At 7pm on the 27th October 1998, I was several hours off becoming a mother. Being a first-time mother and everything being quite s-l-o-w, I was hopeful that it wasn’t as far away as it actually was. In reality, I wouldn’t be ready to push until 2am.
 
I was using water in labour, some 9 years before WA would get its act together and create a water in labour policy. If I had lived in NSW on the 27th October 1998, it would have been much more routine for a low-risk mother like myself to be offered the option of a waterbirth.
 
This demonstrates what I know in my bones – it’s not about the research, it’s about the culture. Unfortunately here in Western Australia, certainly in the maternity world, we are still in thrall to the medical profession. In this world, we are far more afraid of allowing a woman to immerse herself in a tub of salty water than we are to inject a range of powerful painkillers into her spinal area which will definitely cross the placenta.
 
About this time two decades ago, 7 pm on 27th October 1998, I would have been advocating for myself, and my request for more time to let labour unfold was expressed firmly, using medical terminology. What it actually sounded like was; “I WANT A VE (vaginal examination) BEFORE YOU TRANSFER ME!”
 
I was fully aware that I would be bullied. I expected it and didn’t take it personally. I didn’t take it lying down, either. I was firm with the Obstetrician, who did do a VE and noted that at 3-4cm I could carry on. He left me to it. I was “one of those” labouring women.
 
I was having my daughter at the Family Birth Centre Birth, at Swan Districts Hospital. The Family Birth Centre would last for just 18 months before becoming offices for obstetric staff, with all the glorious irony of a Christian Church built on top of a pagan site, as they so often are in Italy and Greece.
 
I squatted and I moved as much as I could. I used the many different labouring positions I had practised for the last five months of my pregnancy. I kept the birth within my power as much as I could, riding the wild waves of nature that birth actually is. I was lucky, and it all went my way, resulting in a happy, healthy, intervention-free birth.
 
The wonder and awe of managing to have a natural birth was a wave of joy I would ride until at least the first 72 hours after birth.
 
A daughter was born. A mother was born. A birth advocate was born. In that order.
 
As I contemplate that day with 20 years of experience as a maternity advocate, what change has there been in my home state of Western Australia?
  • There is a water birth policy. But still, in WA, most hospitals will not routinely offer water birth
  • Midwifery-led care is still the exception, not the rule. It is growing, but with a glacial place.
  • We still don’t have benchmarks across our nation to say what our targets for midwifery-led clinics should be. And we are meeting that by making no coherent progress.
  • Women are still having the conversation with their GP that goes a bit like “You’re pregnant, congratulations! Do you have private health insurance? Which obstetrician would you like?”
  • Women are STILL not aware that they can opt for midwifery-led care if they are low risk, and this GP conversation has shifted little in two decades.
  • Women who are medium to high risk STILL largely don’t have the option of care with a known midwife.
  • Women are STILL emerging traumatised from a first birth, vowing to do it differently next time. They still don’t know what they don’t know.
  • Women are STILL spending more time picking the right pram than thinking about how the birth experience can support them to make the massive transition from woman to mother.
  • We still have only one free-standing birth centre in Perth, but on the grounds of a tertiary hospital. We have another one being constructed as we speak, but this time right inside the ward of a tertiary hospital.
  • We have a smattering of midwifery group practices across our state.
I can say for me that the memory of my daughter’s birth is still with me, twenty years later. It won’t be with the midwife who was with me throughout the labour, or the Obstetrician who popped his head around the door a few times.
I suspect this is true for all women. The impact on us is life-long, and yet we still struggle to see our preferences enacted in the maternity services in our state. It still seems that it is always the health system who gets to have the final say.

imperfectionI have been asking myself this question quite a few times this week.  It is a question to calm my spirit as I try and feel am consistently failing at making a positive difference in the world through the endless committees that I sit on.

This morning for example I am attending a forum about advocacy in the victim services sector, a subject close to my heart.  Only I have found out a key agency won’t be attending.  I know I should not be surprised, but I am, and deflated too.

