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All About The Smear Test - How To Make Cervical Cancer Screening A More Comfortable Experience

Saturday, 23 March 2019


There has been a lot of conversation on my Twitter lately about  "the smear test", or cervical screening, and not all of it has been positive. A lot of my Twitter friends are just having their first tests now, and are unsure of what to expect, or a little bit scared that it will be a painful experience, which it honestly can be for some women. There has also been talk about sexual and obstetric abuse and trauma, and how that contributes to fear around cervical screening, which can be triggering for some people, and also about the experience of non-binary, trans and queer people who have a cervix and need the screening done. Please note that I have very little experience working with this population, and have used the term women throughout this post, not as an intentional erasure of this population, but because I have not yet experienced working with anyone who identifies as other than a woman in this context. However, I pride myself on individualisation of care, and if I have a client who identifies as other than a woman, or uses different pronouns, I am obviously going to respect this and treat that person in a sensitive and appropriate manner. So, because women's health is a huge passion of mine, and as I am both a midwife who does these tests on women, and a woman who undergoes the procedure myself, I thought I would put together a little informative post aimed at both women and health care professionals about what to expect in the procedure and also how it can be made a more comfortable and less triggering experience for all women.

First of all, I'd like to remind my international readers that I am Australian, and therefore we have slightly different terminology and protocols for cervical screening. The Australian cervical screening protocol has just recently changed, and it looks as though our protocol has moved to be more in line with the UK protocol. The procedure itself is the same, so this post will be helpful to you regardless of what country you are in, but timeframes for when to be tested are slightly different. If you're from the UK, you can find that information here, and if you're Australian, the information below will be accurate for you.

Why get cervical screening done?

The new cervical screening test is looking for the presence of Human Pappilomavirus (HPV), which is the virus responsible for most forms of cervical cancer, whereas the old pap smear test was looking for changes to the cervical cells that could indicate that they are pre-cancerous.

Two strains of HPV, HPV-16 and HPV-18, are responsible for over 70% of cervical cancers. It is very rare for cervical cancer to have a cause other than HPV, and neither the old pap smear test or the new cervical screening test detected the early changes responsible in those cases. These types of cancers are usually found when women report symptoms like pain or abnormal bleeding, and should be investigated regardless of how long it has been since your last cervical screening test.

Getting the cervical screening test done is the best way to prevent and detect cervical cancer caused by HPV. If HPV is detected in the cervical screening test, the sample can then be further examined for changes to the cervical cells.

It is also a great opportunity to talk to your health care provider about your sexual health. The health care provider will examine you externally and internally for any abnormalities, including signs of sexually transmitted infections, or moles that may need to be investigated for melanoma, and you may be offered STI testing at the same time, or use the opportunity to talk about contraceptive options.

How is the cervical screening test done?

Cervical screening is done every 5 years in Australia, from the age of 25. The regime is slightly different in the UK. Cervical screening is more effective than the pap smear, which is why the interval of time between tests has increased with the introduction of the new test.

The cervical screening test is done by collecting a small sample of cells from the cervix with a cytobrush, which is pictured below. A speculum (which I am holding in the header picture) is used to hold open the vaginal walls so that the health care provider can see the cervix, and then the cytobrush is inserted just inside the cervical opening, rotated quickly to collect the cells, then removed. The cyto-brush is then dipped into a substance called thin-prep which preserves the sample for it to be tested at a pathology laboratory. Insertion of the speculum is uncomfortable, and collection of the sample is a little bit painful for most women, but it is over quickly,


Traditionally, for the test to be done, women are asked to lay on a gynaecology exam table, with their pants off, their bottom right on the edge of the table and their feet on or legs in stirrups. This position is known as lithotomy, and is an incredibly vulnerable and uncomfortable position to hold, which women often need assistance to get out of, especially if their legs are in full stirrups. The health care provider will then insert the speculum, which is lubricated, into the vagina, open the speculum and collect the sample before removing the speculum and providing a tissue to the woman to wipe off any excess lubricant before getting dressed again.


So, what can be done to make cervical screening more comfortable for women?

First of all, no one should undergo a test or procedure without giving full informed consent to it. This should include a pre-appointment discussion of the information outlined above, showing the woman the equipment used in the procedure and explaining how and why it is used and giving the woman the opportunity to ask questions about the procedure. Knowledge is power, and familiarising the woman with the equipment used helps to break down the fear associated with getting the test done. Information and consent should be given with the woman seated fully clothed at eye level with the practitioner (I know this sounds totally common sense but you'd be surprised how many doctors and midwives try to explain things to women when they already have their pants off and are lying down in a vulnerable position. This is not ok.)

For almost all women, it is possible to get rid of lithotomy and the gynaecology table when doing a cervical screening test. For some women with a retroverted uterus or who have a high BMI, it may be necessary to use the gynaecology table and lithotomy position to view the cervix properly, but it should be tried on a regular bed first.

To examine a woman without them being in lithotomy position, they should be positioned on a flat and firm bed or couch and allowed to relax until the procedure is about to begin, with a blanket over their lap once they have removed their pants for privacy. When the practitioner is ready to start the examination, they should ask the woman to position herself with her feet together up close to her bottom, and let her knees splay out to the sides, relaxing her bottom. The woman should lift the blanket herself when she is ready for the examination to begin. A common reason that health care providers give for the necessity of the gynaecology table in doing the cervical screening test is that the speculum handle needs room to point downward, however it is perfectly fine to use the speculum upside down, with the handle pointing up, allowing for the woman's bottom to be comfortably positioned on a bed. If you are not offered this option, you can definitely request it. Being positioned comfortably helps you to relax during the procedure, decreasing pain and fear.

The woman should be offered to self-insert the speculum. If you are not offered to self-insert the speculum, you can ask to do so. The handle does not need to be sterile, and therefore it is perfectly ok to touch the handle, but hand washing should be encouraged first. The speculum should be turned sideways as it is first inserted into the vagina, then rotated as it advances along the vaginal canal. If the woman declines to self-insert the speculum, the health care provider should ask if it is ok to touch the woman now before parting the labia and gently and slowly inserting the speculum, talking the woman through the process of inserting, opening and any adjusting necessary to visualise the cervix.

