Welcome to Social WorkStories, a podcast exploring social work practice through stories and criticalreflection.
This podcast is recorded on Aboriginalcountry, which was neverseated.
We acknowledge the traditional custodians and cultural knowledge holders of these lands and pay our respects to Aboriginal elderspast, present andemerging.
We offer a warm welcome to any Indigenous listeners who are part of our podcast community around theworld.
If you have thoughts or feedback for our team or just want to find our whole back catalog ofepisodes, check out ourwebsite,socialworkstories.com.
But fornow, on with theepisode.
And welcome to the Social Work Storiespodcast.
My name is Liz Murphy and I am so happy to say myco-host,Dr.
BenFox, isback.Hello,Ben.
Hi,Liz.Hi,everyone. It's good to beback.
So, dotell, how was it over there in the Pacific with yourmicrophone?
I felt like that was with the microphone the wholetime.
I just to feel everyone in just came back from a fantastic trip with nine social work and journalismstudents.
We went all the way to Fiji in Vanuatu on a new Colomboplan, funded Department of Foreign Affairs and tradestrip.
And the whole point of the trip was to do some podcasting and find out what were the critical issues in the Pacific at the moment and have some really interesting conversations around gender-based violence and climate change and a whole range of differenttopics.
And these incredible students worked so beautifullytogether.
We went and met with a whole range of non-government organisations and government departments and worked with the Fiji Broadcasting Corporation and the Vanuatu Television BroadcastingCorporation.
And they just learnt somuch.
And now they're making this little mini series of a podcast forepisodes.
And it's called The Tuller Noah Stories from the South PacificPodcast.
And they are doing this amazingthing.
And we're going to feature some of their recordings on some of our shows in thefuture.
Fantastic. That is sogood, sogood.
And like yousay, we'll be able to link these episodeshere.
Absolutely. Watch thisspace,everyone, because these are fantastic new emergingpractitioners, but alsobroadcasters.
And this is where podcasting isgoing.
It'sco-production. We're working with each other in making telling incredible stories and really hearing from people what actually lived experience around these social issues islike.
Sono, it's been reallyexciting, reallygood.
So speaking about lived experiences and recording and social work in that thisarea, we have a recordingthat,look, it's rather interesting thisone.
Imean, when aren'tthey?
For astart. But thisone, I just wanted to say topeople, the topic of this episode is around latent pregnancyterminations, domesticviolence.
Soyes, and bigissues. But I wanted to say from theoutset, the real focus of thisstory,MIM, is around the complexities that this particular woman has to walk through just to secure atermination.
And byassociation, the complexities of the work of this social worker to support this woman in being able to seek atermination.
Solook, I would say topeople, there's lots of details that you will hear inthis, but it's more about the details of the hurdles that this woman has to jump through more thananything.
So I have been listening with my systems theorylens.
I've also been listening as a feminist and I've felt my blood pressureincrease.
I've gone through the roof several times and we'll come back to that in thereflection.
And there's also some disenfranchised grief too that we'll be kind of reflecting ontoo.
Yeah,look, this is a really interesting story and it reminds me of that oldcliché,G, that devil's in thedetail.
And this is a classic example of something that happens likelegislation, abortion in this particular state is decriminalised and then services are justtold, just roll itout.
And so I know we'll have American listenersgoing, you werestraight.
You've got nothing to complainabout.
Look what's happening over here inAmerica.
And whilst I'm absolutely not saying that it's anything like what it must be for Americanwomen, but I also just want you to hear how difficult it can be for many Australian women to seek an abortion in a publichospital.
Yeah, and I think aswell, youknow, this is an area that we make a lot of assumptionsabout, about what actually happens on theground.
And so it's been eye-opening forme,Liz, to listen to this story aswell.
So let's just let everyone have a chance to listen to it and then let's come back and really think through what it means for women in this sort ofsituation.
I'm a senior social worker that's working in a public hospital in regionalAustralia.
I work primarily inmaternity, pediatric and the critical carespace.
I'm going to be discussing a case that I was involved in where I supported a woman having a late termabortion.
Inparticular, I'd like to discuss how the state government has managed this since the change in legislation in 2019 and the impacts that this has had on hospital social work inparticular.
