 Right. So, in saying that, I would like to introduce our speaker, Hannah Darlin, is the Professor of Midwifery. She's a Discipline Leader of Midwifery and Associate Dean in the School of Nursing in Midwifery in Western Sydney University. She's been a midwife for 30 years. Hannah has over 200 published journal articles and book chapters and has a strong national and international research partnerships. She's received 20 grants since 2000, including being a CI on three NHMRC grants and an ARC linkage grants. She's spoken at over 100 national and international conferences in the past five years and given invites at keynote addresses at most of these. In 2019, Hannah was awarded a member of the Order of Australia General Division in the Queen's Birthday Honest List for her significant services to midwifery nursing and medical education and research. In November 2012, Hannah was named in the Sydney Morning Herald's List of 100 People Who Change Our City for the Better and named as one of the leading science and knowledge thinkers for 2012. Hannah, thank you so much for joining us. I'm going to hand over to you as presenter. Thank you very much for being able to move my slides. You are able to now. I've just made you a presenter. Thank you so much. Fantastic. Thank you so much, Karen. I really appreciate the introduction and thank you so much for inviting me. I've spoken at this conference before and I've certainly enjoyed the presentations. So, well done. I was reading this morning. This is now more than 17 countries are involved and it goes for 24 hours. So, good morning, good evening, good night, wherever you are, whatever time zone you're in and the beauty of the virtual world is in a world where we've been very isolated, particularly with the pandemic. It's enabled us to feel like we're all in the same room. So, I want to begin by acknowledging as we do in Australia that I am on the land of the Dharak people, the Aboriginal people that is the area where I live and I work. I want to acknowledge them as the traditional owners of this land that I live on and I research in and I want to pay my respects to Aboriginal people, elders past and present and any Aboriginal people watching today. I also want to acknowledge the sadness of the past year and the present sadness and I saw some of those people coming up that were from India and I just, you know, our hearts go out to you. We've had an awful lot of sadness this past year and I hope today that I make us reflect and inspired and ready to take on the world that is very much on offer for us at the moment. So, we have come so far. I titled this talk really, I'll be there yet. We've come a long way but I believe we still have a long way to go. So, it's not time to give up our fight but it is time to also reflect on how amazing their effort has been and in such a short time how much midwifery has advanced and done in research and clinical practice in making massive impacts around the world. But I want to ask some questions today. Have we been as strategic as we could be? Do we see the threats today clearly? Can we be braver, louder, smarter, stronger and do we really believe in what we do and how do we reclaim that passion and that hope that I would say is probably feeling fairly worn out right at the moment and I'm sure that many of you like I do feel we've been fighting this fight for a very long time, then we've been dealing with a pandemic and all of the consequences of that. So, many of us are feeling raw, tired and perhaps a little bit over it. So, I hope today that I give you some encouragement. So, childbearing women, midwives and feminism are a historical tripartite. We see those three things woven together. They're at the very core of who we are. From the very earliest records of history, midwives have fought for childbearing women, childbearing women have aligned and fought for midwives and feminism has played an interesting role in that that I want to talk a little bit more. But there's no doubt, as I say to my students all the time, if you want to be a midwife, you have to be a feminist and I hope everybody on the conference today already understands and gets that implicitly because we deal with women's issues. We deal already with often an invisible event in women's lives, an event not given enough importance and support. We deal with women's issues. Midwifery is a predominantly woman-centered and woman-dominated profession and we do a lot of this within the very overwhelming constraints and oppression of a patriarchy that is alive and well. So, both as a feminist issue, it's a power issue. It's a woman's issue. So, we can't get away from this fact that what we are talking about here is a really important power struggle that is continuing and that we need to be very strategic about into the future. So, this is me on a soapbox a couple of years ago outside a hospital. A question I often ask is, did the feminist drop the ball when it came to childbirth? And I think historically, perhaps the feminists have dropped the ball. But I just want to add that I think that in recent years, the me too movement, the breaking the silence, the COVID pandemic have actually led to a real picking up of that ball. And I think birth trauma, I think women's voices are really coming to the forefront now. Wonderful activists and women like Millie Hill who wrote that beautiful book, you know, give birth like a feminist and so many more are now picking up that ball that perhaps the feminist in the early days dropped because they were worried that