The health care provider should check in with the woman throughout the procedure, making sure she is ok, and explaining each step of the process as it is done, and any visual findings so that the woman is an active participant in her health care.

If a woman has a retroverted uterus, you can ask them to sit on their fists to tilt their uterus, but a more comfortable option would be to get them to sit on a rolled blanket or towel, which will provide the same tilt but be more comfortable. This should be tried before lithotomy position.

If a woman has a large BMI, or vaginal prolapse, using the finger of a large sterile glove with the ends cut off to stretch over the bills of the speculum to create a barrier for the vaginal wall should help to be able to visualise the cervix without resorting to lithotomy.

Sensitive language should always be used including correct pronouns, and avoiding the use of phrases such as "good girl" which may be triggering for victims of sexual assault. A chaperone should be offered to all women as well to maintain their safety.

If a woman is finding the procedure particularly uncomfortable or painful, the reason why, including physical and psychological reasons, should be explored and treated and pain relief should be offered, Some women with anxiety may benefit from taking anti-anxiety medication before the procedure, and anyone who has previously found an examination to be painful should be offered nitrous oxide gas or at the very least, panadol before their appointment to make it more comfortable. If it is your first time having the smear done and you are finding it especially painful, let your care provider know and ask if there is anything you can do to make it more comfortable, or any pain relief you can take. You may wish to stop the examination, re-book your appointment and take pain relief prior to attendance, and this wish should be honoured by your care provider, who should cease the examination immediately upon your withdrawal of consent.

The option for self testing has recently come in in Australia for women over 30 who are overdue for their test or who have never been tested before. Self testing takes samples from the vagina rather than the cervix, and therefore cannot detect precancerous or cancerous cervical cells, but will detect the presence of HPV in the vagina. Therefore, it is less effective than the test done by a health care provider. I think this is a great idea for women with serious trauma who cannot sit through the cervical screening test to make it more accessible, but I honestly believe that if all health care providers adhered to the simple steps above to make the test more comfortable for women, a lot less women would find them traumatic and feel the need to do the self-test.

So that's it! A few simple steps that can make cervical screening more comfortable for women!


Change rarely comes from health care providers, who have been trained in a certain way in which they are comfortable. It comes from the consumer. It's important to find a trusted health care provider to do your cervical screening tests, and be your own advocate in asking for these simple measures to make it a more comfortable experience for yourself. If every woman asked for these things, it would soon become the norm!

I hope this post has been helpful to you, whether you're a woman readying yourself for your first cervical screening test, or a health care provider looking for ways to make the test more comfortable for your clients. More information on screening in Australia can be found here, and on self testing can be found here. UK specific information can be found here. If you have any questions, please reach out to me on social media, email me at sunae.reilly@gmail.com or leave a comment here on the blog. I'd love to hear from you!




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Reflecting on a birth

Wednesday, 20 March 2019


Today I was going through the notes on my phone, where I have jotted down many a blog post idea over the years, and I cam across this note reflecting on a birth I attended last year. I will often come away from a birth with scenes playing behind my eyes, and with a rush of oxytocin that sings in my bloodstream on the way home. Sometimes it's so intense that I need to write and reflect before I'm able to sleep, and this was one of those births. I remember this birth so clearly. The primary midwife had been at another birth and was tired, so went to have a nap, and things started picking up fast. It was just me, the woman and her partner, and the atmosphere was one I don't know how to describe, but that I don't think I'll ever be able to forget. We were at The Birth House, and it was sometime in the middle of the night, as most births are. 
I held her as she went through transition. She had that wild, primal fear in her eyes and she looked so deep into mine. I had my hands on her shoulders, easing tension and telling her “you are safe. Your baby is safe. You are ok. You can do this” over and over like a mantra. She held onto me tight like I anchored her through contractions, and rested her head on my shoulder in between while I stroked her hair and her back. Her partner was stroking her back too but in that moment she needed a woman’s touch. She needed a midwife - someone who had seen birth in all its forms, to tell her that she was ok. I told her her body is powerful. That this pain can’t overcome her because it is coming from her. I stroked her hair and held her close. That intimacy is so surreal. The connection and the fear in her eyes that brought tears to my eyes. She roared through contractions as I held her and then she said she could feel the baby’s head. I coached her through pushing after calling Bron and guided her partner to catch his baby. What an incredible moment. What a birth to be a part of. Today I keep seeing it and reliving it and I think this will be one of those births and one of those couples that lives forever in my head and my heart.
The thing I remember most vividly about this birth was the sense of intimacy between myself and the woman. It's not every birth where the woman goes that deep and primal, and yet connection is still so strong. Seeing someone in that state of vulnerability is an incredible privilege. Connecting with them - physically, emotionally, spiritually and anchoring them through the intense rite of passage that is transition is a totally surreal experience. My breath caught in my throat as she locked eyes on me - fearful, teary and wide. I came away from that birth emotionally spent and equally as fulfilled. It's births like those that make me feel so lucky to be a midwife. 

Don't Put Selma Blair on a Pedestal - Just show Us More of Her!

Wednesday, 27 February 2019


Everyone is talking about Selma Blair at the Oscars.

Everyone.

A woman walked down the red carpet, looking like a majestic goddess, with a cane in her hand and it's made worldwide headlines. I can't tell you how happy and disappointed this makes me all rolled into one.

Happy because two amazing, strong women with disabling illnesses were at the Oscars - one of them even won an Oscar! Yet, disappointed that this happens so rarely that it's made worldwide headlines.

1 in 5 people in Australia have a disability, so why is it such a big deal to see it on the telly? It should be commonplace. Representation of people with disabilities - both visible and invisible, is woefully inadequate. So inadequate that, as someone who has been diagnosed with two invisible illnesses that are disabling at times, I burst into tears to see Lady Gaga win an Oscar, and again at the photos of Selma Blair walking the red carpet.

