Ten questions with Joan Skinner


Q1: What drew you to midwifery as a profession?

It probably started before I was born. My Dad was a GP obstetrician and he seemed to be always away at a ‘delivery’. Before having me, Mum had three live babies and then four babies who died of Rh disease [a condition where antibodies in a pregnant woman's blood destroy her baby's blood cells]. You almost never see this now in rich countries as it can be remedied by a blood transfusion. I came along and was the first baby in Wellington to survive such an exchange transfusion. Then, during my nursing training, I saw my first birth. I simply couldn’t believe my eyes - a woman actually pushing another human being out of her body. I still find it incredible. From that moment, there was really no other option for me.


Q2: Midwifery has been through many changes in Aotearoa New Zealand, and your career covers some of those key moments. What was the biggest challenge for the profession during your time?

Well, we were already nearly extinct as a profession by the time I started. By the 1970s all midwives had to have a doctor in charge, and we had to be a nurse as well. Then by the 1980s nurses wanted to get rid of us totally. That really made us get our act together. Women were horrified, too. We joined forces and together we fought the battle of our lives. We did it. The law changes we fought for changed the whole way maternity care could be provided. A remarkable story not to be forgotten.


Q3: What is the state of midwifery in Aotearoa today?

We are struggling. Years of very poor pay over the last few decades and an outdated funding model have made it hard for us to survive, and made it impossible to adapt our care to meet the needs of māmā and whānau who need us the most. We struggle to get and to keep students. And that was even before Covid. It’s been sad to see a country squander a midwifery process that really was seen as leading the world in maternity care. In the area I live in, the Hutt Valley, we have half the midwives that we need. If you have half the midwives, you need you get half the care.


Q4: Your descriptions of childbirth in the 1970s and 1980s could cause women today to shudder – we seem to have come a long way since then, but where should it be heading now?

There are two things that midwifery needs to be doing now. The first is to meet the needs of whānau who are missing out on good midwifery care. We have failed to do this adequately so far. The next is to move the care of healthy mothers and babies out of high-tech hospitals. All the research supports this. We need community birth units that will serve diverse communities. And we need them now.


Q5: Your book talks about the social context of midwifery. What made you interested in that?

After I had been a midwife for a while, I became very curious about some of the issues we were facing. Risk and anxiety seemed to be looming large in my practice and I wondered if all midwives were feeling this. It seemed weird given that childbirth has never been safer. Was it misogyny, medicalisation, technology, social dislocation? I took a deep dive into examining risk in my PhD, trying to make some sense of it all. Turns out it’s not just about birth. The whole of humanity is caught up in these issues. Making sense of birth and how to support humanity into the future seems pretty key to the way midwives should work. We have a role to play in resetting humanity’s values and in supporting new beings onto this precious planet. 


Q6: There are some confronting episodes as part of your role in working overseas for WHO and the UN. Do you feel that international agencies can make a difference?

I was lucky enough to work in quite a few Asian countries supporting midwifery initiatives. By the time the Millennium Development Goals were set up by the UN it was clear to all the international development agencies that any programme trying to reduce maternal death needed to have skilled midwives at its core. And they put serious resources into it. It has been truly stunning, and still is.

I am a great believer in the power (albeit imperfect) of global organisation in the face of what looks like impossible problems. But it did have its hard bits. I would go to a county like Cambodia where the intervention rate was too low and then return to New Zealand where the intervention rate was too high. It would do my head in. Then I worried about my role in recolonising the birth cultures of very vulnerable countries. Yet again more outsiders coming in to tell others what they should be doing.


Q7: … and North Korea, that was a surreal experience!

Oh, that was craziness on so many levels. Especially as Trump was ‘locked and loaded’. I was asked to help the Government develop a midwifery profession. I got toured around the country to see hospitals and nursing schools, but I don’t think anything I saw was real. It was like watching a series of badly acted plays. Then I led three days of strategic planning for the Ministry of Health in Pyongyang. It was extraordinary. The whole experience was both hilarious and deeply disturbing.


Q8: What is your proudest professional achievement?

The things I am most proud of are where I have moved way outside my comfort zone. I moved from thinking home birth was a reckless dangerous process to then doing them. That was a huge shift. My best job ever was helping get midwifery going in a Primary Health Service in the Hutt Valley. The work focused on care for whānau who found accessing health care challenging. I thought that was midwifery practice at its best. I just loved it. At the other extreme of achievement was being asked to chair a global consultation for the WHO in Geneva on developing standards for midwifery educators. It was a huge honour and frankly a terrifying experience. Worse than going to North Korea.


Q9: You are very open about your personal challenges and health issues, as well as your professional life in this book. What is your process for tackling these difficult subjects?

I must admit I hadn’t planned to talk so much about my personal life. My initial idea was to tell the history of midwifery using my own work stories. I wanted to bring the world of the midwife to life for the reader. But it became clear that what had happened in my personal life was crucial in how I experienced my work. I wrote the first draft of the book as part of the masters in creative writing at the International Institute of Modern Letters at Te Herenga Waka Victoria University of Wellington. I was repeatedly challenged to write more into how things felt for me, not just into what had happened. It was such a supportive environment that writing deeper into more personal stuff felt okay. I was surprised at how sense-making it was for me. In doing this I also became aware of the nature of work, of mahi, and how artificial it is to try and keep work and personal life separate.


Q10: Is there more writing on the way?

There is definitely more writing. Now that this book is done, I am free to play. This was my first foray into creative writing and I loved it. It’s so liberating after years of writing as an academic or as a clinician. I’ve become fascinated with how women write about their work. Over the last couple of years there seems to have been a flurry of activity in this genre and I am so enjoying reading it. I would like to write about this some more. I also learned to love poetry while I was at the IIML and have had my first poem published. Not something I would ever have dreamed could be possible. I’ve also started to look at what I might do with letters my mother and I wrote to each other while I was in Tonga in 1972. My notebook is packed full of ideas and snippets (and shopping lists) to work with. I just have to remember to sit at the keyboard occasionally.