if they aligned themselves with childbearing, it would align them with child rearing, it would take away their battle from getting women into the workforce and getting women away from their reproductive chains, as was often viewed in the under that feminist lens. And I think that is changing now. But is no doubt we live in a patriarchy. And I see it in the decisions that are made. I see it in the issues that are overlooked. I see it in the history that has forgotten. And I see it in the future that it's been planned. And I think COVID has exposed that in big ways in the last year. We published a paper last year, showing how COVID has is highlighting an ongoing pandemic of neglect and oppression when it comes to women's reproductive rights. And COVID has exposed the Achilles heel in the patriarchy. And we saw what those in power really thought of women during COVID. We also had freestanding birth centres turned into COVID clinics as an example. Here is one of our top rated freestanding birth centres in Australia. This birth centre gets the best results on the surveys every year. The top marks because it's got full caseload and the most wonderful continuity care. And yet that was the first thing shut down and turned into a COVID clinic when the pandemic hit. And this really makes raises questions as to what do we see as priorities? What do we see as worthy of our attention and our investment? You know, we had football stadiums filled in Australia far earlier than we had women allowed to bring their doolers to their birth. We had people able to sit down next in poking machines and be side by side far before women were able to have a water birth. We had med ones flooded with requests for home birth and we learned just how badly we treated these med ones and ignored women's choice as women were not able to access often because there weren't enough of those med ones. And this is a paper we published last year led by Caroline Homer looking at the impact of the pandemic on privately practising med ones. You know, just like with abortion clinics, private med ones had to sew their own masks sometimes hunt down PPE because they were not seen as an essential service. And so we saw exactly what the dominant construct of health actually thinks about women midwives and childbearing. It's really exciting, however, to see the SOMI report released today and that the achieving of universal coverage of midwifery delivered interventions by 2035 could save 4.3 million lives. That's it. That's a phenomenal thing. This cannot any longer be ignored. The contribution midwives can make to maternal and newborn health. So this is about potentially averting 67% of maternal deaths and 64% of newborn deaths and 65% of stillbirths by the implementation of midwifery universally in the world. I want to talk a little bit now about how midwifery is a story of being revered, oppressed, often adopted, and now we are reclaiming our heritage and I'm a great believer that we need to remember history in order to understand where we are now, but also in order to look into the future and not make the same mistakes. So if you think about the very long distant past where midwives were highly revered, they were the holders of secrets, you know, back in ancient Greece, midwives were seen to be incredibly wise women, often within early sort of prehistoric times, we ended up having a midwife was also the healer and the wise woman of the time. And then we had the oppression of midwifery through the witch hunts in the medieval time, and then with the arrival of medicine and the surfing of midwifery from the home environment and the traditional midwife into the hospital system. And we essentially became orphaned in that time. We lost an awful lot of rights, midwives were literate, midwives had no voice, no collective, and they were quickly overwhelmed by the dominant patriarchy coming in. And you know, for many of us, we were at quite a loss, I'm giving you a very brief rundown in history here. And then of course, nursing adopted us and bought midwifery very much into the, and to the umbrella of nursing. But now it is time for midwifery to reclaim their heritage. And I think this is one of the key things I want to really get through today. Midwifery is still dominated by medicine and nursing. This is a bit of to with this history that I've very briefly gone through. Partly this is ignorance, partly this is competition. Partly this is because we make a significant difference. And partly this is because they don't want us to show how we are different to medicine and to nursing. We're reclaiming our heritage now with the advantages of science behind us. And I think this is now the really exciting thing. As I watch in my role as professor of midwifery, as I'm involved in lots of high degree research, students, PhDs and research, I am seeing midwifery absolutely come to the forefront. We're reclaiming that heritage. But we also have the benefits of science behind us. And this is something we did not have in the past. So in every country, where midwifery as a profession is strong, the outcomes are better. They're better for babies, they're better for mothers, they're better for financial reasons, and they're better for quality of care. Midwifery is a quality intervention, if you want to look at it that way. Midwifery is your bang for your buck. And it is time the world woke up. We cannot continue to spend money on health the way we are. Midwifery is absolutely positioned to say, we are the answer to a large problem that currently exists