Why? Because it's the first time since my diagnosis in 2011 that I have seen a disabled celebrity other than Selena Gomez win an award of this calibre, or walk down the red carpet looking disabled.
Picture from here

I was a couple of weeks shy of 18 when I got diagnosed with Systemic Lupus Erythematosus and Fibromyalgia (which Lady Gaga has too), and at the time I was a very sick person. Getting that diagnosis felt like my whole world was crumbling around me. I felt that I would never be able to work full time, never be able to have a family, never be able to even enjoy nights out with friends again. I was diagnosed with depression and anxiety 12 months later, feeling isolated and unseen because of my illness. There was a time when I seriously considered getting a cane, and had my pride not won out, I would have had a much easier time getting around with one when I was at my sickest. To this day, I struggle to accept my illness, I struggle with my mental health in association with my illness, and my ideas of success are all wrapped up in a standard set by able-bodied people, which often feels unattainable for me. To see people like me on the TV, doing amazing things - living out their dreams! It gives me hope. It makes me feel seen.


I don't think that it should be such a big deal that people like me are at the Oscars. Maybe if I had seen someone walk down the red carpet with a cane that wasn't being used as as a quirky accessory 8 years ago, I would have got one for myself, used it and had better mental health from getting out of the house more. But I don't want to see headlines proclaiming how inspirational Selma Blair is, or putting her on a pedestal. I just want to see the 1 in 5 disabled people in the world represented on our TVs so often that it is normalised, and young women being diagnosed with disabilities or invisible illnesses won't have to feel as alone, afraid and ashamed as I did when I was diagnosed - with or without need of a mobility aid.


Nerding out at the Evans Head Aviation Museum

Sunday, 24 February 2019


Today, Jake and I made the most of the rainy day with a trip to the Evans Head Aviation Museum. Jake was surprised to know, given that before I was a midwife I actually studied history and literature at University with the hopes of becoming a museum curator, or (more realistically) a teacher, that I had never been to the aviation museum. I told him quite honestly that this was because, being in Evans Head, I had just assumed that it would be a bit crap. I was very happily proven wrong!

Evans Head has a long standing relationship with the Air Force, and was home to one of Australia's largest RAAF bases during WWII. Apparently this puts a town in good stead for receiving ex-air force aircraft to display in beautifully restored condition in an original WWII aircraft hangar. While the main attraction of the museum is the F1-11, I actually didn't take a single photo of it! Oops. I was much more interested in the shiny, red Canberra and the Caribou light cargo carrier, which we were able to actually go inside on a guided tour by the extremely knowledgeable volunteer, Shane.


Not really dressed to impress, but this is one of my most comfortable outfits. I LOVE my Nobody jeans so much. 


I'm so glad that Jake convinced me to go to the museum. It was absolutely amazing walking in and around, and even under the wings of the amazing planes and other aircraft on display. Seeing where the gunners had to lie in the older, WWII planes was pretty amazing, and we are very lucky to have such a great museum in our tiny, seaside town. Every year, the Museum hosts The Great Eastern Fly In, which we usually watch for free from the beach like the cheapskates we are, but after visiting the museum and seeing all that it has to offer, I'd definitely consider paying to go to the fly in some time (haha). 


If you're ever in the Northern Rivers, this museum is well worth checking out. For $5, it's worth every dollar if you're into history, engineering, or just want to see some cool planes. Kids would absolutely love it! There was a little boy there today with his parents and his wowed exclamations as he looked up at the big wings of the F1-11 were the cutest thing!



On being the friend who shows up

Friday, 22 February 2019



This media crazy, text happy world we live in is wonderful, and the internet is such a powerful, connective force that I am so grateful for. I've made friends through blogging, and through Instagram and even through Facebook groups, who I am so grateful for having in my life, and with whom the connection runs as deep as with those who I have met in my day to day life sans screen. It is also amazing that I can pick up my phone, in the palm of my hand, at any given moment and send a quick text to a friend. I can read a facebook status and immediately respond with condolences, with compliments or with candour. I can send through snaps of my day and receive the same in kind. We are so connected to one another through social media and texting these days, which is great! I know I rely so much on being able to send a quick text to my handful of close friends on a daily basis for the connection and support I need in my life. But is texting and social media becoming a substitute for actually showing up for our friends when they need us in real life?

Laura Jane Williams explored this idea on her Instagram stories this week when she drove a 100 mile round trip to visit a friend who needed support, and it made me stop and think - am I the kind of friend who shows up? Or am I one who thinks a quick text does the job of showing support?

Being self-reflective is something which is really encouraged and supported in my profession, and I like to think I extend that to other areas of my life, so I'll be the first to admit I felt a sudden rush of guilt at the prospect of these text interactions replacing really meaningful displays of support for my friends, then a second rush of guilt at the immediate need for comparison I felt with Laura upon google-converting 100 miles to kilometres, and finding that it is 160 kilometres - a-ha! I go further than that on pretty much a monthly basis to visit my friend Shannon, and her baby Mila. I win. 

The guilt was warranted. Using the internet to compare friendship prowess is a shitty thing to do. It's not a competition, and as I dug deeper on this topic I realised this amongst other things.

Shannon and Mila showing up for me last month

I am the friend who shows up, but sometimes it comes at a cost. As I mentioned, ever since my best friend Shannon has had her baby, I've driven to the Gold Coast regularly to see her and support her through the postpartum period, and this huge transition her life is going through. At times, I've put the fuel on my credit card to show up for her. I've driven up after births at the cost of sleep, and I've spent my last $20 on coffees for the two of us to lift our spirits on particularly rough days for either of us. It takes me an hour and a half to get to her house, and sometimes the last thing I feel like doing when I get home from Grafton is drive 130 kilometres but I always put the effort in, and it is always 100% worth it. She's given me a bed or a couch multiple times when I've needed it, always answers the phone even if her baby is screaming and basically kept me sane at the end of our degree, to the point where I believe there is nothing that half an hour with her and a chicken schnitty sanga can't fix in life.