It seems to be such a fine line between being useful, and being tokenistic.

I know what I would like to happen, and that is change, positive change.  I sit on these committees, hoping to be influential, to somehow access levers of influence that would allow these positive changes to occur.  Victims of sexual assault to have access to end to end advocacy to assist them through the many different stages of the process from offence to final legal judgement or final extinction of all hope that there will be legal redress.

I am not really sure you can do that without power or money.  I want to be someone who has easy access to the $1m plus it would take to get started with an advocacy service, and some clever way of making it self-sustaining and ongoing.

But I don’t seem to be in that kind of paradigm.

I don’t think grassroots works, today.  It feels like it is all about power, money and which school you went to.

Am I wrong? And is everything ok even if it is imperfect?

habits of the heartIn mid-October, I was lucky enough to attend a retreat which meant I had a whole weekend to myself, no chores,  and a chance to connect with a like-minded group of people.  Most of them I hadn’t met prior to the Retreat, but true Perth-style, managed to work out I was connected to most of them in some way or other.

The theme of the Retreat was “Habits of the Heart” and reflects the work of Parker J Palmer, who I hadn’t really heard of before the Retreat;

“Habits of the heart” are deeply ingrained ways of seeing, being and responding to life that involve our minds, our emotions, our self-images, our concepts of meaning and purpose in life. I believe that these five taken together are critical to sustaining a democracy”

Most of us who attended the Retreat are involved in social change in one way or another; through managing not for profits, being in politics, helping managers and organisations work in a functional and healthy way, through living our own lives with some consciousness of what we think and how we want to behave.

There are five habits of the human heart:

1. Understanding we are all in this together

2. An appreciation of the value of “otherness”

3.  An ability to hold tension in life-giving ways

4.  A sense of personal voice

5. A capacity to create community

I am not 100% certain that I was holding the tension of last night’s discussion with darling husband in life-giving ways. In fact it felt a little more like the red mist may soon have been coming down if I didn’t remove myself from the vicinity to think things through.

It is just possible that my restless, reforming spirit looks at the world with a reformist’s eye, itching to roll up my sleeves and get involved actively in making change.  And accordingly, as I create what I see, I see opportunities for improvements everywhere 🙂  It is in fact possible that everything is unfolding just as it should.

But does that mean we stand by and let people go under that might have been saved with a helping hand?  Does that mean that we just maintain an “I’m all right Jack, pull the ladder up” attitude?  I think no!  and I don’t think waiting for the government to do things is a sensible idea.  I believe we are all creating our own lives and by extension the lives of our communities.

So, I guess that means I am going to carry on being quite busy.  And occasionally a little bit snappy in marital conversations relating to social justice.

imageYou know the time has come to go off-line when your fingers are itching to send the response “spoil sport” to the Health bureaucrat’s email politely requesting that you don’t include LGBTI in the client survey form.  Especially when that impulse is accompanied by uncontrollable public giggling.

It is Melbourne time, and past time to switch off from checking and responding to Perth emails in a responsible way.

Fighting the good fight as a health consumer advocate, in my case specifically as a maternity health consumer advocate is always going to be a delicate balancing act.  Keeping the conversation going – while remaining civil – and yet not rolling over – is a constant tightrope walk.  I am always acutely aware that I could not think of anything worse than being on call 24/7 to provide support for labouring women and any of my many gripes about the system have to take this reality into account.

And, grumpy old woman style, my gripes are many.  I feel frustration that despite WA Health having a statewide home birth policy AND an Operational Directive for all public maternity hospitals in Perth to provide back up services for the Community Midwifery Program more than half of them don’t – *and there are no consequences for these hospitals*. I feel frustration that our National Maternity Services Plan highlights the importance of continuity of midwifery care for women, as supported by all the evidence, and yet there is no funding to make this happen, and an incredible force of inertia against making this happen in our public maternity hospitals.

Some of the stories I have heard in the last few days of the hostility women and midwives face from hospitals when trying to make these models a reality make me beyond grumpy – more sad and a wee bit despondent.