So prior to2019, abortion in this state was considered by law to be a criminaloffence.
Women could only access an abortion by jumping through hoops and often telling doctors what they thought they wanted tohear.
If you were fortunate enough to find a doctor who waspro-choice, they would only approve an abortion for financial and mental healthconcerns.
Women had to make excuses for a decision to be made about their ownbodies.
Fortunately, in2019, the abortion law reform act was passed and abortion was no longer considered a criminaloffence.
And as aresult, the Department of Health released a framework for termination ofpregnancy, which outlined that public hospitals should provide abortions for women requestingthem.
And as a sidenote, most women in my experience looking to end their pregnancies will use the wordabortion.
And that's totallyokay.
I'll be using the language of termination of pregnancy as this is the language that is used by the Department of Health and what is written in our policies andprocedures.
Also I'm not adoctor, however I do talk about some medical things in discussing this case and this is just based on my experience working alongside the medicalteam.
I would never give medical information to women in this process and would always direct those questions to the midwife or thedoctor.
So once the framework wasdeveloped, the Department of Health distributed this to all local health districts in thisstate.
And they said just develop your own procedures based on the resources available to you and yourarea.
And this I believe was the first mistake because it does not give women equal access toservices.
So in order to explain the processes that happened at myhospital, I'd like to introduce you to my patientAmy.
So I received a referral from a fellow social work colleague who was working in theEED.
Amy had presented following an assault from her partner with which she wasstrangled.
The EED social worker was supporting her and safe depending with her when Amy mentioned that she was approximately 17 weeks pregnant with her firstbaby.
And she would like information on abortions as she couldn't afford to have this done in a privateclinic.
My colleague did not know much about this area so she called me foradvice.
And as I started to explain the process to mycolleague, I decided it was probably just a better idea for me to go and see hermyself.
I think you've heard the correctinformation.
So with herconsent, I met with her to discussthis.
Amy explained to me that she was in a very violent relationship with a man who was also using illicit substances and she did not want to be connected to him with a baby for the rest of herlife.
She said to me that she felt very supported with the DV by the EED social worker and only wanted to get information about the abortion fromme.
So I explained to Amy that our process is including her needing to go to her GP and get a referral to our Garnie clinic for the purposes of termination ofpregnancy.
She asked me at the time why she couldn't be referred to the EED doctors and all I could say was because it wasn't the process that's beendeveloped.
I also explained to her that she'd need confirmation of pregnancy and gestation and full anti-natalbloods.
Thankfully at that time I was able to advocate for the EED doctors to complete this while she was there as it was one less step she had todo.
So during our conversation her partner was repeated the calling and she explained that she did not want him to know that she was considering a termination ofpregnancy.
So I discreetly provided her with my details and said she could call me further clarification at a time when she felt safe and I assured her that if she came in she would see me as her social worker so she didn't have to continue to explainherself.
What do I feeling a bithelpless?
Expecting that I probably wouldn't see heragain.
However just in case I handed over the information to our clinical midwifery consultant who coordinates the terminations just in case she did get a referral from Amy'sGP.
So when I talk about the procedures put in place the document is 25 pages long with a long list of people who wereconsulted, none of which were socialworkers.
Interestingly social work is mentioned in the documents six times with the expectation that we would be able to providesupport, information and advice for women and for the medicalteam.
We were given no extra resources and no training to provide this service for women and theirreports.
I in fact paid for myself to do the non-directed pregnancy counseling training and I know some of my team members watched TED talks and read journalarticles.
We all want to do a good job in such an important area of work and we knew the referrals would just keep comingregardless.
So back to Amy'sstory. She received a referral from her GP which was sent to our Garnie clinic and the referral was taken over by our midwifeconsultant.
So there's different procedures based on what gestation youare.
So if you're under nine weeks this can be managed by GP with medication which costs about $30 or $7 if you're on a concessioncard.
So from nine to 13 weeks this can be managed out our hospital surgically with a procedure called a DNC or a dilation andcuratage.
You might have heard some people refer to this as acure.
So this procedure is an operation to scrape away any tissues of products from the uterus and if this is done in a private clinic which there is only one in my local area it costsabout $300.