Another friend of mine I see at least weekly. She lives much closer to me and although our friendship is young - we only met last March, we barely go a day without talking. Actually talking, not texting. She got a babysitter and came and helped me pack my kitchen when we moved a few weeks ago, and when she messaged this week to say she was having a tough time, I went to her without giving it a second thought.

A third friend and I have a standing market coffee and cake date, and she gave me free life coaching at the start of last year when I felt completely disorganised and was struggling to get my head around subcontracting, studying and maintaining creative outlets in my life. Jake and I drove 14 hours to Bermagui with a farting dog in the backseat of the car to spend her 30th birthday with her in September. You can't really put in much more of an effort to show up for someone than that!

But am I showing up for all of my friends in this way? I wish I could say yes, but no. I'm not. It would be physically mentally and emotionally exhausting to show up for all of your friends in this way all of the time. There are friends who I have shown up for in the past in this way, but I don't anymore. Reflecting deeper, I wondered what is it about these women that makes me want to go the extra mile to show up for them, when I've maybe given up on showing up for others in this way in the past? And I realised... it's because these are the women who do it in return. Friendship is a two way street, and overwhelmingly, in almost every relationship I have ever had, I love hard, fast and long and have wound up being the one who puts in the extra measure of effort to keep the friendship going, but it's not like that with these women I have in my life. I don't feel like it's any effort at all to show up for them when they need me, because when I need them most they're there for me as well.

It's taken 25 years to reach this point in my life, but I finally feel like I've found the women with which I will have lifelong bonds. True friendships that will stand the test of time. Friends with whom a text is not enough, and who show up for me just as much as I show up for them, despite distance and despite us all having busy lives. On my birthday, as I looked around the table in my favourite Thai restaurant, and read the beautiful cards the four friends I invited wrote, a tear came to my eye. I felt completely content with my life in that moment, and yet I was overwhelmed. Overwhelmed that it had taken me 25 years to find this tribe of people who I've come to love so much.

I implore you to think critically about the friends you have in your life, and where the majority of your interactions with them lie. Do you show up for them physically when they need you most? And do they do the same for you? Go deeper than a text or a social media comment with the people you love - the rewards of doing so for those true and meaningful friendships are boundless. But choose wisely who you go deeper with - question, would they do the same for you?

The Graduate Midwife Road Less Travelled: Reflecting on the year that was

Wednesday, 13 February 2019

On the way home from the hospital I started working in in October.
The town is absolutely stunning in spring!

If you haven't read them yet, click for part 1, part 2 and part 3. 

It's the end of an era! Almost 14 months has passed since my midwifery registration came through and I attended my first birth as a registered midwife. I have so much to say about my experience choosing a non-traditional graduate year, and working in private practice directly from uni, but now I have sat down to write, I feel a little bit choked up and it's hard to get the words to flow as they usually do when I write. I think this is because it has been such a big year for me, and  it's hard to get my thoughts and experiences to behave themselves in my head so that I can make sense of them on paper.

I will start simply with this - I have had the absolute best graduate year that anyone could possibly have.

I feel so wonderfully privileged to work with women, to support them fully and wholeheartedly in their choices, to have physiological birth totally cemented in my practice as "the norm", with no fear of physiology. I've learned so much about women's bodies - the incredible feats they endure to bring their babies earthside and the incredible range of "normal" experiences. From the women who I didn't make it to in time because they birthed so fast, to the one that had a 4 four third stage and the one that had an 8 hour second stage with mum and baby totally fine clinically the whole way throughout. The women who love birthing, to the women who fight each contraction. The women who roar, and the women who breathe baby out quiet as a mouse. The women who have a tribe of support people around them when they birth, and that one woman who asked me for privacy and then pushed her baby out into her husband's loving arms.

Maggie the Midwifemobile all packed for a birth

Working in private practice in my graduate year has totally cemented physiological birth in my practice, and taught me to trust the birthing process with all of my heart and soul, but it's also taught me to use my critical thinking skills and clinical decision making skills wisely. When you're faced with normal all the time, the abnormal sticks out like a sore thumb. I've done a fair few hospital transfers this year, for many different reasons (the 8 hour second stage being one of them), and in almost every case I felt absolutely confident we as midwives had made a good and timely decision. Even after transfer, many of these women had vaginal births, just needing increased monitoring or pain relief that we couldn't provide at home.

Bron and I have been creative in the roles I take on at The Birth House to try to maximise my experience and knowledge while staying within the legal parameters of our current system, which requires Medicare endorsement for antenatal and postnatal care. Aside from attending births as a second midwife, I have done administration, reviewed pathology and ultrasound results and flagged anything abnormal, used the ACM Guidelines for Consultation and Referral to carry out risk assessments at different gestations and written referrals to obstetricians and paediatricians. I've contributed to collaborative care plans, done extensive antenatal education, debriefing and facilitated postnatal support groups. I've written policies, marketed, collated and published our statistics, communicated with women, doulas, photographers and other people who contact us through The Birth House. I've written articles and appeared on radio, and even took part in a documentary being made about home birth in our area, all as a apart of my role as a midwife at The Birth House. I've also been facilitating student placements from the UK and running student study days, whioch I've found incredibly rewarding.

With Manchester Uni student, Abby, at the Byron Lighthouse


In October, I started working in a small, country hospital on a permanent, 24 hour a fortnight contract to build up my hours towards endorsement and expand my skills as a midwife. The unit I'm working in has a truly lovely bunch of midwives, and low birth numbers mean that we are able to give the women so much one to one time, and support with breastfeeding and mothercrafting that I know we wouldn't have time for in a bigger and busier hospital. We also often care for the same women days in a row, giving a sense of continuity in an otherwise fragmented system. However, this particular hospital relies on locum obstetric and paediatric staff, and has high rates of intervention. It's been a challenging transition for me, from an 89% normal vaginal birth rate to a 35-ish% normal vaginal birth rate. I wanted to expand my skills while I'm there, but there are few births, so few opportunities to get better at suturing, cannulating and the likes, and while I've been performing these skills at home births (except suturing - I've only done that twice), and have the theory of the health district's learning packages done, I'm yet to sign off a single skill completely, which is frustratingly narrowing my scope of practice.

