The veteran midwife talks to Michelle Langstone about the increasing challenges of her profession – and the priceless moments that remind her why it matters.
Portraits by Edith Amituanai.
When Anna Saunders gave birth to her baby boy in a cottage on family land at Wainamu, Bethells Beach, her husband’s family drove all their 4WDs onto the sand dunes beside the lake and formed a circle so it would be easy for a helicopter to know where to land if there was an emergency. Saunders, a midwife of 30 years, just absolutely twinkles when she tells me this, and erupts into a delighted laugh. “They were all still up at 10 at night, waiting for the news! Nobody had been born at Wainamu at that stage, and they were a bit uncomfortable.” She gave birth to both her children on the West Coast property; her husband Jim Wheeler burst their hot water cylinder filling a pool for the water delivery she never had with her son, but managed a few years later with her daughter.
The land out there, and her family, feel deeply woven into Saunders’ career as a midwife. When Edith Amituanai and I arrive at the property Jim comes out to meet us, beaming, stopping by my window to talk to me, because he’s heard the news that I am pregnant. I’ve known the Wheelers through work for a while because the land out at Wainamu is often used for film sets — those high silvery-black dunes a stunning backdrop to action. He tells me through misty eyes that having a child is the most wonderful thing you can do, before Anna shushes him good-naturedly, and ushers us inside.
It’s a funny thing, coming to interview a midwife when you’re pregnant. I feel exposed somehow, my belly on display, but also glad for the opportunity to sit down and talk with an experienced practitioner about a career in an industry facing huge pressure. There are currently over 200 vacancies for midwives in DHBs around New Zealand, and further shortages in community care, where midwives are having to turn away pregnant women because they can’t physically see any more clients. These shortages are part of an ongoing maternal health crisis in New Zealand. Earlier this week Allison Eddy, chief executive of the College of Midwives appeared on TVNZ’s Breakfast programme to speak about the problems facing the industry, saying our midwives are “overwhelmed” and pay conditions are still not sufficient, despite strike action. There is a real risk of losing our experienced midwives to Australia, and better conditions and support in maternity care.
I think Saunders is also feeling exposed, or perhaps nervous as she makes us tea, taking time over the measuring out of tea leaves, and cutting up pieces of a slice to go with it. The criticism and scrutiny midwives have faced in the New Zealand media over the past few decades have left their mark on the profession, and it’s easy to see why they may not feel valued for their work. Saunders’ eyes are searching behind heavy spectacle frames, her blonde hair cut in a tidy bob, her manner earthy, but pragmatic. When she sits down next to me at a big table in her sunny living room, she begins to talk about the role of midwifery unprompted, and continues for almost 20 minutes about the challenges the profession faces in New Zealand, not least the media coverage: “It’s really one-sided, and you wonder if there’s an agenda in there, and you wonder whose it is.”
The model of midwifery care changed when the job became professionalised in 1990 with the Nurses Amendment Act, Saunders says. “Under Helen Clark, nursing, physio – everything in health became a profession, and became a degree. Midwives had autonomy. I agreed with it initially but now after 30 years I’m not so sure…Midwifery means ‘with women’ so traditionally it meant that you cared for women and you looked after them. What most women really want from a midwife is someone to be kind to them. Lots of women are having babies older so they don’t necessarily have a parent around, and they may not live near their siblings, and so they want someone who cares for them.”
The adjustment affected the education programme for midwives. Prior to the change you had to train as a nurse for four years and gain experience in the field for a few more before you could specialise to become a midwife. Now entrance into the course is open, and does not require previous nursing experience, and the intensive degree is just three years. The course is loaded with papers and academia, and the experience in the field is not as comprehensive. Saunders wonders if that is partly where the criticism comes from.
