'Keep fear out of the birth room': an interview with Professor Hannah Dahlen

When I first heard Hannah Dahlen speak, it was in Grange-over-Sands, England, at the Normal Birth conference. Hannah gave a talk on the 'Juggernaught of Intervention', describing the potential consequences of unnecessary medical intervention in childbirth,  and  I was hooked. Each of Hannah's words rang true to me, I was, and still am, concerned about the ever increasing focus on 'risk' in maternity services, and the impact this is having on childbearing women and those caring for them.    Since then I have followed Hannah's brilliant work, via academic publications, with enormous interest. After the success of interviewing Prof Soo Downe OBE and Dr Helen Ball, I asked Hannah if she would be willing to participate too. I am thrilled that she said yes! Hello (or G’day!) Hannah! Thank you for agreeing to be interviewed... could you introduce yourself, please?

Hi Sheena, my name is Hannah Dahlen and I have been a midwife for nearly 25 years. I am currently the Professor of Midwifery at the University of Western Sydney, which is in NSW, Australia. I am also a practising midwife and I work with five other lovely midwives (Robyn, Jane, Janine, Emma and Mel) in the largest private group practice in NSW, called Midwives@Sydney and Beyond. I provide continuity of care for women throughout pregnancy, labour and birth and for six weeks following the birth. Around 90% of our women give birth at home. I am also the national media spokesperson for the Australian College of Midwives, which means I can be woken up as early as 5am to tiptoe through political landmines as I try and represent midwives in the best possible light. Once I did a radio interview at 4am and had a very funny time talking to truckies about birth, as apparently they are the only ones awake at that time. I am also on the executive committee of the NSW branch of the Australian College of Midwives and I have held this position for 17 years.

When did you realise you wanted to be a midwife? 

I don’t remember realising that I wanted to be a midwife because I can’t remember ever wanting to be anything else. My mum was a midwife and I grew up Yemen, where I was also born. My earliest memories were being cordoned off in a playpen in the corner of the clinic with a kidney dish and tongue depressor to play with as my mum worked. I also remember being sat on a tin in a backpack so I could see the countryside as mum and dad trekked into the villages to vaccinate people. Because I was so blond and fair skinned and had vivid blue eyes the Yemeni people found me fascinating and my hair was always being pulled to see if it was attached to my head. When I squawked in protest they concluded I must be a wizened up old woman with white hair. But of course there was a moment that I knew without a doubt the kind of midwife I would be when I was 12 years of age. My next door neighbour gave birth to her third child and I helped the local midwife catch the baby. When my neighbour saw it was another girl she turned her head away and said , ‘take it away.’ She feared that her husband would divorce her or take a second wife as she had not produced the much valued son yet. I remember carrying this perfect little girl, which they named Hannah after me, to the window as the dawn was breaking and the minarets began their melodic calls to prayer. I remember as girl on the brink of womanhood feeling both spellbound by the miracle I had witnessed and outraged that girls should have less value than boys. I knew then that you could not be a midwife without fighting for women’s rights and that was when I think the political passion I consider inextricable from the job of midwifery was born. I believe if you are apathetic about women’s rights then you are not cut out to be a midwife and if you are frightened to be political then choose another career.

What does a typical day in your working life look like?

Gosh, I have no typical day, as that sounds too much like the definition of boredom. My life is often very eclectic and unpredictable. I get to work about 9am after putting my youngest daughter on the school bus and then I might be doing several things, such as teaching, undertaking research, going to meetings, answering telephone calls from journalists or the women I care for. I have lots of wonderful PhD, Masters and Honours students who give me such delight, as I love growing the future of our profession, and they are indeed the future. I might end my day with a postnatal or antenatal visit in a woman’s home, and if I get called to a birth it is usually at night. I have only had to get someone to fill in for me once in the past four years of being on call because a woman gave birth when I had a lecture on. Once back home I do what all mothers do: get the dinner on, nag about homework, listen to stories of the day and hopefully collapse on the lounge to watch Call the Midwife with my daughters, or Modern Family, which is another favourite.

I am a great advocate of your work on how the ‘risk agenda’ is influencing maternity care. Can you tell us why this is so important to you?

