And this midwife was talking about the rhythm of birth and the emotional rollercoaster, and that she loves being part of that. And I mean, I'll let you read that. But the tears and laughter, the adrenaline, the peaceful calmness, I'm sure that most of us attending a woman in labour can relate to that. And then in New Zealand where we've got a continuity of care model, that midwife and her student in this picture, she knows that when she goes to visit her, that she'll actually see the impact of all those hours of work that she put into that woman and her family. And the falling in love process with the baby, midwives love all that. The other thing that midwife said a lot is that she knows that her involvement with this woman has changed that woman. And hopefully it is a positive change, but as you know, when working conditions and resources are not there, that change is difficult to achieve. But if I love this photo from the Solomons, where the young teenage woman is actually confident enough to wear the t-shirt, and she hit the midwives in the Solomons, we're completely able to talk about what the relationship was that they had with the woman as well in the same way as we do. It's sort of universal, isn't it? And then the other part of it is the whānau, or family involvement, is that whilst midwifery is women-centred, it's the woman who chooses all of those around her, and she sometimes chooses to be alone, but not very often, but she will choose to have a partner, she chooses to have a family. And when you're a midwife watching that, and you know that the family is right behind the mother, you know, you sort of feel a bit privileged that you're sharing with her and her family, and you also enjoy the relationships that you have with the dads, and you sort of feel like you've made a major contribution to the well-being of a humane society. I love that quote, I just think that underlines pretty much everything that we believe in. And of course, we've got to be proud of what we do, because if loving what you do makes it easier to get up in the night, but also the structures around us are pretty essential to sustain it. So loving midwifery in a way is not really enough in today's world. And, you know, so I thought, well, let's have a look at what the barriers are, what the barriers are in most countries, and all of this won't be news to you either. But, you know, pretty much everywhere women's work is taken for granted, and in the main, it's undervalued. I think New Zealand in the early 90s was the first country to be paid at the same rate as doctors who provided midwifery care, and we celebrated that a lot. We were aware that as soon as midwifery became the predominant provider of services, that it was probably unlikely we were going to retain that amount of value, and that's exactly what's happened here in New Zealand. So right throughout the world, I think that midwifery is constantly facing, valuing underpaid, and we read constantly all around the world about the stress that midwives are under. I mean, it is really, really sad, I think, that in many countries some women still don't even have a midwife at their labour and birth, and most don't have a known midwife, and even fewer have a midwife who actually know them and have gone through their pregnancy and will be there after the birth. But actually, if we're to do that, and New Zealand, we do do that, we can only do it if we're well supported and equitably funded. There has to be a value placed on midwifery, and we've spent quite a long time in New Zealand trying to fight for that. In the last couple of years, we've tried to take on a public education campaign, because even after 28 years, many of the public still really put the medical viewpoint on the pedestal above the midwifery's specialty knowledge. And successive governments, we've had a reasonably neoliberal right-wing government for the last nine years, and over that nine years, it failed dismally to support and pay midwifery properly, which is why we've ended up in this position of having to go back to women and say, help. So our public campaign has taken quite a few roads. We had to actually protest on some occasions we've had to take to the streets. In 2015, we actually went to the High Court, and we lodged a complaint against the government, we sued the government for gender discrimination, and we did it under the Bill of Rights. We never made it to court because the ministry actually came back and said, look, we will now talk and we will mediate. And for those of you who have ever been involved in any legal action, it is an extraordinarily expensive process. And the New Zealand midwives, I think, are to be congratulated in that they were prepared to take on that enormous cost to try and get a human rights principle seen and heard. I know the Canadians amongst you will feel this is very familiar to you, and I've talked a lot to your lawyers in the midwives that took your court case, and our lawyers talked to each other in Canada and New Zealand, but actually the issues are exactly the same. Most of the lawyers that we worked for us just couldn't believe the gender nature of it. In your day-to-day-to-life, if you're an educated person, people find it very hard to believe how insidious gender