in the world regarding this. So we are one of the oldest professions on earth, but that doesn't mean that we're dusty crusty and out of date. We are actually the newest, coolest trend again. Midwifery and midwives are the choice from the princesses today to the superstars. And I think I just want everybody online today to remember how many people now regard us, revere us and want us. You know, midwives and nurses are listed in so many countries as the most trusted professionals that exist. This is a huge credit to us and what we do. But despite our ancient heritage, we've only just recently entered into university and research. So I want to just bring this point up, that the very first professors of midwifery are alive today. That's extraordinary. We are a very young academic discipline, but a very ancient practical practice clinical discipline. And the reason I bring that up is our first professor of midwifery is alive and kicking. I saw her on Saturday night, Professor Leslie Barclay. This is extraordinary when you think that the leaps and bounds midwives have made in research in the past 20, 30 years. It's absolutely astounding how midwives are shaping policy. You just have to look at the SOMI report to see the impact of fantastic midwifery research. You only have to look at WHO guidelines. You only have to look at what is now coming out in evidence-based recommendations to see that midwifery has made an extraordinary impact on the intellectual academic research and knowledge scheme scene. If you think back over the past five years, midwifery has been placed absolutely back on the map. We have had the state of the world's first midwifery report, the 2014. We've had the Lancet series on midwifery. We've had the Too Little, Too Late, Too Much, Too Soon. We've had the Midwifes voices, Midwifes realities. We've had the WHO case for midwifery, the Lancet series on Caesarean, the WHO Interpartum Care for Positive Childbirth, and today the state of the world's midwifery in the Sony report. This is an amazing and every single one of those are an endorsement of what we do. And I just want to highlight one of them because we don't have time to go into all of them, that the Interpartum Care for a Positive Childbirth Experience that was released in 2018, it is extraordinary that the words of Positive Childbirth Experience are now in the title of a world major guideline. And what are the top four recommendations? They are respectful care, their effective communication, their companionship in labor and childbirth, and most profoundly continuity of midwifery care. And it's really exciting in the Sony report today to see that midwifery models are now being recommended for all women, not just as it was previously where you had well functioning midwifery programs. So we are making huge strides, and all told those four top recommendations in the WHO guidance are all at the heart of what midwifery does so well. So we are positioned in such a powerful position. So why is midwifery not embraced? Why do midwives feel so tired and so despondent? Let's explore this a little bit. These are my reasons, I'm sure you can add to my reasons. These are some of the reasons that I have for why we are not there yet. Midwifery is predominantly a female profession embedded in a patriarchal business structure. Midwives are hampered at every step from providing relationship-based care. Belief is stronger than evidence, especially today in our post-truth world where what people feel or the greatest voice, the largest voice of the biggest opinion seems to derail, you know, hundreds of years or hundreds of publications of evidence to the commentary. Belief is informed by what we experience, and for many women today, birth is traumatic and midwives are seeing as part of a system that is causing that trauma and abuse. FIA has consumed the delivery of maternity care and we have had a very limited view of safety. So we think of of safety very primarily being about the mother alive, the baby alive done, we've done our job, end of story. Women tell us safety is much more than that. Safety is about cultural safety, spiritual safety, psychological safety, emotional safety, yet we focus so almost entirely on perinatal maternal and perinatal and maternal outcomes. Midwifery doesn't make money, but it saves it, however, and money is power. Midwifery is dominated by medicine and nursing, as I have said before, and everyone is focused on immediate outcomes, not long-term health and well-being, and this is where much of our research is now being channeled. What are the long-term implications of what we are doing to women and babies around childbirth? And you know, until we really start to focus on the life, the reproductive life course, and what the implications of this first birth are on the second, the third, and the fourth, we are going to have a very skewed view of what is the best practice to recommend. Women and mothering still don't matter in many countries, and midwives need to stop fighting each other and start uniting, and these are for me the top reason as to why we are actually not there yet. You know, Eugene DeClaire published this article back in 1994, and it rings true today for me, but midwives' roles, he said, were diminished over the last century, not because of their failure as caregivers, but because of their failure to respond to the political challenges they face, and this is what I really want to focus on today. And again, Eugene DeClaire and the same article said, we need to recognize the importance of