Born in Ōtautahi, Saunders, 56, initially wanted to be an artist. Her parents, she recalls with affection, couldn’t afford to send her to art school, and suggested she get a job instead. She began her nursing training aged just 17 – she was accepted while still at high school – and following in the footsteps of her aunt, a nurse, and her great grandmother, a midwife. “I was really young! Imagine nursing at 17. These poor people looking at some little girl looking after them! I didn’t think I’d really stick with it, but I actually loved it. It’s a whole thing, nursing. As a young woman you learn so much about people. I knew back then [in training] I wanted to be a midwife but you had to wait five or six years — they wouldn’t accept you straight from nursing.” Saunders completed her training and was ‘bonded’ to Tauranga hospital for two years. “When there was a shortage around the country in the 80s, we all got bonded and sent to rural places that were short of nurses. Twenty of us got sent there [to Tauranga] as new graduates, all 21. You had to do two years. They don’t do that anymore.” Now freshly trained midwives enter the industry and have to immediately find work at a DHB or in the community. They hit the ground running in a complex industry with only their training experience to back them. “It’s a huge learning experience for a new graduate, and anyone who does it will say ‘Look I’m loving the midwifery, but God I didn’t realise how much paperwork I had to do, and I didn’t realise how many claims I had to do, and how much communication on emails.’ It’s a big thing to take on. I’d never do it as a new grad, no, no.”
Saunders went overseas after her time as a nurse in Tauranga, and came back to work in Auckland, before switching to midwifery. “I’d been a cancer nurse, and at that stage was working at Auckland’s bone marrow unit. I really loved it, but people die, and they did die, and back then people died of leukemia quite young. I looked after lots of young leukemic people of a similar age to me, and I was about 24. I was like — oh my God. I wasn’t sure I could keep doing it, even though I really loved it.” The change to midwifery felt natural. “I loved midwifery and the training was amazing. I spent a lot of my work experience in West Auckland because I was dating Jim then” she says, holding her cup of tea in her hands with a gentle smile. She still remembers the first time she helped to deliver a baby at home, and her smile grows wide as she leaps to her feet to rummage in a bookcase for a photo album. “You’ll laugh! I found this the other day, because the kids wanted to see the albums they made when they were little.” She turns the pages for me, the tissue rustling dryly. There is baby-faced Anna, still so much as she is now, though without glasses, the same smile making her cheeks round, sitting with a woman and a tiny newborn baby. As a young midwife of 26 with no children of her own, Saunders entered the profession somewhat naively. With a rueful smile she tells me, “When I look at what I used to say to women, mostly postnatally, I cringe! You have no concept of how tired they are…I was 26 and I’d arrive there and I’d been out for dinner the night before, and these poor women were exhausted.”
The birth of her own children added a new dimension to her work, and her understanding of just how tired and vulnerable new mothers are. After all this time, her perceptions about pregnancy and labour have changed: “The role in the last 30 years for me has gone from being ‘the midwife’ to you making it the woman’s experience. My practice has changed a lot. I always say to women, it’s not about the labour, it’s about afterwards. Whatever happens in your labour, if at the end of the experience you had some ability to feel like you had decisions in it, it will be a good experience. It’s when women feel that they have no decisions in the process that they feel really out of their comfort zone, and feel traumatised.” Saunders leans toward me and says, almost conspiratorially, as if midwives aren’t meant to hold the view. “And it doesn’t matter whether you end up with a caesarean or you have a natural birth! Believe me, after 30 years, I don’t care. All I care about is that the mum and the baby are OK, and that they’ve come out feeling really good about themselves.”
As Saunders talks two pīwakawaka fly into the living room, taking up occupancy on the light shades hanging from the ceiling above us. Saunders looks up at them as they cheep and flutter “We’ve had them since Covid! They stay here. They like the lampshades and they sit up there and catch the insects that come in.” During the Covid-19 lockdown in Auckland, Saunders went back to work at Waitākere hospital to help out. She looked after the young women giving birth, her experience and wisdom filling in for the mothers who weren’t able to be birth partners for their daughters, because there could only be one support person in the room per Covid regulations. That support person was often a young boyfriend, and Saunders gives me an exasperated look when she tells me she would have liked to boot some of those young men out of the delivery room for “always texting, always being on their phones!” It was particularly frustrating knowing that a much better birth partner was hovering and worrying: “Sometimes mums would be waiting in the carpark sobbing because they couldn’t come in. It was so hard.” Taking on that role of support at such a crucial time, in the middle of a global pandemic, meant a lot to Saunders. “I loved it. I just loved it.”