From 14 weeks women must get a referral from theGP,ultrasound, blood and non-directed pregnancy counseling with an outside service and that's all before they even get to thehospital.
If everything is approved then women must have a delivery now birthing unit where she will stay until she's medically cleared fordischarge.
I should also state that the procedure gives health workers the opportunity to conscientiously object to being involved however they are required to referon.
Unfortunately in my local health district there's many people who object in this base and so that leaves very little options when it comes to doctors and midwives which contributes to delay in women getting caresometimes.
Women can have this procedure done surgically without a delivery up to 19 weeks in a private clinic however the further along in their pregnancy they get the more expensive it is and can be thousands of dollars and this I believe is due to the complexities of the medical procedure and this is referred to as a D&E or dilation andevacuation.
This is a second trimester procedure that uses a vacuum and sometimes four-sips and otherinstruments.
The doctors do not do this at the hospital that I work instead women need to go to our women's hospital in the city which is another barrier extending the time and adding another financialburden.
So for Amy the non-directed pregnancy counseling was organised through a family planning service and Amy did this over the phone and a report was sent to the hospital forreview.
By this time Amy was 19 weekspregnant.
The next stage of that process was to convene a termination of pregnancy committee which included socialwork, CMC or clinical midweek for aconsultant, the birthing unit nurse unitmanager, maternity operationsmanager, the consultant obstetrician and the director of medical services who provides legaladvice.
The social work role in this meeting is to explain thebackstory, disclose any concerns and give any advice on how best to support thewomen.
It's quite an intimidating meeting for a social worker as the other people in the matter have a lot of medical and legal experience and in high managementpositions.
I distinctly remember trying to advocate to not focus on the reasons why Amy was wanting a top and whether we should approve it but how we could get her to hospital in a timely and safemanner.
Eventually everyone agreed and Amy was often in appointment with socialwork, clinical midweek for a consultant and theobstetrician.
It took a couple more weeks for Amy to get to the hospital as she was trying to work this around her work commitments and also her caring responsibilities that she had for herdad.
But the biggest barrier for her was getting out of the house without her partner findingout.
She didn't turn up to a few appointments but was in constant contact letting us know why when Amy did eventually come to herappointment.
Myself, the clinical midweek consultant and the obstetrician met with her to discuss the nextsteps.
Due to the delay in getting tohospital, Amy was now 22 weeks so the process changedagain.
In 22weeks, two doctors are required to sign off on the termination ofpregnancy.
In Amy'scase, this wasn't aproblem, however from this gestation onwards due to the risk of the baby being bornalive, they must have a procedure called a fetusside.
This means they inject the baby through the uterus with potassium so that they gently passaway.
As mentionedearlier, this procedure is done at another hospital so Amy had to travel two hours for the procedure and then returned to this hospital to deliver on the sameday.
So the social work role in this initial meeting is to support the women while she gets the medical information and that could purely just bepractical, like gettingwater, tissues or even distracting the toddler who might bepresent.
I will then sit with the woman and her support person after the doctor and midwife have gone to ensure that they understood and make sure their wishes are heard and that they didn't feeljudged.
A really important part of the social work role is to talk to Amy about the different arrangements that will need to be made post-birth based on what gestation theyare.
If a woman was under 20weeks, there's no legal obligation to have a funeral or register abirth.
If there are over 20weeks, the law states this is a stillborn baby and the baby's birth will beregistered.
They will need to be named and if funeral is required through a registered funeralhome.
These can be really hard conversations to have because most women don't know any of this information and they are hearing it for the firsttime.
It can take some processing and not every person comes out of that appointment with a clear plan for what theywant.
Social work will often have to advocate to slow down a process that is quite timesensitive.
It's a strange balance to manage and I'm not even quite sure I found that balance in my practiceyet.
So Amy had made up her mind on that day that she wanted to continue with determination ofpregnancy.
She fortunately had the resources to go to the hospital two hours away and they had the procedure within theweek.
She was just over 23 weeks and when she returned to deliver herbaby, I met with Amy in the birthing unit and she had a friend as a supportperson.
Amy had not yet delivered and I wanted to clarify some of herwishes.