political awareness and activity if midwifery is to survive and to prosper. We haven't come far enough, I'm sure you're all aware of that. We have got escalating intervention rates, we have rising birth trauma, we have got a widespread ignoring of scientific evidence, we've got control again, I'm going to put this up again, again, again, because actually this is the heart of one of the biggest factors affecting midwifery, the control by nursing and medicine. Midwives are burning out and they're traumatized. We have got inappropriate funding models for midwives. We've got no ability to get our heads around insurance for midwives to practice privately or independently. We've got lack of midwifery models of care and place of birth options and lack of respect. So we've got a long way to go. I don't want this to depress you because I'm actually very excited by our opportunities in this area. So how do we get there? Let's get our campus out, let's find true north and let's try to be more efficient and strategic and wise and strong and loud about our journey down the road. I'm going to put this in for a bit of levity but I also going to follow it by a serious statement. We recently had the happiest countries in the world listed and here they are in order and we've also had the best place to be a mother report released. Very interesting I highlight the countries that seem to cross across both of them and you could argue that you know being northern european appears to be the answer to everything and of course northern europe has had a long history of very strong midwifery but they've also got a lot of weaknesses and having been over the early last year you know continuity carries a relatively new concept in much of the Scandinavian countries. What I think really I will put this up for is a couple of reasons because it is of course wider and beyond us not everything is within the remit of midwives to sort out. The social policies, the way motherhood is regarded, the way women are supported, the way parenting is supported also form a huge part of this picture and why I put this up is because I want to take us to start to think outside the box to start to think differently to not be constrained by the traditional ways we thought of with midwifery activism. So my recipe to make midwifery strong medicine needs to release its grip over maternity care. Nursing needs to stop being insecure and raining midwives in. Midwives need to rise up and be accountable and practice to their full scope. Women need to stop being silent and they need to say enough and governments need to put women, babies at the center of policy funding and insurance decisions. Now that all sounds fantastic and you're thinking well how on earth do we ever get there. Well I want to talk a little bit about expanding our influence in the areas we have not traditionally focused on. Thinking about midwives getting really active in politics in art, in literature, in understanding economics, health economics, negotiating, looking and getting more savvy around business, human rights and sustainability. These are the things that I think we need to start to get more active in in order to influence the future of midwifery but most importantly influence the future of women's health and best outcomes for mothers and babies. So I'm going to take you through a little romp of slides in this. This is our first federal MP in parliament Dr Helen Haynes. Not only a midwife, a midwife with a PhD and with lots of public patients. She tweeted this morning with a picture of her taking care of a woman. The voice of our more and more midwives in politics I think is going to be critical into the future. So if you've ever wanted to go into politics and you're a midwife I say go for it. The other thing that is very powerful and a lot of people underestimate is art. The role of art. Behind me I have a beautiful painting that my daughter painted for me. The power that a visual image can portray and I just want to alert the world to this amazing documentary that's been touring Australia made in Australia but including many international people in the documentary called Birth Time. And this documentary comes straight into the heart of birth trauma and what will it take for a woman to emerge from her birth healthy well and strong? It's a very powerful film and we're working with the filmmakers at the moment and all the consumer organizations in Australia putting out a birth experience study along with my fantastic colleague and recently got her PhD Hazel Kiedl and we're doing a the birth experience study in Australia. Really looking at the last five years of births and we have seen an unbelievable pandemic to use those terms of birth trauma. We're also seeing the effect of what a model of care can do in ameliorating or preventing that and we now have 6,000 women who have responded to this survey. So we've got to start to think of strategic ways to join up with the arts in order to put the art and the science side by side in order to have that impact literature. I mean call the midwife swept the world. It was a such a powerful series. We had a book release called Ozzie Midwives. Again people love the stories of midwives and we need to be really active in making sure we have other ways to represent ourselves out there in the public. Funding and health economics you know. We have so many smart people coming into midwifery but we also have very smart people who are very aligned to the philosophy and the social principles of midwifery and you know do wonderful