MIDWIFERY students and their tertiary training providers need support to help address the chronic shortages of regional midwives across the State.
Curtin University's Master of Midwifery course co-ordinator and midwife Lesley Kuliukas said tertiary institutions needed to be provided with more incentive in order to provide and expand their midwifery courses, after Western Australia's midwife shortages had been exacerbated by the closure of the State's borders to domestic and international midwives during the pandemic.
"The fact is, every single midwifery course in the country runs at a loss," Ms Kuliukas said.
"There is not one midwifery course that makes a profit and universities are businesses, so it's the first course that universities get rid of."
Ms Kuliukas said Curtin's Masters of Midwifery course benefitted from and was only able to keep running due to the profit created by the larger number of students enrolled in Curtin's nursing program, and that this was a common scenario for most of Australia's universities.
"The government needs to understand this and realise that more investment needs to go into universities in order to create more midwives," Ms Kuliukas said.
With about 100 students enrolled in the Masters of Midwifery course at Curtin University, over two years each student is required to follow 30 women throughout their pregnancy, birth and postnatal period, as well as complete clinical placements in order to fulfill the course requirements.
READ MORE:
Students are required to have completed a previous degree to enroll in the masters program and if their initial degree does not fall within the faculty of health sciences, students need to complete two bridging units to be eligible.
While Curtin University students are able to apply for their clinical placements regionally, they are still required to travel to Perth for their theoretical block weeks, deterring potential regional students and nurses from enrolling in the course.
Bree Leske, who studied nursing at Curtin University before becoming a registered nurse midwife, said this was just one of the barriers for regional students completing the midwifery course.
Upon graduating from her nursing degree in 2018, Ms Leske secured a nursing job at Kalgoorlie Health Campus and after a year in the role successfully applied for a paid 18-month position as a student midwife there.
While studying Curtin's graduate diploma of midwifery course online, she said she was required to follow 10 pregnancies over 18 months to complete the course, rather than the standard 30 pregnancies over two years.
"Unfortunately Curtin has stopped that process now, with February 2020 their last intake," Ms Leske said.
Transferring to Esperance Health Campus nearly a year ago now, she knew of a lot of nurses who would be keen to do the midwifery course if they had the opportunity to complete their training in regional hospitals but that having to travel to Perth to complete their studies acted as a huge barrier.
Ms Leske said the provision of more regional training providers and midwifery student placements would also likely ease the burden for students trying to find women to follow through their pregnancies.
Heavy course workload
With an average of about 10 per cent of students dropping out from Curtin's midwifery course, Ms Kuliukas said the heavy course load to become a qualified midwife was not at all unique to the university.
"Although we have many women that the students need to follow through, our clinical placement hours are reduced compared to other courses to make up for this," Ms Kuliukas said.
While other midwifery courses have more clinical placement hours and the students follow fewer pregnancies, she said Curtin University had designed their course the other way around due to the results provided by a national survey in 2010 on what women wanted in their maternity services.
"The overriding thing women wanted was continuity of care by a midwife," Ms Kuliukas said.
"So as a consequence of that report, lots of midwifery group practices were developed in the State in which the midwife looks after the woman antenatally, she's on call for her labour and birth and then looks after her postnatally as well.
"This is what women want, but not all midwives are prepared for it, so we thought that with our course we'd make sure that students graduating were very used to understanding the value of this continuity of care relationship and the fact that it usually creates better outcomes for women."
Evidence shows women who received continuity of care from a midwife were less likely to have interventions in their birth, were more likely to end up with a normal vaginal birth instead of a forceps or cesarean section and were less likely to have a preterm birth.
"We want our students to understand and see the value of having continuity of care from a midwife and then be prepared and able to work in that model when they graduate, because clearly this is what women want and we know it does make an enormous difference to them," Ms Kuliukas said.
While Ms Leske agreed that the continuative care model for midwifery led to the best outcomes for expectant mothers, she knows of students who had experienced a lot of difficulty in getting their clinical placements and the birth numbers required to complete the course.
"I think that's something Curtin needs to look into, particularly given the shortages we are facing," Ms Leske said.
"The student hours are really heavy with antenatal appointments - you have students travelling all across the city waiting up to two hours at King Eddies (King Edward Memorial Hospital) for an antenatal appointment.
"However when I did it, I was based in Kalgoorlie so the longest I had to wait was half an hour."