We should not assume that because someone is having a termination of pregnancy that they don't want to make memories or that they are not grieving thisbaby.
Regardless of what their concerns are for having a termination ofpregnancy, they still offered the same things we would if the baby was still born unexpectedly or verywanted.
Amy was offered hand and footprints an opportunity to hold and spend time with herbaby.
Photos and we provided her with lots of information on different supports in the area and what next steps are for organising a funeral and registering the baby'sbirth.
Amy chose to see her baby and got some hand andfootprints.
She did not spend much time at the hospital and consented to social work contacting her via phone at a pre-arranged time when her partner would not bepresent.
A week later I contacted Amy and she was in the process of organising a funeral and she chose to keep the ashes of herbaby.
Her partner was aware and she stated he was supporting her to makearrangements.
We arranged a six week check-up for Amy where she could get a medical check and social work could also follow up however she declined this and went to her GP instead which is well within herrights.
When I reflect on Amy and the processes and procedures we've put in place at the hospital to support women with a termination of pregnancy I feel reallyfrustrated.
Not only are we making women jump through a lot of hoops to get a medical procedure on their own body we're forcing a service on social workers with no resources andtraining.
Our maternity and pediatric social workers do such a great job with the women just like Amy but we're also supporting women having stillbirths and miscarriages of very wantedbabies.
There's also women having terminations because their baby has significant medical issues and while these things are the same they're also very different and it's difficult to change your headspace when you're doing all of thethings.
My dream for this area of work is that there's equal access to publicly funded termination of pregnancies and more importantly that there are just as many social workers as there are doctors working in thisspace.
My dream is that women can have a termination without having to explainthemselves.
I think it's a privilege as a social worker to support women through a process that can be quitedistressing.
It's a space of immense advocacy and empathy and no one cases thesame.
The knowledge I've gained in the last three to four years in this space has inspired me to do something I'd never thought I'd do and that's continuing mystudies.
I'm now enrolled as a matured student in a master's degree in women's and children's health and I'm doing this with the view to get into some sort of policy work so that we have more social workers involved in making these really important decisions in regards to healthcare for women because abortions health care issue and that's all it shouldbe.
You know I always like to refer to immediate first reaction on listening to itagain,Mim.
How was it foryou? Do you knowLiz, when I was listening toit, I listened to thisstory.
I was all poised to takenotes,right?
I was all ready to and I actually didn't write any notes not because I'm generally not a note taker but because actually I was so engaged in listening to the steps that were happening and what the meaning meant and having a visceral reaction tothat.
I think I was getting more stressed as the story went on to the point where I couldn't even write anything down because I was just quite amazed at what I was listeningto.
What aboutyou, I know that you had quite an impassionedresponse.
Idid, I absolutelydid.
I understand what youmean.
I of course I am the note taker in ourpartnership, Mim and as usual I've written pages because for me it was really interesting to one be really clear about what constitutes a termination of pregnancy and I love the languagestuff.
I'm not using the termination of pregnancy women use the termabortion.
And sometimes you're here topT.O.P.
at Health we love a goodacronym.
But depending on the gestational period that that pregnancy is at will depend on thetermination.
And so there be lots of people thatthink, oh yeah it's just I go and see myGP, I go to Women's Health Center and I take atablet.
But what I found really interesting was all the different nuances and procedural changes that occur over the course of the pregnancy depending on when you know that you're pregnant depending on when you ask forhelp.
But gosh a couple of weeks makes a hell of adifference.
And you know the other like when you think about Amy'sstory.
So Amystarted, she came into emergency department at 17weeks.
She had her termination of pregnancy at 23weeks.
So six weeks went by and my goodness what a difference it meant between 17 weeks and 23weeks.
So I get at Mim allthose, yeah all the different nuances and of course how much that then impacts on the role of socialwork.
But that wasn't so much my initialreaction, my initial reaction was unbelievable yetagain.
Yet again the health department willrelease, youknow, make a statement that now you'll be able to have a termination in publichospitals.
We're not going to resourceit, we're just going to let the local hospitals work it outthemselves.
We're going to provide staff that are actually trained and educated and happy to work in the area ofterminations.