help economic analysis on how we deliver maternity care and that's so powerful. This is one released in Australia by some very wonderful economists looking at the trends that are impacting on maternity care with privatization, medicalization and limiting women's choice to midwifery care and human rights. It's so exciting to see more and more lawyers being drawn into advocating. More and more midwives also going off and doing law. More and more advocacy and lobbying in the human rights space and this of course was the special rapporteur report that came out a couple of years ago looking at human rights violations and obstetric violence in much of the world and the conclusion was that the painful stories told by women through the submissions revealed by the special rapporteur received by the special rapporteur revealed that mistreatment and violence against women and reproductive health care services and childbirth in health facilities happen all around the world and affect women across all socioeconomic levels. This is not just a problem of low-resource countries or low-income countries, this is something happening in all of our highly resourced high-income countries as well. This is a problem for the world that we all need to address and we need to do it allegedly. Maternity care is a machine and we midwives really understand that and we want and we know we need to humanize that machine. So how do we go about that? I'm going to put up a slide that you all know back to front and inside out and sideways but you know continuity of midwifery care is more than just nice. It's quality maternal health care. It addresses intervention, it addresses live babies, it addresses healthy women emerging, it addresses how women feel about their births, it addresses reducing stay in the hospital and cost effectiveness, it addresses every big ticket item in health and we have to absolutely lobby and now with the Sony report out that more and more women get access to this gold standard care. And we just had a fantastic Lancet publication released in Australia looking at our original women and the effect of a birthing on country service which was a continuity of midwifery program working with culturally appropriate providers, Aboriginal providers and in that study there was a halving of preterm birth and there was more than a third higher breastfeeding on discharge. This is no longer something that can be ignored. This is a matter of life and death and this is something that we now need to absolutely stride forward and push forward in every level of government and in every level of the community. There's no longer a debate about this. This is fact. The other thing that I just want to make mention of is birthplace choice. For so long we've been stuck in the rut of discussing whether or not more babies die at home than in hospital. We've been stuck in the rut of perinatal mortality and it's not because that's not important. But if we look at the two systematic reviews that have come out in the last couple of years and I was involved with Vanessa Scuff in the first one, there was no difference in baby outcomes. So I'll get that out of the way. I just want us to change the discourse around this. I think we can no longer say it is safe for low risk mothers to have their babies in hospital. It is not safe for low risk mothers to have their babies in hospital. When you think of a, you know, more than a halving reduction in cesarean, when you think more than twice the normal birth rate, when you think, you know, two-thirds less instrumental birth, half the rate of third and fourth degree test, it is no longer safe for low risk women to have their babies in hospital. And I just want to make that point really clearly. Of course, if they want to, they should. And of course, we must humanize hospital. But let's change the discourse. Rather than is birth safe at home for women who give birth, is it safe for their babies? It is very unsafe for women. So midwifery is the balance that the world needs. We are the answer to sustainable healthcare system. We are the answer to the impact on the environment with the less products and interventions and all of the things that happen with midwifery, the impacts environment on economic scale and on that social primary healthcare framework that we embed and uphold so strongly. So I want you to keep calm. I want you not to be discouraged. I know it's been a hell of a year to to keep calm and not be discouraged. We're completely exhausted, particularly on the back of COVID. Don't lose hope. Don't lose your fight. Don't let your passion be dimmed. I really beg of you. Don't let it go. Otherwise, everything's been won and we have the ones that have lost. Let's unite. Let's coalesce. Let's collaborate. Let's bring more and more people into our amazing gravitational form. So many people say to me there's just something about midwives and isn't there just something about midwives. We now need to take our imagining of a maternity service where women are at the center of every decision and we need to turn that into reality. And I want to end with a poem that I have written for International Midwives Day called Gentle Warriors of the Night. We are the gentle warriors of the night. We are the guardians at the crossroads of birth and death. We are the soothsayers of tomorrow. We are the mermaids of the underworld. We are the truth tellers of the netherworld. We unearth secrets and pain, wrapping them in arms of silk. We impart strength in a glance and love in a single touch. We are