Fear is ruining birth and we have to stop the fear. When I am asked what I do as a midwife I say my job is to keep fear out of the room. I knit at birth now and work very hard to keep fear at bay in my own practice. I left the hospital system after 20 years of practice because I recognised I had become undone by the fear that was manufactured around me and I was no longer providing women with the best care. Now that I work in private practice and out of the system, supporting women mostly to give birth at home, I have re-found my faith in birth and realise it is not birth that is dangerous, it is us! I love working with midwives on how to put risk in perspective and manage the fear that is so endemic in our maternity systems. We need to make friends with fear and work out when it is protecting us and when it is destroying us. We also need to stop blaming women for their fear as I think the models of care, attitudes and language of health professionals are most to blame. I love watching women give birth without fear now, surrounded by love and trust. Women are so amazing and we are so lucky to share this magic journey with them and their partners and families.

We have a situation where maternity services are focused on risk reduction, and yet outcomes aren’t improving. What do you think the answer is?   

Get women and midwives out of the hospital. Move back to primary health care, community based models. Give every woman a known midwife and make relationship based care the priority. I often say to my students the largest organ involved in childbirth is the brain not the uterus. If you want the uterus to function well then start working with the brain. Value women and value birth. Base practice on evidence and make health services accountable to the evidence and provide cost effective care. In Australia we have been calling for private obstetricians to make their caesarean rates public so women know when they are cared for by a doctor with a 90% caesarean section rate. In my country I think this would have a big impact on our caesarean section rate which is nearly double in the private sector. Lastly, and most importantly, if women are to trust in themselves and birth then surely those caring for them need to trust in women and birth.

What other areas of maternity care are you interested in?

Just about everything, this is my problem. My mother always said the worst thing you can do with Hannah is make her bored. I can promise you one thing there is nothing about being a midwife that is boring. I say my job is perfect because I combine teaching, research, clinical practice and politics together. I would hate not to believe in what I do and I really, really do believe in the amazing job midwives do. I would love to see my colleagues hold their heads up high and say ‘I have the most amazing job in the world’, after all we usher in the future! I really love history as well, as I am convinced that the past has much to teach us and some really good midwifery practices happened in the past. This is why I chose to undertake a randomised controlled trial looking at the effect of perineal warm packs in second stage for my PhD, as it was branded an ‘old wives tale’ with no evidence to support it. This so called ‘old wives tale’ is now Level 1 evidence. It does give me a thrill that amidst all the ‘machines that go ping’ a midwife can hold her head high as she walks down the corridor with a bowl of steaming water and flannel to give a woman in second stage comfort. I am also very interested in how birth is shaping society and founded the group EPIIC (Epigenetic impact of Childbirth) with Professors Soo Downe (UCLAN) and Holly Powell Kenney (Yale) in 2011. I think this is where we need to really channel our energy in the future. If the way we are born is re-shaping society, which is increasingly looking likely, then we need to urgently get the message out before it is too late.

What are your plans for the future Hannah?

I never think about the future and I never really have. I never thought I would do a PhD - I kind of fell into that. I never thought I would be a professor and that just seemed to happen. I believe in doing what I love and believing in what I do and whatever eventuates usually is a good thing. But most important of all you sleep well at night when you adhere to this philosophy - that is if the phone doesn’t ring to call you to a birth of course. Best of all I can honestly say I have no regrets. Every part of my life, even the sorrows and mistakes have made me who I am and provided me with such valuable lessons.

And lastly, what inspires and motivates you to be proactive what you do?

Women’s rights motivate me and making the world a better place.   None of us should come into this world and leave again without making the world a better place. Until we do right by women and recognise, value and facilitate their amazing role in society then everything we do will be incomplete. The hand that rocks the cradle does rule the world whether the world is willing to acknowledge it or not. When every girl baby is born into the arms of parents who want her as much as they want their sons then we will be on the way to bright and certain future. In many ways I feel today that I am still that 12 year old girl standing by the window in the dawn light gazing at that perfect little girl, spellbound and outraged but always full of hope that we are on the way to a brighter future.

Hannah, thank you SO much for taking time to tell us more about yourself! It's such an honour having your input into my blog….I am thrilled!

You can follow Hannah on Twitter:  @hannahdahlen

And her website: http://www.uws.edu.au/fach/fach/key_people/associate_professor_hannah_dahlen

Photograph by Holly Priddis