Compounding the difficulty of the transition, the hospital is a few hours away from where I live, so I travel down and stay in the accommodation centre, which is the original old nursing quarters of the hospital, where I often feel socially isolated, and miss home. Disrupting the natural rhythm of my weeks in this way has been huge. It feels as though it takes me days to recover. When I get home there is laundry to do, a house to clean and tidy, missed time with Jake and Lou to catch up on, and then before I know it it's time to go back again and I'm packing, bulk cooking and preparing to say goodbye again. Working away has meant missing home births with women that I've build trusting relationships with, which has been tough. Missed home births also mean missing a huge chunk of my regular income, which has meant needing to pick up more hospital shifts, and the cycle continues.

One of the rooms in the accommodation centre. Not the most homely!

Financially, the last few months have been tough, and sometimes I have wished I took a salaried graduate position with a regular income, but when it all boils down to it, there are more important things than money, and doing it a bit tough this year has all been worth it for the wonderful experience I now have under my belt. Every day I am a midwife the fire in my belly for working with women burns brighter. When I look within myself, I know who I am as a midwife. I know how to support and nurture women. How to make them feel safe and strong at the same time. To find the power within them that helps them bring forth new life and builds their capacity as mothers. Midwifery isn't just a job - it's my calling. Money can't buy that level of satisfaction with life.

At the Lismore Art Gallery, admiring an exhibition of belly casts painted by local Bundjalung women

A day at the beach in my new, sustainable swimwear

Saturday, 9 February 2019



Recently, I've sparked renewed interest in learning to surf (maybe this time I'll stick it out?), and I've also started learning how to kite surf, which is my partner, Jake's passion. Now, I'm not sure if you've ever kite surfed before, but one of the key steps when you're learning is body dragging through the water, which essentially is like jigging for bait, but your body is the jig and you're praying to god almighty that nothing big enough to swallow you wants to play the part of bait (there are videos of me doing this on Instagram if you want the visual and have never been fishing before). Now, as you can imagine, this is not an ideal thing to be doing in a bikini, as the water often catches on your swimmers and pulls as your body lifts out of the water, resulting in a little bit more flesh baring than is desirable. Surfing is also not something I particularly enjoy doing in a bikini, because it tends to result in both sunburn and board rash - ouch! 

So when these new interests surfaced, or resurfaced, I decided to invest in some new, more appropriate swimmers. I wanted something full piece with sleeves to protect my arms from the sun (they get quite enough), that was feminine, still sexy and sustainable. Cue a long internet search over a period of about a week, and an instagram poll to help me choose between two different suits, and I finally settled on the Soulti Surf La Mar Onezie. I loved that Soulti is a local to me small business run by a woman who surfs, because I knew the swimmers would be appropriate for my climate and the activities I wanted to do in them. They're 75% recycled nylon, made from nylon spun from discarded fishing nets fabric offcuts. I love our ocean so much, and so it's incredibly important to me that my actions in it and outside of it contribute to it's health, which is why I have decided to only buy sustainable clothing this year. I also love that even though I'm far more covered than I typically am at the beach, especially once a kite surfing harness covers my lower back, I still feel super sexy in them.


Yesterday the wind was blowing hard and Jake was keen to get out in it for a kite surf. I originally intended on having a session too, but when we got to the beach it was actually too windy to be safe for a beginner on the size of kite that I had with me, so I ended up just taking photos and videos of Jake instead. We drove onto the beach at Evans Head and went down to Salty Lake, which is a tidal tea tree lake that joins up with the ocean on the high tide. Jake loves flat water kiting and was up for the challenge of the narrow lake, and the wind was perfect to try it. We went between the lake and the ocean to swim in the morning, and then when the afternoon wind picked up, Jake hit the lake on his kite. Lou had a ball chasing him through the shallows, and I had fun watching, playing with my camera and swimming and playing with Lou in the lake and the surf. Considering that we were on the beach all day, I'm so glad I had the foresight to put my new swimmers on, or I'm sure I'd be in a world of pain, burnt to a crisp right now. The long sleeves also provided a buffer from the wind while I sat on the shore and Jake kite surfed. My only regret about the day is that we left the beach for lunch. I wish we had packed a picnic to enjoy in the shade by the lake. I can already guess that we will be spending a lot more time down there before the end of summer though, so there is always next time for that!


Why is it that I'm always getting brilliant, candid shots of Jake and he never gets any of me? I'm starting a pact with him - I'll only sit in the wind to take kitesurfing pictures for hours on end if he takes cute candid shots of me when we are hanging around and out and about. 









What's in a blog?


For the past year I've been subcontracting to private midwives, so essentially run my own business, and I wanted to add in a creative aspect to that to increase my reputation as a midwife, satisfy the creative itch and better serve the birthing community. I started wondering what that might look like and experimenting with a few ideas - blogging, instagramming, belly casting. In choosing a direction to go in, I started listening to Jen Carrington and Sara Tasker's Letters From A Hopeful Creative podcast, and in doing so, came to quite a few lightbulb moments for incorporating a creative aspect into my midwifery work, as well as for this blog.

8 years ago when I started my first blog, Little Foal,  blogging as a business didn't exist. Bloggers were just creative people who talked from the heart about things they loved and what was happening in their lives. Blogger templates were about the only templates you could get, everyone did blog hops and guest posts and built up a community, and some very real, deep and authentic friendships came out of that time in my life. I was still blogging when blogs became profitable. I've watched as some of my friends have risen up in the world of blogging and created whole careers out of social media, sponsored posts and their "little" voice on the internet, and I am so happy for them!

I started being offered sponsored posts a couple of years into blogging, and I took on the work for a while and relished in earning money from this beautiful, creative outlet I had started as a hobby in a difficult time in my life. Pretty soon though, the hobby began to feel like a chore, and I got too caught up in comparing myself to other people and lost sight of where the joy was in putting my voice out into the world. I decided to step away from my blog at that point, and it was probably the best decision I could have made at the time. A lot of my friends did the same. The blogging landscape was changing and I was embarking on my career as a midwife. I focused my energy there, and it paid off. I have an amazing job, which I really love, and I couldn't have put as much focus and dedication into my midwifery journey if I was still caught up in blogging, and the unhealthy cycle of comparison I was in at the time.