The love Saunders has for midwifery tempers the difficulties, of which there are many. She says every birth is a story, and it’s a privilege to meet women and glimpse their lives. “I love families and I love their stories. You look after the funniest people sometimes and you get to meet their kids and their partners and families. I was at a really lovely home birth in Oamaru about 10 days ago. The [labouring] mother was in her grandmother’s house, a big old 50s house, and she was in this beautiful room. She was quite young, and her mother was there, and her grandmother was there, so three generations – it was incredible. She had this big screen TV and she was watching Bridesmaids, the movie. And I said, ‘Do you think we should turn this off? It’s sort of a bit weird?’ And she goes, ‘No, it’s really funny!’ So she was watching Bridesmaids and laughing through her contractions! It was fantastic. And you’re sitting there afterwards having a cup of tea with the whole family…fantastic.”
Saunders has her fair share of difficult stories, many of them in West Auckland, where she worked at Waitākere Hospital and in the community for many years. She left in 2002, finally worn out from the challenging social problems her role saw her dealing with daily. “I stopped practising in West Auckland because we had quite a big meth problem here from about 1999 to 2002. It was a really big issue, and we didn’t have a database. Tamariki Ora now have a database, they can look up a woman’s name or a family’s name to see if they have any children taken out of their care, but back then we didn’t have that.” Women addicted to pure methamphetamine would come into the hospital to give birth, and leave with their babies, disappearing back into the community because midwives had no record of their histories or problems. “So you’d have cases which were just heartbreaking. We had quite a few neglect cases back then too, where women would forget to feed the baby, because when you’re on P you forget.” The introduction of the Children’s Act in 2014 meant if midwives saw neglect in homes they were legally obliged to report it, but Saunders says CYFs, now Oranga Tamariki, never had the staff or systems in place to manage it well, or they managed it on generalisations that could harm families. It got on top of Saunders, who found it difficult losing touch with women and their children while the problems with drugs seemed to go on unabated. “There was a stage where Jim used to say to me ‘Is there anyone normal that you look after anymore?’ So I decided to stop working for Waitākere.”
Saunders has worked in every capacity as a midwife in her career – in the community as part of midwifery collectives, in Middlemore and Waitākere hospitals, and now as a remote rural locum in the South Island, where she covers shifts for midwives who need a break. Life as a rural midwife is varied, with Saunders spending most of her time based in Oamaru, and travelling the large catchment area by car to look after women. “I do Taihape, Taumarunui, up the East Cape north of Gisborne, and Wānaka. Rural midwifery’s really interesting, because it’s like everything that would happen in a big base hospital happens there, but it’s just on a smaller scale. They have exactly the same issues as everywhere else.”
She says she is staggered by the workload the rural midwives face — she’s covered shifts that have stretched for 22 hours, involving ambulance rides to Dunedin and back in the middle of the night, napping for three or four hours before resuming another full day’s work. You wouldn’t be allowed to work shifts of that length in other jobs, but in midwifery it’s par for the course. “You can’t sustain it. Midwives get really tired, and that’s when accidents happen. It’s not good for your health to be up all night, that’s why women don’t last.” It is relentless, and has a broader impact on lives: “People’s marriage won’t survive, that’s the thing — midwives have terrible divorce rates and a really high cancer and breast cancer rates, and while we don’t know if that’s connected…you can’t keep working like that and not have outcomes.”
The more Saunders shares her history, the more apparent it becomes that midwifery is a vocation, one you are called to, but even that may not sustain the gruelling nature of the work. I ask her about losing babies, and while she begins in her usual pragmatic way, I can feel her energy seem to shift somehow – it’s like the gravity in the room has increased. “You never forget it. It’s always a huge experience to go through. It’s part of midwifery, babies dying, unfortunately.” Saunders has witnessed stillbirths over her 30-year career, but one case while she was working as a locum nearly took her out for good. Saunders had just logged off a shift in Raglan and was on her way back to Auckland when a tired midwife asked her to pop into Hamilton hospital for her, to check on a woman who had turned up. “It was just one of those awful social cases where she was by herself, she didn’t have anyone with her. She was about 30 weeks, and I got there and the baby had died. And she was by herself. I had never looked after anyone with no support, and it really shocked me.”