the high priestesses of hope. We anoint life with the first human touch. We feel the soft waft of hair tumbling in that mysterious watery world. Our sweat mingles with women's in the tangle of birth. Our hands move dexterous as a maestro and certain as a boxer. Our joints are stretched to their limits, our backs are aching, our hands blossoming with oil, glide and soothe and wait. We master waiting in a world racing breathlessly ahead. We flirt with uncertainty in a world escaping its reach. We crouch in dark corners like ancient mystics etched in candlelight. We croon like night sounds traveling through time and space. Negotiators could learn from us and weary soldiers could lay down their arms forever. Politicians weak with envy at a high regard and wonder at our esteem. We do not sit upon the world stage yet we see those who do. We knew you when you were helpless at your mother's breast. We take secrets to our grave, we forget nothing, yet no form of torture could distract a single utterance. We hold the burdens of others so that they may feel light once more. We sail unmapped seas without a compass but with the certainty of Magellan. We laugh with angels, we cry with saints, being neither yet we are bothered. We see souls clearer than any celestial being in moments raw and cellular. We are co-creators in the universe yet retreated into the shadows knowing the praise belongs to others. We see the hem of the universe touched, we see veils into other worlds pierced. Our names may be forgotten but our eyes and our touch are remembered forever. We are the last remaining master of hope in a system that has swallowed birth like a kraken. We were breathed into being with the dawn of time and will be here until time's size took close. We are the gentle warriors of the night. We are midwives. Thank you. Hannah thank you so much for that amazing presentation. Just to read one of the comments from the public chat. Thank you for voicing such an important message so strongly. It brings hope for midwives, midwifery way forward and I think that echoes everybody's thoughts and also some requests to be able to where we can find that poem. So it would be wonderful if you're able to share that or if you're willing to share that with us. Sure, I've actually shared it widely on social media today, Twitter, Facebook, Instagram, it's everywhere. Thank you so much and so everybody you can find that on Hannah Darlin's social media profile and now is an opportunity for us to take any questions if there are any questions from our audience and while we're doing that just reading one of the other comments so beautiful and inspirational Hannah thank you for being a strong advocate for us as midwives and for your commitment to changing the lives of women and families around the world. Well I think we're all amazing I just think midwives you know are some of the most extraordinary human beings I've ever met and I know I'm a little bit biased but my mother was a midwife and I've been surrounded by midwives most of my life and my daughter who recently did a university degree used to sit in the cafeteria and she said I'd always know when the midwives came to get coffee and I I said what is it she said it's the look it's the warmth it's the chatter it's the way they hold themselves. Absolutely definitely something very special about us as midwives and it's wonderful to know that there are so many midwives in our audience today as we saw from the poll are there any questions from the audience members please put them in the public chat or let us know and if not I do see somebody's typing remember for those yes. I was just going to make a comment while people were typing that you know the COVID pandemic has been referred to recently in a really interesting article it's the fifth wave of feminism and I think what COVID showed was when the chips were down women did the work women were the ones doing the child care women were the ones sacrificing women's issues were the ones that were often overlooked and ignored and I think we have unlocked finally the biggest dirty secret and I hope that now we will move forward and put women where they should be. So you know COVID's a terrible thing and my heart just bleeds for what people are going through particularly what I'm hearing about India but maybe in a decade we will see this as the fulcrum on which we turn out earth and I really hope that and we can't just hope we have to make that happen. Absolutely and thank you so much for framing all those challenges that we are faced with as opportunities and reminding us that we really do have that that way forward to grab those opportunities to change and there is a question here about whether you can elaborate more on the insurance aspect so much if we have time for that but maybe if you have a few points yeah so very briefly in Australia midwife still do not have insurance for home birth if they're privately practicing when the moment labor starts till one hour after birth they are uninsured and we have been waiting for over a decade now to get an insurance product and as of as of December this year if it isn't found home birth will be illegal as of midnight on December 31st in Australia now the UK has gone through similar things midwifery is caught up in medical the medical model of insurance and often doctors sit with table and advise on risk so that's sort of what I was really getting at with insurance. Cool and that in itself is a another conversation so thank you so much Hannah for joining us today and for everybody else