For a while now though, I've felt as though a creative outlet was missing in my life. I crochet, embroider, sew, macrame, paint and work creatively with any medium I can get my hands on, but writing is a huge part of my creative identity that I haven't been giving a voice to lately. I'm writing a bit of fiction, but at the time that I started this blog, I hadn't put anything out into the world for a long time. I started this blog out with an outfit post, and intention of just sharing my life, my outfits, my food and my craft like I did in "the good old days", but then I felt the pull to write about my journey as a midwife - arguably the biggest journey I've embarked on in my life, and a piece of content that I felt could really serve others, as well. Since writing my "Graduate Road Less Travelled" series (in which there will definitely be a new instalment soon, exploring my journey one year on), I have ummed and ahhed, tossed and turned over the kind of writing I want to put out into the world on this blog. Do I want to write about being a midwife? About fashion? About coastal living? Do I want to share information with women to help them in their fertility, pregnancy and postpartum journeys? What about sharing recipes? I love to cook! DIY projects? Tutorials? Right before I stopped blogging last time, I struggled with the same problem. At the time, there was a real push in blogging to "find your niche", to be an expert in one field, or one type of writing, and to create a "brand" that was very specific, and dare-I-say, pigeonholed bloggers into sharing just one facet of their lives.

As a creative jack-of-all-trades, master-of-none, this did not work for me. I can not pigeonhole my creativity. I'm not a one dimensional person, and I didn't feel like there was space for me to be all that I am and all that I feel on the internet, which was becoming increasingly uniform in my eyes. The pressure started mounting when I tossed and turned over what direction I want this blog to go in. I had a creative itch and I needed to scratch it, but i was holding myself back with all this thinking and worrying over what topic to write about and how to fit the many facets of myself into one blog. Then I heard Sara and Jen's podcast on just this topic - To Niche Or Not To Niche? and it was honestly like a weight lifted off my shoulders! This blog isn't a business for me, it's a creative hobby, but regardless of whether it's a business or a hobby, it's mine and it's a reflection of my creativity! Creativity doesn't need to fit neatly into a box - the fact that it doesn't is exactly what inherently makes it creative! There is space here on this blog for all aspects of my life, and whether or not anyone reads it doesn't really matter. Those who do will stick around regardless of the variety of topics I choose to write about, because they're here for who I am, which is injected into every bit of writing that I do, published or unpublished, and that is something pretty wonderful!





Book Review: Nevermoor by Jessica Townsend

Saturday, 26 January 2019


"Morrigan Crow is cursed. Born on an unlucky day, she is blamed for all local misfortunes, from hailstorms to heart attacks - and, worst of all, the curse means that Morrigan is doomed to die at midnight on Eventide.

But as Morrigan awaits her fate, a strange and remarkable man named Jupiter North appears. Chased by black-smoke hounds and shadowy hunters on horseback, he whisks her away into the safety of a secret, magical city called Nevermoor.

To stay in the safety of Nevermoor for good, Morrigan will need to  pass 
four difficult and dangerous trials - or she'll have to leave the city to confront her deadly fate."


Given the comparison on the front cover  by Kirkus, I had really high expectations for this book, and I'm pleased to say, it exceeded them all! I bought this book with birthday money after posting a tongue-in-cheek meme on Facebook hinting ever so subtly that I'd like a book, or money for a book for my birthday off anyone who wanted to buy me anything. My uncle's card said "I got the hint, kiddo" (yep, I'm 25 but I don't think my uncle will ever call me anything other than kiddo), and immediately knew that this is the book I would buy, after spending months admiring the captivating cover in the bookshop window.

Nevermoor is truly brilliant kids' fiction. It is aimed at middle grade readers (8-12 years old), which is not to say that it has a simple storyline or writing style. Jessica Townsend took 10 years writing this book, and the hard work shows. She succeeds, in the same way that J.K. Rowling succeeded, in creating a fully realised fantasy world and multi-dimensional characters that are able to capture the hearts of children and adults alike.

Morrigan Crow is smart, funny, tenacious and, at times, acerbic in the way of so many wonderful, unfiltered kids who are dealt a bad hand in life. As she grapples with her curse, the threat of death, displacement, deportation and the literal challenges that are presented to her in her quest to become a member of the Wunderous Society, Morrigan truly "steps boldy" in life, inspiring the reader to do the same.

Jessica deals with heavy themes in this book with such great care as to provide real teaching moments for children, and tug on the heartstrings of adults at the same time. She is a very thoughtful author, with every word on the page feeling like it carries purpose and adds to the truly engaging plot. The world she has created in Nevermoor is such captivating, vivid fantasy. It truly comes to life in your mind as you read, and stepping into Nevermoor provides a true sense of escapism, in the way that only the most wonderful works of fiction can. I can see this book inspiring a new generation of avid readers, in the same way that Harry Potter did for so many of my generation.

I completely devoured this book (along with the tea and biscuits in this flat lay - mmm... pfeffernüsse!), and I can't wait to read the second book in the series, Wundersmith. Originally pitched and sold as a trilogy, I am so excited by the news that Jessica has plots for nine books set in the wonderful, vivid world of Nevermoor.

The graduate Midwife Road Less Travelled Part 3 - The Road Is Not Always Straight and Flat

Saturday, 23 June 2018


 Photo by Sergio R on Unsplash


If you haven't read them already, part 1 of this series can be found here and part 2 here.

In deciding to work in this model of care straight from university, I knew I was going to face some challenges.

The first challenge was going to be people's perception of my work, or my ability to work in private practice as a newly qualified midwife. The next challenge would be finding a structure which worked for Bron and I. Then, there was the financial challenge of not earning a salary. Finally, there was the challenge of trying to work towards endorsement as a Medicare eligible privately practicing midwife - my long-term role, which would enable me to continue working as a private midwife with my own caseload, and which involves a lot of jumping through hoops. I started the hoop jumping as soon as I started working with Bron, and thus begins 3 years minimum as AHPRA's circus animal.