discrimination is. And I think over the years, New Zealand started to sort of try and drop that women-gender narrative and trying to get more family-based, all those things, but actually we probably should never have done that. We should have stuck to our knitting and called it a feminist issue, an agenda issue. But all of you who have ever been political, you know how difficult it is to maintain that stand against such, you know, I would call oppression. Every time a woman stands up, she has to stand up, better dressed for the better hairstyle, much more articulate, and it just gets too hard, and I think midwives in New Zealand just were so relieved to get the fact that they were autonomous and they were paid well, they all got on with being a midwife. And we sort of lost a little of our political drive. But boy have we got it back. We started a campaign called Midwives in Crisis, and it was interesting using the word crisis was something we've never done because in 28, 25 years we were always putting the positive on midwifery, saying that, you know, like midwifery is well-educated, midwifery is a proud profession, all these sorts of things. Never asking, never trying not to put a chink in our armour because in politics if women show any gap that someone can get in and destroy you, then that was our experience, that's what happened. But actually after the court case and the mediation taking so long, midwives just became quite despairing about change, and so we thought we need to rally the troops and we need to ask for help. So we did this thing about writing to every member of parliament in the country and saying that they need to take a cross-party approach, stop playing party politics and actually get behind women, get behind your women, get behind your families and actually approve the budget no matter who the government is. Could you not all just get behind the midwives? And that has been very successful, the midwives and women, they've all, every MP in the country has been visited. The other things that Regents of the College have done is that they designed postcards and thousands of postcards, just postcards written to the Prime Minister, written to the Minister of Health, the Minister of Women, they've gone through in the thousands. Some primary birthing units or birthing centres that have invited politicians for afternoon tea, showed them round, tokened them through, really trying to demonstrate what it is that we do. Lots of stories in the local media doing sort of case study type stories that people can relate to. And those over the last two years, it's built up and built up. And what we were building towards is sort of getting women to see that the service they got from their midwife on an individual level was actually under threat. And because, you know, I mean, we always took the view that we didn't want to undermine women's trust in the system. But actually in the end, in 1990, when we got the law changed, it was women's voices that came to the front that the politicians listened to. And some 28 years later, here we are again, right back at nobody listening to the profession and we needed women to be our voice again. And it is really extraordinary how they've done that. And so it's that, you know, the saying that it was very popular, women need midwives, need women, need midwives. It is so true. If we are not joined together and providing care in the way women want and recognise we can get lost. And I think the New Zealand midwives should be congratulated for carrying on for 28 years. And the same sort of support that they got 28 years ago, they got today. And we've been doing all sorts of protests and marching and getting help from all sorts of people. Rural women in New Zealand, we're very influential in New Zealand. And, you know, if in your country you've got groups of voting people that hold influence, those are the ones that can get to the politicians and rural women have been very supportive. We have journalists, a woman called Emily Wrights who's been really an amazing advocate for women. And we've got lots of those women consumers and they organised picmics on Parliament Law last year and another one this year. We even, and I want to say thank you so much to the international middle free community. The Dear David campaign was a sort of a grassroots movement with women and starting with rural women actually and rural midwives. And they started writing letters to the Minister of Health who was called David. And it became the most amazing grassroots movement and he received, I don't know how many, he's not telling us, but essentially the catch word was Dear David and then anyone and anyone was able to write in. And these are just a couple of examples of the thousands of letters. The Dunedin midwives who were the Minister of Health lives posted them all up on yellow sticky notes up on the Minister of Health's window. It was certainly very uplifting, I think it's fair to say, for those of you New Zealanders who are listening in, it was extremely uplifting for those of us who've been around for so long and here were women coming to the fore. And as did the international community, thank you to Mavis, thank you to Barbara Katz-Rothman, to Susan Crowther too, all sorts of people that came in and