We're just going to you know roll it out and you know if you don't have staff that want to work in thatarea, yeah well you know sort that one out and the remaining staff who are prepared to work in thatarea, not going to have towhat, what did I hear hersay?
Even the moment they're themselves offered training or watched TEDtalks, unbelievablememe.
I couldn't believe that social workers were needing to take themselves off to watch TED talks just to get any education in thisspace.
So that isshocking. It is shocking because let's say for instance a different professionnow, let's gocarpentry, whynot?
What if I was to say look we want you to use a completely different tool in building this particularstructure, we're not going to give it toyou.
In fact work it out is self but we still want that built and we're going to be promotingit.
It'soutrageous, I don't know if socialworkers, why we put up withthis, that's my milk cratemoment.
That'sokay, stand tall on that milk cratelist, I think it's a fairone.
It's actually amazing to me how little the policy works with the practice and you could and this is one of those stories where you could just really see how policy was written in such a disconnected way to thereality.
I mean nineweeks, the difference between nineweeks, 17 weeks and what did you say 22weeks?
Thedifference, those are just numbers on a page but when you actually think about what that meant for this woman in this story and what it means for all the women in the storiesright, where actually now six weeks has passed and that has changed completely what now can bedone.
It actually means the policy and the practice are100%disconnected.
And how important isinformation, youknow, like we oftensay,oh, information'spower, by crikey itis, isn'tit?
So we need our social workers and health workers to be able to give accurate information to these women so that they can make adecision.
So if you come to me at this stage in yourpregnancy, I'm going to give you this bit ofinformation.
If you come a few weekslater, it's changed now and so are the hurdles that you have to gothrough.
So, I would love to listen to Amy's story again just to kind of count how many hurdles Amy would have had to have let over to have got the finaltermination.
And this is a woman who's already living in a violentrelationship.
So withchildren, so it's not like she hasn't got her own huge amount of stress is going on outside of an unwantedpregnancy.
Andthen, youknow, even the little thingslike, you've got to go back to your GP to get areferral.
Even though you're right now in a hospital emergencydepartment.
That'sright.Just,yeah, but Imean, it started off like that and it just continued on for this poorwoman, didn'tit?
Well, can we take a minute to talk about the eight-person panel that got to make a decision about whether this was going to be allowed ornot?
And the fact that a conscience vote is built into the entire process so that at any point intime, any of those health professionals could have stepped out of theprocess, therefore meaning that potentially she couldn't have the abortionregardless.
Well, that'sright, because I know about hospitalin,well, actually I know of several hospitals who don't have this staff in order to performabortions,right?
So that would mean that those women have to find another public hospital that will doit.
And if you're out ofarea, you will sometimes be turned away becauseone, the hospital may not be able to keep up with the demand that they have of their localpeople.
Andlook, there are also areas in this state that the hospital is run by a Catholicorganisation.
They don't even offertermination.
So what do those women do in thatsituation?
Where do they goto? And yet they're still receiving public funding fromgovernments.
I, youknow, that just blows mymind.
But if you take a theoretical lens to this for asecond, that is literally what intersectionality tellsus, that if you are living in a less metro or more rural environment or regionalenvironment, if you have a low socioeconomicincome, if you havea...
languagebarriers, culturalbarriers,etc., you will end up with poorer healthoutcomes,right?
That's literally what the theory is sitting theresaying.
And what the SDG goals and everything else is actually crying out for issaying, thisis...
And what the social worker at the end of the storysaid, this is a healthcareissue.
This is actually not just about whether or not abortion shouldoccur.
This is actually about the women's lives at the very centre of thisquestion.
And here comes my feminist perspectivenow.
I think that's part of theproblem, I think the fact that this is a women's health issue is why we are experiencing these particular health issues around the issue oftermination.
Because we know that health is a very patriarchal systemand, youknow, there is a very strong linkbecause...
Well, that's what I see in thework.
And I think that's what the social worker was clearlysaying.
I actually want to continue my studies now and promote women's health because there are some huge gaps in the services we're making our women jump through multiplehurdles.
And I want it tostop. And this is why I feel like if I can encourage more social workers to get into policy development because this particular socialworker, imagine what she would do in terms of developing a policy for terminations inhealth, publichealth, knowing what she knowsnow, knowing about the lived experience of herpatients, knowing what she has to do and the importance of accurate information and the types ofsupport.
