One of our instructors told us pretty early on to evaluate the difficult decisions that we’ll have to make as midwives, and see how it makes us feel. While I’m working within the Australian hospital system, there are going to be parents that want to make decisions about their baby that I disagree with, or that I don’t believe in. If I were in their position, I would feel very strongly about these choices, and I wouldn’t want a midwife to think it was their place to offer opinions. Many of them are made on the basis of religious beliefs, or socioeconomic status, and I must be impartial and do my best to help them birth a healthy child. My opinions must be separated from my clinical advise. It will be difficult.

Abortion: I am, and always have been, pro-choice. I was lucky enough to grow up in a pro-choice country, that respects a woman’s right to choose. There are myriad reasons why a woman would want or need an abortion, and I have no issue with supporting a woman through this process. Throughout our program, we will not be learning how to perform abortions under any circumstances, and so it is a procedure that I will have to learn elsewhere in order to support women the way that they may need me.

Vaccinations: This is one that may just cause me to internally roll my eyes. If there are any parents I have to deal with that choose not to vaccinate their children, I will do my best to change their mind using the available evidence. I understand the strong desire to protect the pure state that their child leaves the womb in, but I also have a greater desire to protect society as a whole. Vaccinations have been developed to better support all of society, and I think it’s a fundamentally selfish choice to not vaccinate. However, I will do my best to be even-tempered, and demonstrate the impartial evidence towards vaccinations safety, efficacy, and necessity.

Placenta: This is such a strange one. Plenty of mothers want to consume or preserve their placenta. I don’t particularly care either way; so long as it doesn’t do any harm to mother or baby, they are welcome to consume whatever they like. I do think that it’s a bit strange though. If it makes them feel more comfortable with their birth, I’m not going to stop them.

Partners: I know that I will have trouble with some partners. We will work with victims of domestic abuse, and have no choice but to release mother and child back to the abuser’s care. We will also have partners who are overly controlling, dismissive, overpowering, or making decisions for the mother based on religious practices that I disagree with. These will be difficult for me, and my patience will be tested on a case by case basis. On the topic of partners, my instructor also brought up same-sex relationships. I dismissed it, thinking “why would I ever have an issue with a same-sex partnership having a child?” Then, she gave us a circumstance: we’ve just helped a woman give birth through hours of labour and delivery. After giving birth, rather than having skin-to-skin time with her baby, practicing breastfeeding, and bonding… she says goodbye, and hands the baby to the same-sex couple. This is a situation that I would be uncomfortable with, and that would take me a lot of effort to overcome. I support surrogacy in all forms, but to watch a mother hand over their child is different.

Genital Mutilation: This is the hardest one for me. I am anti-GM but pro-religious freedom. It’s difficult to respect cultural boundaries when I am so against this very cultural practice. I highly recommend anything written by Nawal el Saadawi, an Egyptian doctor who discusses the patriarchal roots of FGM. I am also very anti-circumcision, and will have great difficulty supporting parents who want to undergo this equally baseless religious practice. I think all children deserve to be protected against religious mutilation.

This is an opportunity for me to learn from parents and more experienced midwives. Many of these choices are not things that I will understand until I have been in the situation. In what ways do you disagree with me? What major ethical decisions have I missed?