'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

Recycling and helping others.... another tick for Australia!

This is my niece's bed, on the 'nature strip' (grass area) in front of their house in Barwon Heads, Australia. When we arrived to stay with them, we already knew what that meant. Whilst visiting Bondi with Tom and Claire we discovered this fabulous recycling idea. 

Tom and Claire had completely furnished their rented accommodation with other people's cast offs...beds, tables, chairs, television. They's taken some from nature strips, and other items had been obtained via Gumtree. As we walked through the streets we would see items of household furniture left out in front of houses and shortly after they would be gone, taken by some grateful person. Apparently the council removes items that aren't possessed within two weeks, so streets don't become unsightly. We were staggered, yet amazed. Instead of taking unwanted items to rubbish dumps or selling them on eBay (I am sure that still happens) they were donated, free of charge. 

I know this happens in England, where possessions can be donated to raise money for charity or through the brilliant Freecycle website, but I have to say the idea and ease of using the front of your house really appealed to me. BUT, this may be tricky in the UK with the unpredictable weather...

So what about Lottie's unwanted bed? Well, it was taken by some lucky individual a week later. 

Meet Bert and Tess: an extraordinary ‘ordinary’ couple

I couldn't believe my luck.

There we were, at Julie and Tony's wedding anniversary party in their home, Barwon Heads. I was introduced to Julie's parents Bert and Tess, and their English accent came through loud and clear. When I asked the question 'how long have you lived in Australia?' Tess told me they came in 1969. I was hooked! My interest in Australia's growth, especially from the European influence, was sparked again through this fortunate meeting with this extraordinary couple.

Tess and Bert and their three children Roger, Julie and Ian came to Australia on Wednesday 28^th August  in 1969 as Ten Pound POMs .

Now this couple think they are ordinary, and unremarkable. As with most married folks reaching their 60^th wedding anniversary celebration they have a story to tell, which in itself is an extraordinary thing. And as I sat wide-eyed, intrigued and enthralled by Cockney sounding tales of their life’s journey before and after they met, I quickly reached the conclusion that their story was in no way run of the mill.

Both from England, Tess is from Dunstable, and Bert was born in Luton.  As a midwife I find this quote from Bert interesting:

'Aunt Nellie’s husband had a brother who was married to a woman that practised midwifery.  Her name was May Irons and I’m not sure if she had had any proper training as a midwife.  In any case it was she who delivered me in their house at number 8 Kenneth Road in the suburb of Round Green, Luton, in the county of Bedfordshire'.

Bert Virgo was born in 1924. He had a fascinating early life which I will write about another time, then he met and fell in love with young Tess and went on to marry her.  When Bert was offered a job with Ford motor cars in Geelong Australia, and an immigration package, he jumped at the chance but Tess took a little more convincing.  With three young children it would be hard, with no close family and friends to rely on. But as with others who were offered a new start in the Southern Hemisphere, the Australian Government paid for the Virgo’s flight and their belongings to be brought across the sea. They were given accommodation and transport until a time when they could afford to sort their own, and Bert’s salary increased substantially.

The young family, pictured here, flew to Sydney and then on to Essedon (then airport for Melbourne) on this Boeing 707-338C. It took 24 hours all in all, but they look surprisingly refreshed! Can’t get over your shirt and tie Bert!What an adventure it must have been.  At the airport they were met by two of Tess’s aunts who had emigrated previously (pictured) and Bill Howard, a representative from Ford. Bill had never travelled far and clearly didn’t understand the concept of flying from UK to Australia, as he took them on a pleasure tour of Geelong,  dined in a small restaurant, then took Tess shopping! The tears Tess shed at this stage were probably from extreme exhaustion, although she said the strangeness of the environment didn’t help.

What were Bert and Tess’ first impressions of Geelong, and this new, far away country? ‘Dodge City by the sea’ said Bert. ‘I could almost imagine hitchin' posts being there to tie a horse on. It was quaint. Geelong only had one roundabout, and one set of traffic lights'.  I have to agree Bert, even today some of the towns I have passed through in Australia remind me of scenes from the Wild West.

Bert and Tess found their new world quite different from their home in England. Shortly after arriving Bert woke at 2am to the sound of a horse going up street. He woke Tess, and they looked out of the window into the faintly lit street below. It was the milk man!

But the family loved the beaches and the sunshine, and settled well into schools and a new life. Their children and grandchildren are Australian and are very proud of it.

Bert is 88 years young and recalled the fine detail of his tales as though it were yesterday. And Tess with her bound volumes of rich, intricate family history that I didn’t have time to read. It would take me months, and how I would relish looking in more detail if I lived nearer.

Thank you Tess and Bert, you both have so much to offer the young. Your wisdom, experience and historical stories remind us how and why this great country is flourishing.

I will be writing more about you. You really are an extraordinary couple.

Dodge City photo

My lovely great-niece and school uniform

Meet Lottie, my niece Claire's lovely daughter. Claire and Lottie moved to Australia when Lottie was 9 years old, and she has grown into a fine, wonderful young woman. Lottie is now 17, and is in the English equivalent of 6th form college. Now take a look at the uniform. The shoes in particular. I remember wearing these sandals in the 1960s at junior school! And the whole school wears the same uniform from 11-18, without fuss or bother. 18 year old lads with huge long hairy legs, in short trousers and lace ups. And they think it's cool.

Where have we gone wrong in England? I know there is the 'should we wear uniform' debate in the name of individuality, but Lottie tells me her peers like it as it reduces stress and competition. 'No worries' she says with a singing Australian accent.