Saunders lays her palms flat on the tabletop, as if gaining additional support from the surface beneath her fingers, and I see her eyes film with tears, and I see her fight it. “The hospital in Hamilton then was going through a big change, and they didn’t have enough senior doctors, so there was an error made with her care. She wanted to take the baby home with her that night, and I couldn’t find a social worker and I couldn’t find a bassinet… I went down to the Warehouse at 10pm at night in Hamilton and bought a bassinet with one of those baby dolls in them, threw the doll in the bin, and gave her the bassinet.” The woman had no one to collect her, and Saunders ended up calling a taxi company and asking for a woman driver to come. “She was a gorgeous Lebanese taxi driver, really hard case, a night taxi driver. I said to her, ‘Look, you’re going to be with a woman who has just lost her baby, and the baby is going to be in the taxi with you. Are you OK with that?’” The woman was, and her kindness in the situation was everything: “She said to the woman, ‘Have you got any milk at home? And the woman said no. So the taxi driver said ‘We’ll stop at the dairy for some milk, and have a nice cup of tea when we get home.’ So I knew she was safe.”
Three days later things started to go wrong. “The woman…they couldn’t find her in the community, she’d taken her baby out to the urupa in Raglan, and they couldn’t find her. She ended up getting really sick, and it turned out she had meningitis, and that’s why the baby had died. So she was really sick and the results came back and we were trying to find her.” The death of the infant became a coroner’s case, and the legality took a toll on Saunders’ mental health. “I knew I hadn’t done anything wrong but it was still awful. It was a full coroner’s case and we had people from the ministry coming down, and I had to go to Hamilton to be interviewed. The outcome was fantastic but the process was gruelling.” Problems in the hospital meant the woman’s tests had been misread by a junior doctor, but Saunders still had to fight from her corner, something she says is the norm in midwifery – you are guilty until proven innocent. “I then realised I wasn’t really coping.”
Worried, her husband Jim kept checking on her. “He kept saying to me, ‘you’re not alright’ and I’d go into the shower and cry where he couldn’t see me. PTSD has this weird profile, and I didn’t really see it in myself, though I’d known midwives who had had it. In the end I decided to get some help, because I didn’t want to go back to work.” Saunders eventually re-entered the workplace, and got through it, but she wonders about the toll on younger midwives, particularly community midwives. The burnout rate is high, hence the shortage in numbers: “What’s happening is that they’re only lasting five or six years. When I practised you looked after four or five women a month, but now women are looking after double. It’s a numbers game – you will get something that’s not right. It’s a consumer’s environment out there and people expect everything to be perfect.” It’s not uncommon for midwives to face some kind of litigation, often minor, sometimes more serious, around that five to six year mark in their career. Combine that with the exhausting hours, the great responsibility of pregnancy care and birth, and the remuneration, which Saunders says is poor, and you can begin to see why the situation is so serious at this end of maternal care: the incentives aren’t great. I ask her if she can see a day when community midwives are obsolete and she nods and shrugs. “Yeah, I can. I can.”
For all that, Saunders is quick to defend the weight of the things she has just shared. “On the positive side of it all, the actual career is fantastic! Don’t get me wrong – I love it! And I love babies.” It’s in the last eight years that she’s found a balance that works for her, enabling her to avoid burnout and continue in a profession she loves. Her children have grown up exposed to a wonderful profession. “My son Johnny is 24 now, and he was very used to coming to the hospital after school, and he’d wait for me and everyone knew him.”
The legacy of the birth of her children at home is part of the Wainamu landscape and part of their family’s story, and the hundred and hundreds of babies she’s helped bring into the world are also part of that story. Edith takes Saunders into the kitchen for photographs and they talk about the birth of Edith’s daughter, the warmth flowing between them like the sunlight that floods the space. I see her examine me almost unconsciously with her eyes, and she tells me about the skeletal structure of the body, and how that relates to the pelvis. She talks about her big feet and her height, which match mine, and how that impacts birth, and she shows me how to sit to open up my pelvis for the baby to move into the right place before birth. She’s smiling and laughing when we talk about the pressures on women giving birth “Oh, birth is political! The one thing you do is make sure you don’t listen to people in the last five weeks. There are a million different opinions and you have to take a little from a few places and ignore the rest. It’s really hard for women!” On the way out to the car she pats my shoulder, and I feel her reassuring weight there as she tells me I’m looking good, and I feel the power of her profession in that moment, in the transference of the kindness she has spoken about, which passes into my body with her touch.
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