I am trying to re-frame this hostility to the last stage – just before we win. And all women can access a midwife. And everyone in Australia can pronounce “midwifery” correctly – even customer support staff from telcos…

justiceI have been doing a lot of thinking this week about accountability and what happens to Inquiries when their voluminous reports are released.  Specificically I have been thinking about the Recommendations from the West Australian Inquiry into the Prosecution of Assaults and Sexual Offences undertaken several years ago now; the above link is to the 2008 report. PASO for short, for there must be an acronym.

Ostensibly fuelled by the preventable death of a young girl after her murderer had escaped prosecution on prior offences, the Inquiry aimed to look at what had gone wrong to allow the perpetrator back out onto the streets after a bungled handling of a prior offence.  After its inception it grew to encompass sexual assault as well, and that is when I became involved, giving evidence at the Inquiry.

The Inquiry undertook all the processes that typify Inquiries.  Thoughtfully conducted, with painstakingly recorded testimony from victims, secondary victims and service providers.

And at the end there was more than 250 pages of report,  and 37 recommendations.   This is it quietly entering into parliament – need I say that 2009 has long come and gone, with no Hansard mention of a Report?  I liked this 2009 soundbite:

To this end, I will be asking the Sexual Assault Services Advisory Group to investigate a number of the issues that these reports have raised, including addressing the reasons for withdrawal of complaints of sexual assault and ensuring that established processes put the onus on victims or complainants to access supportservices themselves. I restate this government’s determination to ensure that individuals who are victims of sexual assault receive a very clear message that their issues and experiences are important and deserve the highest level of care.

Alas, alas this laudable sentiment did not survive the change of West Australian government, and there has never been an obligation, other than a moral one, for any of the relevant service agencies to report back.  At risk of breaching confidentiality, I can say that I sit on the Sexual Assault Services Advisory Group as a victim representative, and have done since its inception in 2008.  I was motivated by wanting to know what happens with a public Inquiry, whether all the work, time, care and effort that goes into writing recommendations actually translates into action.  Five years on I certainly question when I think it might be time to step away…

Certainly there are recommendations that have been actioned or superseded, but others still awaiting time and attention.  For example,

Recommendation 19: The Office of the Director of Public Prosecutions,in collaboration with the Department of the Attorney General, investigate and report on the meritsof therapeutic justice.

I was googling for the PASO Inquiry’s link today to write this blog when I came across this UK article; the tragic story of a woman who felt so violated by her time on the witness stand being cross examined that three days later she took her life.  It just made writing this blog all the more urgent; as the article states:

Victims of burglary do not have to prove that they have been burgled or to justify their behaviour before the burglary. With rape and sexual assault allegations, victims still find themselves subjected to hostile questioning.

This is a really key part of the issue with sexual assault and abuse cases and why they are so difficult to prosecute, so hard for the victims to make it all the way through the process to hopefully a conviction.

I really would like to know more about Recommendation 19 – what therapeutic jurisprudence might look like, whether survivors of sexual assault are routinely offered a pre-recorded interview to give their evidence, if so what the uptake is, what the legal outcomes are in relation to trials using pre-recorded interviews vs trials where women are excoriated on the witness stand.

So back to the meeting next time I will go, to see if I can winkle out some more answers…

Many many moons after my early brush with The West, I once again was contacted, through channels that are hard to be clear about (probably old online references to Reclaiming Voices) to contribute to a GP magazine.

Hold on a minute, GPs.  I run a not for profit that supports women’s choices, including homebirth.  Not perhaps a sympathetic audience.  I can also be ambivalent about disclosure in the health sphere, as there can be a different kind of response from that in the community.  Sometimes, dare I say, a bit of opporbrium and judgement can creep in.

But what the hell, I did it anyway.  An opportunity to raise awareness of the issue.  Here it is, the GP Medical Forum Article.

http://www.medicalhub.com.au/wa-news/guest-opinion-editorial/3989-sexual-assault-the-silent-epidemic

newspaper

One of the defining experiences for me in wanting to write my book, was my early brush with the media.