I was really nervous to tell friends, family and my colleagues at the hospital I trained at about my decision to forgo the traditional grad position I was offered in Sydney to work at The Birth House. Most of my close circle of family and friends don't know a lot about home birth, haven't been exposed to it and I wasn't sure if they'd be supportive. While I got a few strange looks, and was asked a lot of questions about safety and what I'd do in emergencies, it was really clear to all my loved ones by the way  my eyes lit up when I spoke about it that I'd chosen a job I absolutely love, and over the past 6 months, they've all become a lot more accepting and supportive of my decision (I may have even converted a few into potential home birthers!) Not to mention the fact that taking this job kept me at home with my loved ones, rather than working fly in, fly out in Sydney.

My colleagues at the hospital I trained in were absolutely delighted for me when I told them. This job is my dream job, and I think that while some of them may have encouraged me to take a traditional grad job if I'd discussed it with them, they know I'm onto something really special here, and know how well supported I am by Bron. The first time I had to transfer in to the hospital with a client, I was shaking in the car on my way in. It was completely nerve wracking doing the transfer - were we making a good call? How would  be received by the midwives on duty? I wondered who was in birth suite and who was team leader the whole way in, and practiced my handover in the car. When I got to the hospital, the most lovely midwife was coming onto birth suite for the night shift - one I'd worked with a bit at the end of last year and got along with well. I was so, so happy to see her walk into our room, and she made the whole experience more like a homecoming than the scary transfer I'd built it up to in my mind. Over the following few days, I visited our client in hospital and ran into many of my old mentors, who were so beautiful, kind and helpful to us and our clients. I remembered why I had loved my midwifery training so much - the midwives at our local hospital are incredible, kind, intelligent and funny. most of all, they're great friends to work with.

Bron and I are still working out what structure works for us - my role is ever-evolving as our client load and needs change. Mostly, I do 6 hours of admin per week, Saturday morning antenatal classes, a few hours supervised clinic plus whatever birth plan meetings and births we have on. Sometimes I also mind Bron's daughter while she works, and more recently I've started liaising with the international student midwives we have coming to visit over the coming year, and I will be trying to fill their days between appointments while they are here. The days are fairly flexible, and I'm often back and forth to The Birth House and to our clients' homes  4 or 5 days in a week, despite my hours only being part time. When something isn't working, we just have a chat and try something else, and as the practice grows, so will my role within it, which is something Bron and I are both working hard for.

Not earning a salary is difficult at times. When we have a lot of births on, money is great! When we are quiet, my admin hours cover my rent and I'm thankful that I haven't been totally cut off from Centrelink yet, which tops up my pay when I'm having a bad week at work according to my fortnight's earnings, which I continue to report. I'm also thankful for an incredible landlord for our tiny little granny flat, and my partner who also subcontracts, but somehow always has work when I don't. I'm honestly very nervous for tax time, as my book keeping has been very lazy and I've got a lot of work to do to get my receipts and car log book in order if I don't want a massive tax bill. These are challenges I wouldn't face with a traditional grad role, but I gladly do because I love this job, and its flexible, part-time nature which gives me incredible work-life balance even while I pursue further study.

Which brings me to the next challenge - possibly the biggest one. To become endorsed by AHPRA, which will give me a medicare provider number, prescribing rights and make me able to get insurance for antenatal and postnatal care, and carry my own caseload, there are several hoops I need to jump through.

First, I need to do a Prescribing and Diagnostics course, which I begin as a part of my Masters in Primary Maternity Care through Griffith University in July. The postgraduate study, in my eyes, is the easy part.

Next, I need to get 5000 hours of experience across all settings - antenatal, birth and postnatal care. Now, working part time as a second midwife for births, this is the truly challenging part! I'm not insured for antenatal and postnatal care, so have to be under supervision, and I have absolutely no control over how long a birth takes! Often, I'm only there 4 or so hours, including clean up. To top it off, the 5000 hours needs to be completed within 6 years, which means I need to supplement my hours with casual work at the local hospital. BUT, the local hospital won't give me casual work without postgraduate experience. Hmm..... I can see your brain ticking over, and this is not adding up, is it? No. Sadly, it is not.

I've been working part-time for 6 months now. I've completed a certificate in immunisation for health practitioners, and I'm enrolled in my Masters degree, so a week ago, I emailed the Midwifery Unit Manager to ask about potential casual work at the hospital, but so far I've heard nothing back. I've asked a few times how much experience I need, and I've not yet been given an answer. I'm eager to get my foot in the door - not for money's sake, and not just for the hours, but also because there are many valuable midwifery skills that you use often in the hospital that are rarely used at home that I would like to maintain, and there are opportunities for continued professional development in the public health setting that aren't available privately. I"m trying very hard to be patient, and to enjoy the slow build that my grad year has given me - the nurturing, supportive environment and beautiful foundation to practice of normal, non-medicated, vaginal births that I have been so privileged to attend over the past 6 months. As a very driven, goal oriented person, it is difficult to be patient though. I want to get my hours done as quick as possible so that I can fully immerse myself in private practice and work to my full scope and full potential as a midwife. It's also difficult thinking that my fellow graduates in bigger hospitals are getting their hours towards eligibility so much faster than I am, as full-time midwives despite not getting the hands on home birth experience, and business experience that I'm getting with Bron. I have to remind myself every day of how blessed I am, that it's not a race, and that the experience I'm getting right now, and the job I'm doing, which I love so much, is worth more than the full time hours I'd get in a hospital. Even if I can't work in the hospital until the end of the year, my time there will come and my hours will build. In the meantime, I need to just enjoy the ride.

The fact that my scope of practice is so limited after 3 years of university education, and registering as a midwife is very frustrating. The fact that this restriction is at the hands of the only insurance company in Australia that will cover a private midwife appalls me. The challenges I'm facing in pursuing this career pathway are unjust and uncalled for. They are designed and implemented by the medical patriarchy, which is more concerned with reigning in autonomous midwifery practice, which threatens its livelihood, than with creating positive outcomes for women and babies.

