I have loved being a midwife for the  past nine years. It is more than a job. It is a vocation, and for me personally, it’s a big part of how I identify and navigate myself through the world.

When I first entered my profession, I understood clearly what my purpose as a midwife was: to support women, to advocate for them, to help care for them through all aspects of their pregnancy, their labour, their postpartum care, and to do so with a holistic approach. 

Today, my views haven’t changed, nor has my purpose. My passion for midwifery and helping women bring new life into the world has never wavered.

But I can no longer avoid the stark truth of my profession. 

The fact is, midwives today are suffering. 

We work under constant pressure of unrealistic workloads, and that has a flow-on effect to the holistic care we work so hard to provide to women and their babies.

On a typical morning or late shift, I generally look after four women and four babies – so eight people. That’s postnatal women, but I may also have some antenatal women in my care as well. On a typical night shift, that can increase to six to eight women – so between 14 and 16 people. That’s up to 16 humans in my care, if you count the babies.

And why wouldn’t you count the babies? 

They are people, and often their needs are more complex and demanding of my time as their midwife. 

When it comes to documentation, we sign for things we have assessed for the mother, and we sign for things we have assessed for the baby. At the end of a night shift, a midwife can sign up to 16 different care pathways. 

Babies have their own doctor for discharge, and babies have their own observation and feeding charts. Even in the coroner’s court, a newborn is considered a separate entity. 

But as far as my workload is concerned – and the way the federal government funds babies, and therefore the way our wards are staffed – babies are not counted as a separate entity.

That’s right. Babies are not counted as patients in their own right when calculating how many midwives are needed on a shift.

The result? Midwives are time poor. We’re exhausted, and I’m seeing colleagues burnt out. 

That means increasingly, mothers and newborns are not being set up for success the way we midwives know they should and could be.

Here’s a simple example. I remember caring for a young new mother who was really struggling with breastfeeding, which was causing her incredible distress, and so she requested to use formula. Part of our care as midwives is to talk them through that and go through what that means before they sign a consent form. At the same time, I was looking after a baby who was on blood sugar monitoring and another baby who needed to go onto phototherapy, not to mention the other mothers and babies who were also in my care. 

I had so many other competing demands that I didn’t have an opportunity to sit with that mother and set her up for a little more success in terms of breastfeeding. Instead, I simply had to hand her the consent form she’d requested.

I still find that hard to talk about. It might seem like a little thing, but that’s pinnacle to us as midwives.

It’s stories like this that are happening every day, and as a midwife, I feel helpless. 

The 2019 Check in on midwifery survey conducted by the QNMU found that 73% of respondents were not able to fully complete their job to their satisfaction within the paid time available.

The situation is only getting worse, with more women and babies often requiring more complex care today than they have in the past. 

For example, fewer women are having normal uncomplicated births due to a variety of factors, with guideline-driven health care being a significant reason. 

According to statistics from the Australian Institute of Health and Welfare, the number of women who start labour naturally has decreased over the last 20 years – from 35.8% in 1999 to 28.9% in 2019. 

There are also rising numbers of caesarean sections and birth traumas, as shown in a survey conducted in 2022 by the Australasian Birth Trauma Association, Birth Trauma Association, and Make Birth Better. 

All these increasing complexities of medical needs is creating additional workloads for midwives. 

Because here’s the thing: midwifery encompasses not just the physical assessment of care or medication administration, it also incorporates a significant amount of emotional and psychological support.

So much time is spent listening to women, helping them process what’s just happened to them, what their concerns and questions are.

It means imparting essential education and information to women on their journey, to help with that transition of returning home, learning about their babies, and what their needs and cares are.

This all takes time… and when you don’t have time because your workload is unmanageable, something has to give. 

I can’t imagine asking midwives to choose who to give best practice care to, and where to cut corners where it doesn’t present any risk, is what anyone wants. But make no mistake, that’s where we are. 

So what needs to change?

It’s simple. All babies are patients and need to be counted as such in developing midwife-to-patient ratios. 

This means that the way we fund maternity services in Australia needs to fundamentally shift. 

The Federal Government relies on the Independent Health and Aged Care Pricing Authority (IHACPA) to advise a price signal or benchmark for the efficient cost of providing health services, including maternity.

Here’s the problem – the IHACPA is partly informed by legislation that was written in the 1970s and a lot has changed since then. More women are giving birth much older and pregnancies are more complex. 

The Federal Government needs to update legislation – specifically, the Health Insurance Act 1973 – so that all babies are defined as ‘qualified’. 

Currently, babies that don’t meet certain strict criteria – which is most babies – are considered ‘unqualified’, and therefore don't attract funding as a single entity from the federal government. 

With the right funding in place, we can staff our maternity wards to best practice standards.

The Queensland Government must pass legislation to count every baby and make minimum midwife-to-patient ratios law by 2026. 

Ratios are a minimum safety net that will allow midwives to do the role we have trained so hard for. We know minimum ratios work – the jury is not out on that. Nurse-to-patient ratios have been in place in prescribed Queensland Health wards since 2016, thanks to the QNMU’s Ratios Save Lives and Money campaign. 

A thorough evaluation of these ratios was published in the prestigious medical journal The Lancet, and showed in the two years post implementation there were 145 deaths avoided, 255 admissions avoided, 29,200 hospital days avoided, and up to $81 million saved. 

Other national and international research also shows how ratios lead to improved outcomes for staffing and work environments, and how the number of nurses directly impact the safety and quality of care provided within the health system. 

There is no reason why a similar model cannot translate to a midwifery context.

The QNMU, through wide consultation with midwifery members and other key midwifery stakeholders, has already done much of this work. 

In 2016, the union published our Safe Work in Midwifery Standards, which sets out 10 principles to achieve a safe work environment for Queensland midwives. This Standard was updated in 2021.

It’s an evidence-based document that articulates a way to effectively identify midwifery workloads and outlines what the minimum ratios should be (one midwife to a maximum of three women and three babies, in an inpatient unit context). I encourage you to read it for yourself here.

Finally, if we don’t have a plan to grow the midwifery workforce and allow midwives to work to their full scope of practice, how will we ever attract the number of midwives we need for the future? 

Creating a workforce strategy is a job for both federal and state governments, working in consultation with midwives – and not just level 7 executives and bosses, but midwives on the floor who understand what’s going to work best for us.

And if we don’t plan, and governments don’t improve the way we fund and staff maternity services, what then?

Well, we can look to the evidence on that, too.

In the same QNMU check-in survey mentioned above, 25% of midwives indicated they were contemplating leaving midwifery in the next 12 months (compared to 20% in the QNMU’s 2016 survey). Their reasons included excessive workloads (21%), lack of workplace support (21%) and burnout and stress (14%).

I don’t know a midwife who doesn’t go above and beyond every shift to make a real difference in the lives of the women and babies in their care. Even though we’re struggling, we always do it with a smile on our faces. 

The mothers in our care see how under pressure we are, but I’ve never seen a midwife let them know the real impact it has on us. 

It’s a testament to midwives. But we don’t want sympathy. We want to do our jobs. 

We want governments to count the babies.

Read more about the QNMU's Count the Babies campaign at www.qnmu.org.au/CountTheBabies