Financial support to attract students
Acknowledging that the heavy workload meant most student midwives were unable to work while studying, Ms Kuliukas said the Federal government should provide students with a bursary to help relieve financial pressure.
"I also think all country students should get scholarships to enable them to travel to Perth and to pay for their accommodation, and all metro students should get a scholarship to go to the country and do a placement there - so they can realise how great it is in the country and perhaps think about getting a job there afterwards," Ms Kuliukas said.
"While there are Commonwealth supported places available for students, in which students pay an undergraduate fee rather than a postgraduate fee for the Masters of Midwifery course, Ms Kuliukas said the funding didn't support the universities which were " still burning money".
Time to think outside the box
State opposition leader Mia Davies said it was time for the State government to "think outside the box" to support the delivery of tertiary courses and training in regional WA and that there had been a missed opportunity three years ago with the Geraldton Universities Centre (GUC) proposal to train student midwives regionally.
"In the short-term, we need to ensure anyone that wants to study midwifery is supported through their studies," Ms Davies said.
"Likewise, the State government needs to partner with tertiary institutions to retain their midwifery courses, and expand into areas that will encourage regional students to study and graduate closer to home."
The Nationals WA leader said the failure to invest in this pipeline of workers had resulted in dozens of families forced to travel hundreds if not thousands of kilometres to deliver their babies safely.
"The Minister for Health has been unable to answer questions in parliament relating to the number of families impacted by the regional midwifery shortage, but we are aware the shortage has impacted up to 100 families in the Mid West and Gascoyne," Ms Davies said.
Retired midwife incentive program
A State government spokesperson said while university funding was a matter for the Federal government and university placements were a matter for individual universities, the WA Country Health Service (WACHS) was exploring partnerships with metropolitan Health Service Providers for graduate midwife rotations, as well as paid student midwife models to encourage country nurses to move into midwifery.
"From January to May 2022, WA Health's clinical workforce grew by 1107 FTE (full time equivalent) nurses and midwives, and 412 FTE medical practitioners," the spokesperson said.
"National and international recruitment programs continue with a strong focus on attracting midwives to work across community and hospital settings.
"The Department of Health is writing to midwives who have recently retired to offer casual appointments with more flexible working arrangements."
The incentives on offer for the regional placements include travel, meal, accommodation and daily allowances.
The spokesperson said work was also being undertaken to increase the number of neonatal nurses caring for unwell newborns, to enable midwives to focus on midwifery care.
"Similarly, telehealth supported services give country families access to lactation consultant services and antenatal education, supporting local midwives to provide clinical care," they said.
Band-aid fix
However The Nationals WA spokesperson for regional health Martin Aldridge labeled the government's newly-announced campaign to lure retired midwives back into casual appointments as a "band-aid fix" and said more permanent solutions recruiting and training Western Australians were needed.
"In February 2019 I wrote to then Health Minister Roger Cook and implored him to back a plan by the GUC to offer a local midwifery training program," Mr Aldridge said.
"The health minister's response was simply there were an adequate number of midwives entering the health system and not enough births in WA to justify additional clinical placements.
"Less than three years later, the number of FTE midwives in WA has decreased by 40, while births have increased dramatically - with 1,600 more births in 2021 than the previous year.
"This short-sighted decision by the State government has resulted in a critical shortage of midwives across regional WA and has left families in the Mid West and Gascoyne regions particularly exposed to staffing shortages and service closures."
Burnout within the sector
A situation not unique to WA, a shortage of midwives continues to be reported nationally and internationally in places including the United Kingdom.
Even prior to the pandemic, the results of a 2017 online survey in the UK with 1997 participants indicated that the UK's midwifery workforce were experiencing high levels of stress, burnout, anxiety and depression.
Sixty seven per cent of respondents recorded moderate and above for work-related burnout, and midwives aged 40 and below more likely to record high levels of burnout, depression, anxiety and stress.
The study said supporting the emotional wellbeing of midwives globally was "not only for ensuring childbearing women receive quality care but also for retaining a healthy and motivated workforce".
Ms Leske said she had witnessed first-hand burnout among midwives within the sector.
"It's really rare to see a midwife who is in their fifties or sixties and have been in the industry that whole time," Ms Leske said.
"I think probably due to the nature of the job but also because of staff shortages as well."
Ms Leske said visiting midwifery services needed to be expanded throughout the State to not only help expectant mothers but to also help reduce burnout being experienced within the sector.