I had always had it in my mind that I would speak up about my experiences, once all the legal processes had been completed and there were no possible repercussions on that front.   Hell my need to talk about it was all-consuming in the early weeks and months after the assault, to the point of wanting to blurt out my story to an unsuspecting woman working on the IGA checkout in the first week after the assault.

While this particular need to over-share was well under control by the time the legal all clear was imminent – nearly 2 years later – I knew I really wanted to have a chance to have my say in the media.

I decided on the way back from my one and only visit to the courts – mercifully I did not have to appear as a witness – to proceed with the story with a keen journalist.  She had contacted me coincidentally a few weeks before the legal processes in my case were coming to a close.  At the time she was chasing a comment about another sexual assault case, and the in the vacuum of  those willing to comment, she had approached me.  She still had my details from when I had contacted her trying to interest the West in doing a story about the few of us who were starting to get some momentum going as a voice for women survivors of assault and abuse.

As we had made fortuitous contact, I told her that the legal process in my own case was drawing to a close and I would be interested in having a public say if she wanted to do a story.  She did.  She seemed quite surprised and pleased that I was willing to have a picture of me to accompany the article as well, not pixellated out because what did i have to hide?  Why should I be ashamed?

Accordingly, I made my way from the court house and met with her to get the ball rolling.  I posed for a photo with a considerate and skilled photographer who instructed me how to pose to achieve the calm, credible complainant look of the published shot.

Afterwards the journalist and I talked for about an hour, more than could possibly be used in a 500 word article, and I felt a creeping anxiety about what would come out the other end. It is always difficult in these situations to continue to feel focussed on what you are doing and why.  Was it all just about an overblown need to have my wounds  witnessed, endlessly? Was there a legitimate need for me to speak out? Was The West an appropriate vehicle? (cough!)

I was hoping to have some idea what the article would be like before printing, but as the hours dragged before the deadline on the journalist asked if it could go in without editing from me.  Being a kind soul, I heard her fatigue and trusted the quality of our face to face meeting that she would do me no harm.

Can you imagine with what trepidation I rushed out early to buy a paper the morning of the story, and hurried home to read it? My first reaction was to squirm a bit at phrases that I felt made me sound stupid or didn’t reflect the complexities and subtleties of the conversations we had had or the views that I hold. The gist of the article was about the traumatising process of giving evidence as a survivor of sexual assault.  While I felt that this was important and was happy to lend my face to this so the journalist could write whatever she wanted regardless of my own circumstances, it was not what I really wanted to talk about.  Sure, I was more than happy to heighten public awareness on this shameful area of law, where it seems the witness rather than the accused is on trial.

But I also wanted to talk about  the need to address the “casual sexism” that pervades Australia and is very much alive and well when it comes to prosecuting sexual assault cases – the attrition rate of cases from reporting to conviction is appalling.  I also wanted to talk about the need for better, more responsive services for women, providing longer term counselling for those grappling with issues from years before.  I wanted the message of women’s resilience and recovery with the right supports, and where those supports could be found, to be broadcast.

I also wanted to talk about the ills of society that breed such sad, lost souls, and the prison and justice systems that don’t seem to address the addiction, mental illness and pain that abound among prisoners.

In 500 words?  Somewhat ambitious.

Much more recently I had the experience of meeting a friend of a friend who was interested in my story.  We met and I spoke at length, but she never ran the piece she had planned.  She felt the message of women’s rights was diluted by the added complication of trying to document my feelings of sadness and frustration with our justice system.

But that is what I want to talk about.  All of it.

And so, I have the whole space and time of a book to write about all the complexities that have presented to me, for me to sift through as the years pass, looking for answers when there are none and many.

The things you find in your Other Messages – stupid old Facebook! This was messaged to me by the project officer Jon Rose who was freelancing for George Jones to develop their Advocacy Training project to support advocates for child and adult survivors. They have run the training program a few times around Australia – here’s hoping the momentum for advocacy for survivors of abuse and assault keeps on building…