In a previous blog I wrote about nurses/midwives uniforms and had a great response. What do you think?

Here is Lottie just leaving for the beach. Everyone is proud of you Lottie!

So Australia, what will you be like in 1,000 years?

We just got back from a 25k bike ride along the coast (well some of the way) from Barwon Heads to Torquay. I saw lots and thought lots along the way. I cycled on long, long empty roads next to vast expanses of unoccupied land. The population of Australia is continually increasing, and I thought about when Cook and Philips first arrived here and this great land was only inhabited by the Aboriginal people. Such dramatic change, yet for the most part, Australia is empty.

Then I thought about the things I love about Australia.

Good (my view!)

Optimism

Open spaces, traffic free roads

Sunshine and cornflour blue skies 

Happy people!

Tropical birds to see and hear 

Courteous slow drivers

Vast blue ocean, foaming waves and white sand 

Free BBQ stations along the beech

Outdoor life

Not so good

Lack of wifi for visitors...

Insects, bah. I'll never get used to them

Perceived racial prejudices

Gambling

I'm sure there are so many different opinions.

Australia has a definite pull for us, and more so now that Tom and Claire may settle here. 

But Australia, what WILL you be like in 1,000 years?

Family, friends and lots of talent!

It’s been an unusual yet very happy week.  Happy because were with our son and his girlfriend, and unusual because we were guests in their home.  Staying with Tom and Claire and their housemates Helen and Andy was an absolute pleasure. How very inspiring to be around young ones who have passion, flare and a drive to do well, in a new country on the other side of the world.

Their little quaint rented home is delightful, full of character and charm…made more intriguing by the fact that Helen made fabulous innovative jewellery in one of the rooms, and Andy’s hand painted surf board was propped up in the corner. Andy works for a charity ChildFund, as a team leader and is responsible for securing donations to improve the lives of children, and leading and managing others to do the same. What an incredibly selfless and rewarding job to do.

Our son Tom is a brilliantly talented chef in one of Australia's top restaurants, Four in Hand in Paddington, Sydney. We were so proud to be invited to dine there on Sunday night, and were treated like royalty. The fine dinning menu was something to experience- we have never tasted anything like it. Tom chose for us....exquisite. We had five creative and taste bursting courses and equally delicious carefully chosen wines. What a treat.

And then there is the lovely Claire. Claire (Babsylamb) is Tom's amazing girlfriend and is the best waitress AND the most wonderful company. Claire works at Hurricanes, a popular eating place in Bondi....famous for it's steak and ribs. Claire seems to be the web that binds everyone together in the house, loving, caring, chatting and sleeping! Oh Claire...you are such fun. Thanks to you all for making us welcome and taking such good care of us!

So we are now on holiday...down the East Coast heading towards Lakes Entrance. We have memories of being here before!

Keeping fit (phew)...well, sort of!

Paul and I have been trying to get into shape. In Broad Beach Waters we were joined by Lynne and Frank and it was a ‘team approach’ with all the activities, jogging (not good) swimming, aqua-aerobics and cycling. It’s essential at our age to keep moving, but my joints aren’t always happy! The water aerobics at Burleigh was the best….and quite an education. Quite different to the English sessions we attend, as apart from being in the open air I was surrounded by 'Hollywood' women look alikes! And that included perfect lip liner. I had to remind myself  I was in the Gold Coast.

Anyway, we’re here now at Bondi Beach where Tom and Claire live, and it seems we’re the oldest by at least three decades. More to be told of that later!

We had a completely new ‘pool swimming’ experience on our first morning, at the famous Bondi Iceberg.  The adjacent sea was lapping energetically over the walls and into the pool...what an experience. I have never been in a cold (ish) saltwater swimming pool, and I found it bracing to say the least!

Yesterday morning we arrived for a repeat session, and the pool was empty and being cleaned. MIxed feelings....

Oh no! I am hot and really needed to plunge in.

Great! I don't have to swim a mile.

So we jogged along the promendade with ultra young fit specimens, and later in the day took refuge in the sea at Tamamara. Bliss.

Goodbye Gold Coast, hello Sydney!

The past two weeks have been eventful. As I sat on board the Tiger flight to Sydney I was so very excited to be seeing my son Tom who lives there with his wonderful girlfriend, Claire. We haven’t seen them for 15 months, when we visited Australia in 2011.  We have had a luxurious two weeks staying with our dear friend Vi, sister of Frank and Lynne…and have been thoroughly spoiled.  With the mixed weather we only managed three beach days, where we sat under shade and marveled at the surfers performing their magic. As their boards arrowed over the mountainous foamy structures I was spellbound; what skill and energy they have, and it kind of symbolizes Australia for me. But the greatest respect must go to the Lifeguards and Lifesavers who work hard to maximize our safety  whilst enjoying the delights of the sea. Thank God for their courage, skill and passion to help others. It's wonderful to see.....

And the rains came....on Australia Day!

We knew it was the rainy season in Queensland, and we live in the North of England, which is a constant rainy season. But we didn’t ever expect this. Rain, rain and more rain. The ex-tropical cyclone Oswald hit Broad Beach with winds up to 125 kilometres an hour as it moved down from Cairns, and Vi tells us she has never experienced anything like it in the 25 years she has lived in Australia.

The weather forced organisers to cancel Australia Day celebrations yesterday, but at No 7 Bermuda St the revelry went ahead with Vi’s friends…we had a blast. 

The tropical weather is causing havoc still, and tonight we felt worried as we drove home after seeing the Life of Pi at the cinema.

I do hope it passes soon.