helped us. Helen Clark also I met with her and she worked behind the scenes, I'm sure, to try and help. It is interesting that in the end it was all the women's movement that actually got action here in New Zealand. It was one woman, a woman called Mary Lou Harris who was working in Radio New Zealand and she did this big interview on the radio and it just took off. So when you think all is lost, actually it isn't, women in the end are what matter. And if we're still in tune with what women want, we can actually achieve things. We're fairly hopeful that the Prime Minister and the Minister of Health are listening. I actually spoke to the Prime Minister yesterday. She was in the Coro Club, which is where you meet when you're flying around the country all the time. And she indicated that she was very supportive. But I suppose it's still up to us in the end, isn't it? It is our profession and one that we should take hold of as well. And I think it's a bit hilarious. I found this Hugh Laurie, he plays that house doctor and I thought, here we are taking the advice of the doctor. It was a joke. But I do think that, you know, it is, everybody thinks that someone else is going to do something and you're not quite ready to do things. I think that's very true of midwives that they're not quite ready to stand up, they're not quite ready to do. But actually in New Zealand they all were ready and they were ready now and in unison. And I think generally speaking, I agree with Hugh Laurie now is a good time as any and you just have to keep sticking to it. And I hopefully at the next virtual day I hope we were able to report back that we've had our pay increases and that we now have the resources and are paid for what we do. Thanks so much everybody for listening. Thank you Karen. There's been a lot of supportive comments down the side. I didn't see very many questions except the one there about the Prime Minister. Did you think that having DeCindra Durn in that position will make any difference? We've actually tried to leave DeCindra Durn out of it. I think as midwives it is not okay to call the Prime Minister on her pregnancy. That's her as a woman. And so I've said to her quite clearly, you are a Prime Minister number one, number two and then you're a woman. So it is your choice what you do and how you do that and it's not our role as a profession overall to be trying to bully you into one way or the other. And then I did say to her, but I do hope you're getting a lot of rest. So I think we have to be careful that we don't make women politicians have, you know, don't make them feel the way a lot of people make midwives feel and that's put upon. We need to be really careful that our pregnant politicians are actually politicians and that their pregnancy shouldn't be held over them in a way that would help us. We just need to provide those politicians. Our Minister of Women is also pregnant. She's having a home birth and she stood up yesterday and said she's got a midwife who she loves and she's feeling very confident and all her family are medical people and so, you know, that's a huge change for her and good on her. But actually she's still the Minister of Women and Jacinda is still the Prime Minister and that's their number one job and hopefully the midwives that they do have are making sure that they're supporting them in that role. Are there any more questions for Karen? I see there's a question here about how would midwives wanting to get more political? It depends, Sarah, what you think political is. I think political is daily life and I think gender is daily life so for me, political is about sticking up for your gender and making sure the inequity is called out, whatever you are as a midwife and I'm not sure that we're particularly good at that. We tend to talk amongst ourselves as opposed to talking to the person that's causing the inequity and, you know, that takes practice. So I think that the College of Midwives here I think we provide forums for a lot of midwives to feel, you know, to feel strong enough to make sure that if they see inequitable behaviors if they think that they have an answer that they're able to stand up and do those things I do think New Zealand midwives are very strong and brave but even being strong and brave society is much stronger than you so I think someone here says that private is political I couldn't agree more I think that every midwife provides a different perspective when she provides fabulous middle free care she can model what shared decision making and informed consent and choices and make that mother and her family understand the role of women in society and that mothers need to be strong if society is going to stay strong. Thank you Karen. Thank you very much. I didn't catch any more questions there but certainly the comments have been very supportive and encouraging that people have been making throughout the time you've been talking and of course in New Zealand we owe a huge debt to Karen and her team and for midwives all over New Zealand who have kept the faith despite all these pressures that have been peaked upon them so thank you very much and I see that Jane thinks it was fantastic and uplifting so that's good. Thank you. Thanks for listening everybody. Thank you Karen.