The WHO CC UTS acknowledges use of key language from The WHO Global Strategic Directions for Nursing and Midwifery (2021–2025).
Dr Nicky Leap has been a women’s health activist since the 1970s. She played a foundational role in the development and implementation of Bachelor of Midwifery Programs in Australian Universities. And also had a leading role in creating practice and education standards for Midwifery in Australia.
Nicky was deeply influenced and involved in the women’s liberation movement of the 1970s in the UK and inspired by things like the Boston Women’s Collective, and initiatives like ‘our bodies, ourselves’ and spiritual midwifery, as well as her own experience of giving birth and becoming a mother. She also began her career working as a community worker and as a childbirth educator in the UK and then, in the ’70s, worked as a sex educator for the Family Planning Association in Southeast London. The women whom she engaged with were usually young, very poor and living in high-rise housing. And some of these young women didn’t have anybody to support them during labour. And because of her background as a childbirth educator, she used to go along with them, sit with them in labour, and support them.
On one occasion I was with this young black woman, she might have been 16 or 17, and I saw that the way she was treated was just appalling. I knew then that if I wanted to actually make a difference to birth experiences for people like her I had to train to become a midwife.
From that time, she recalls:
It was an era of coming together to really improve things for women. The development of philosophies and ideologies around woman-centred care put women at the centre … of health care in Midwifery.
While working with vulnerable women, Leap realised that many of them did not have any support during childbirth. To help change that situation, Leap decided to become a Midwife.
I got on to what was then seen as the last direct entry course for people who weren’t nurses first,
In the following 10 years, the UK saw a rapid change in the paths for Midwifery formation and the majority of the courses to educate Midwives became three-year and four-year direct entry programs.
When she moved to Australia in 1997, she became a part of a national initiative to introduce a three-year bachelor of Midwifery. While at Flinders University, part of Leap’s role was to gather people, from all over Australia, who were interested in creating a three-year Bachelor of Midwifery course for Australian Universities. UTS was one of the first Universities to participate.
We brought together people, through word of mouth, from all over Australia. We formed a group that, we decided should be situated within the Australian College of Midwives, to develop standards for the introduction of three-year BMid courses
she recalls.
Alongside the collective action to develop standards came the realisation that Midwifery in Australia should be reviewed. That necessity would later lead to the development of The Australian Midwifery Action Project (AMAP), led by Lesley Barclay.
We got national government funding to look at midwifery education, regulation and practice standards across Australia. It was an enormous project, which changed the face of Midwifery in Australia
says Leap.
While investigating Midwifery accreditation, the group carried out telephone surveys of all the schools and departments that provided Midwifery courses. The results showed that different States had different standards, and schools had varying lengths of courses and different ways of evaluation. Leap became concerned upon realising that some courses offered little to no practice components, as she recalls:
One university was only doing competency-based training, ticking Midwives off as competent after attending three births
After helping standardise Midwifery courses in Australia, Leap soon realised that establishing Midwifery education standards was only the first step to other necessary changes. She says:
There were no regulations for people who weren’t nurses first because Midwifery, at that time, was still seen as a branch of nursing. Not as a separate profession with its own very clearly defined scope of practice
At that point, regulations had to change because it was not feasible for Midwives to be registered as nurses who were limited to practising Midwifery. After she moved to Sydney, Leap got her doctoral degree through UTS. Her research became profoundly political in terms of creating change and identifying issues in Midwifery education, regulation and practice.
While having a clinical chair at Southeast Sydney Area Health Services, Leap was able to develop Midwifery continuity-of-care projects and drive significant changes in maternity services. Throughout her career, Nicky Leap has continued to lobby for continuity of care in Midwifery and still is an activist for less medicalised labour. She states:
My research always had an activist arm, and it has always included something I learned back in England, which was that you [should] write about your ideas. You don’t have to have a research grant in order to write.
Leap stresses the importance of community-based Midwifery, and how it could help increase the availability of obstetric services and while promoting better outcomes and experiences for women during childbirth.
“If you know your midwife and go on a journey with her, you will have a better experience than if you see lots of people”
, she says.
Although Midwifery education and practice have come a long way in Australia, a lot has yet to be done to improve community-based continuity of care. As childbirth becomes increasingly medicalised, many Midwives who practice in hospital settings work under doctors’ orders. As Leap explains:
[As a Midwife] you’re there to identify when there are problems, but otherwise, you’re the guardian of the normal, you are there to keep birth normal and keep it out of hospitals.
However, Leap believes that there are signs of change. The Government starts to acknowledge the importance of community-based continuity of care and begins to take initiatives such as subsidising home births. She states that research can support us in advocating for greater involvement of Midwives in community-based health care.
We have an enormous body of both quantitative and qualitative research to inform us in our attempts to improve maternity services and in arguing for community-based Midwifery and Midwifery continuity of care. Particularly for vulnerable and disadvantaged women.