Continuity of care with a known midwife is the absolute gold standard of care, and leaving the comfort and safety of your home is the first intervention in birth. Graduate midwives having access to working in continuity models of care is absolutely integral to midwifery thriving as an autonomous profession, and to women having access to the safest model of care there is. As we learn more and more about the long-term impacts of birth on maternal and neonatal health, and uncover the mysteries of the microbiome, and epigenetics and birth, its importance is highlighted. As women have more access to information highlighting the benefits of continuity of care with a known midwife through the internet, it is also growing ever more popular.

It's so important that new graduates like myself are supported to pursue this line of work. A study in Queensland reported that up to 85% of midwives in both public and private hospitals have fear around childbirth. Midwives working in continuity of care models did not report the same level of fear. The road is not always straight and flat, but I know I'm doing important work in paving it for future graduates, and making continuity of care more accessible to women. If you're a private midwife, consider how you can open your practice to a new graduate and show them what it truly is to be 'with woman'. If you're a graduate, seek out this kind of work, and if you're a pregnant woman looking for the best care you could possibly have, and a positive, empowering experience, step outside the system - hire a private midwife and support an autonomous midwifery profession. Consumers are the voice of change, and by demanding this service, you create opportunities for more women to access it.

Despite all the challenges of choosing a non-traditional graduate job,  if I was offered full-time work in my first choice hospital from my graduate application last year right now, I wouldn't take it. I love my job so much. It's so worth every instance of stress, because working in continuity of care, in partnership with women who are making informed and empowered decisions about their births is the most amazing job in the world, and tucking a new family into their own bed after a home birth, leaving their house in the wee hours of the morning with the warm fuzzies inside me is a feeling I will never tire from.

The Graduate Midwife Road Less Travelled Part 2 - A Gentle Start

Monday, 26 March 2018

The front verandah of the beautiful federation home that is The Birth House
Read Part 1 of this series here.

I started working with Bron in October, before I graduated. As a part of the structure of my job that we had agreed upon, I would be doing 6 hours a week of administration, helping Bron with the running of her business and learning the behind the scenes of being a private midwife. I was excited about this, because I knew it was setting me up for my future as a private midwife, and that I was lucky to have someone who had been doing it for years to learn from, rather than starting from scratch myself and making lots of mistakes. So, I started my admin hours straight away, started meeting Bron's clients as they came and went from the clinic while I was there, and waited for my registration to come through - hopefully before the baby that was due on Christmas Eve came.

I met the woman who was due at her 36 week birth plan appointment, as Bron and I had discussed I would, and I was introduced to her as the second midwife for her birth. We discussed her wishes for her birth, and she had a few requests for her birth which deviated from standard care. We discussed reasons for and against, provided her with evidence relating to her decisions, discussed when risk factors might present themselves which would suggest deviating from her choices, and gave her time to process the information and come to a decision. When we left the appointment, suspecting that I would find it a massive transition moving from hospital policy to a practice of informed consent led by the woman, Bron asked me how I felt about this. I was surprised to find that I was actually totally comfortable with the woman's decision. I asked Bron some questions about how we document her decisions to cover ourselves legally, and then said "I trust the process. I trust birth. I trust that the woman is making the decisions she feels are best for herself and her baby, and that she is taking ownership of her body and her birth in her decision-making. I trust that we have given her the information to make an informed decision, and I trust you. I trust that we will document her decision correctly to cover ourselves legally, and I trust that I will be well supported by you in her birth, and that if there are any indications that we should divert back to standard care, we will pick up on them in a timely manner, and have those discussions with her." Every word of it was true. I trusted birth. I trusted Bron, and I felt so well supported in practice by her, that I felt comfortable with honouring this woman's wishes for non-standard care. In fact, I felt like that was exactly why I was working in this model of care.

My registration came through late December and a couple of nights later I got my first midnight call out! The woman worked beautifully with her partner in her birth, calling us to come late in the piece, and being 45 minutes away, I missed it entirely! I got there in time to watch her have her first breastfeed and birth the placenta. I checked the placenta, cleaned up the birth space a bit, tucked the new family into bed and drove home. I was back in bed before the sun came up, smiling ear to ear.

Over the following weeks, I attended a few more births - all of them beautiful, natural and calm. Bron and I started to feel more in sync working together. I worked with another private midwife in the area, Libby, a bit and I really enjoy seeing the similarities and differences in her and Bron's practice.  I feel really at ease working with both of them, and I commented to them both one morning after a team meeting that I feel like I'm exactly where I'm meant to be. They both gave me beautiful feedback about my presence at a birth and my way of working. To begin with, I didn't really feel like a "real" midwife. I sort of still felt like a student, but I'm slowly gaining confidence in my practice and at least I've stopped having to correct my signature from SM to RM on documentation. I drove up to the Gold Coast for a birth at 2am one night, and was coming home just as the sun rose. It was so beautiful and peaceful. I was totally in awe of my own life! I wrote this on facebook later that morning:

I love waking up in the middle of the night to a phone call, rushing to the car and driving through the still of the night, the only car on the road, to a birth. I love pulling into the street to see the lone house with lights on; thinking that's the one! And being present when new life enters the world. Sitting quietly in the corner of the room, writing notes and observing the woman and her support people as they work together to bring baby down and out. Anticipating needs and providing reassurance and encouragement. Seeing a family grow in an instant, as they meet the baby, and then tucking them up into their own bed to sleep, before heading back home to my own. I watch the sun rise from the road, and climb back into bed to sleep as the rest of the world wakes, feeling contented.

Everything felt right in those first few weeks of working in this way. I was in a blissful, private midwife, normal birth bubble. Everything about it still feels right 3 months in, and I'm really appreciative of the gentle start I've had to life as a registered midwife thanks to the support of Bron and Libby. Taking the road less travelled isn't straightforward though. I've come across a few challenges, which I'll discuss in my next post.

Part 3 can be found here!
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