Imean, she was actually talking about the factthat, youknow, over 20weeks, she essentially had to be talking about registering thebirth, having afuneral, naming thisbaby.
All of that information isvital.
But I would imagine if you're someone who doesn't work in this area but you develop policy in some kindof, youknow, lovely office in the innercity, you're not going to know that type ofstuff.
No, but that's exactlyright.
And then coming back to it being a feminist issue is that we know that reproductive health is absolutelyfundamental, a patriarchaltool.
Soactually, when you look at it thatway, if you've got people making decisions in policy that have not had experience from actually women who have lived through these processes and lived through what it actuallymeans, the disconnection is absolutelyenormous.
Andtherefore, the potential for that policy to have real world implications is justmassive.
And I love that we can tell it through Amy's storybecause, youknow, I just think it just helps for someone like me to actually hear a lived experience story of how a policy plays out just really hits athome, and I really hope that's been the case for our listeners because just coming around the corner in the state I live in is voluntary assisteddying.
And I can guarantee we're going to be having some similar storiesthis, youknow, in a couple of monthstime.
Yeah, I just think the disconnect between the policy and the actual rolling itout, NDIS was another classicone.
That'sright. And it's so routine now that thathappens.
It'sunsurprising,unfortunately.
I think in the same way that this was Amy'sstory, which is so many women'sstory, this is actually a very classic social work story where you have a social worker in the middle of policy change really struggling with how do we enact policy and how to support women in the middle of thatprocess.
And I really want to congratulate the social worker for the work that she did on thiscase, but all the social workers who have been there on the front lines trying to navigate this policychange, trying to stay true to their feminist values and actually put women at the centre of the story because actually that's what's missing every singletime.
Oh,again, beautifullysaid.
And all I can say is you are myheroes.
These social workers are myheroes,Mim.
And if we can keep on telling their stories as well as the Amy'sstories, I'm going to be as happy as a pig inmud.
Yeah. I'm just going back to what you said at the beginning of the episode is about how we do have an international audience and particularly thinking about our American colleagues in certain states who are really struggling with the criminal implications of working in thisspace.
And really reaching out that hand ofsupport, but also saying if you have a story that you think would be really in the same waychallenging, standing by your values and challenging the policies that are happening for you in yourspace, please reach out and let usknow.
And we'd be really keen to hear how this actually looks in different spaces because what has happened for us is that nobody has learnt from thepast.
Our state is not the first state in Australia to be going through this and yet lessons have not been learnt and have not actually travelled throughout ourcountry.
So let's not do that in globally aswell.
Let's actually learn from each other in this space and what good social practice can actually looklike.
Because I want to say there is plenty of room on my milkcrate.
You are more than welcome to get on the milk crate withme.
I love the milk cratestories.
I might need to have a lie down after this because I think my blood pressure just went through theroof.
Butwe, wellsaid,me. We actually want to support you to tell your stories and we're here foryou.
Yeah,yeah, we stand in solidarity with these really difficult times actually in our practice forsure.
Liz,it's... I know it's hard to sort of hear these stories and then have to think about it but it's also kind of good to come back to a really passionate space because I think as we go months to months telling these stories and airingthis, it's really nice to come backto.
What is the essence of our social work practice and it always is it's that value space and it's those moments of passion that keep itgoing.
And it for me it's aprivilege.
So I'm prepared for my blood pressure to go up any amount for thesestories.
So bring it on sisters andbrothers.
SoMim, I think we can call this awrap.
It's been anothergreat, great period of time spent with you and I'm glad we got to reflect on such an awesomestory.
I know metoo.Liz, take careeveryone.
We hope you have a goodmonth.
We hope you take care ofyourselves.
Speak to yousoon.Bye. Thanks for listening to the social work storiespodcast.
All of the stories we share are de-identified to respect and protect the peopleinvolved.
We create this podcast because we're passionate about building the global social work community and strengthening our practice no matter thecontext.
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The social work stories podcast is made by LizMurphy,Dr.
MimFox, JustinStesch,Dr.
Ben Joseph and MaddieStratton.
