The baby boy was starting his third day, and he hadn't yet worked out how to breast feed. He wasn't really awake when I arrived for a visit, so not much was happening. He had been sleepy, and the little attempts he had made at the breast had been inadequate. The new mother had learnt how to bring her milk out, and the small amounts on a teaspoon seemed to have satisfied the baby. I wanted to see some improvement that day.

The plan had been to birth at home. We decided to transfer to hospital after labour became slow and seemed ineffective. I have no reason why this happened. The partnership of woman with midwife draws on the strengths of both, and it must also accept individual weaknesses.

We went to the nearby hospital, and the midwife who greeted us immediately began to list what would be done. After a brief non-verbal communication with the woman, I spoke up:

"We have come to hospital because we feel that we need help. That is obvious. However my client has told me clearly that she wants to be fully informed of any recommended treatment, that she wants to make decisions, and have her wishes respected. I am here as her midwife. This hospital does not give visiting access to independent midwives, but I hope we can work together. I am fully accountable for everything I do, and I will be keeping my own records."

The midwife listened, took the written birth plan that the woman had brought, and left the room. When she returned her language was inclusive rather than authoritarian, and she suggested that we share some of the work.

Labour was augmented with IV Syntocinon, and the woman worked well standing under the shower. After a few hours we called the hospital midwife, who assisted us while the father and I received the baby. The placenta came away without difficulty, and the woman lay back in bed for a well-earned rest, with her beautiful son skin to skin against her chest.

At that stage I felt sure that our decision to go to hospital, and the subsequent management decisions, had been affirmed. Home is a good place to have babies born when both mother and baby are well. Physical and emotional exhaustion can sap the mother's strength. Yet I am also conscious that women who plan homebirth have to be very determined to do so, and may be open to feelings of failure if they transfer to hospital. They pay substantial amounts of money to employ experienced midwives. Can they not feel that I have failed them when we make that move?

From my perspective, everything had gone well, the baby was born with minimal intervention, and narcotic pain-killing drugs had been avoided. But I don't think that was the woman's perception.

There was a perineal tear, and the decision was made to stitch it. I think by that stage both the woman and I were so relieved, and so exhausted, that we did not have the energy to seek options. I remember saying that I did not think it needed stitching, and if we had been at home it probably would have been left.

The young female resident doctor came with the male obstetrician to do the repair. He was obviously teaching her, and soon after the anaesthetic had been injected he made a couple of deep sutures. I believe the suturing was more traumatic than the birth, and I think it was more than physical pain. There seemed to be something that hurt the woman deeply.

I went home to bed, and the new family also went to their home. When I visited the following day the new parents were weary, as is usual, but very happy. Baby's efforts at the breast were ineffective, and I encouraged the mother to take all the time she and her son needed to learn the art.

My second postnatal visit was cut short when I received a call to another birth. I spoke of visiting again that afternoon, and if I was busy I would ask our second midwife to visit for me. The mother seemed to be managing well, and seemed to understand that some babies take a little while to get breastfeeding right.

Something has gone wrong. My client has refused further visits.

There is a lot incomplete in my mind about this birth. Is she well? Is the baby well, and thriving? How does the woman feel about the birth? Has something happened to hurt her? Have I let her down?

When a midwife is with woman the partnership can only be built on trust. Not on need, and not on a business contract. I must trust the woman, and the information the woman gives me is as important as the information I give her.

I am waiting to complete this partnership. I will continue to seek that opportunity.

The Midwife's Journal has become a composite tale of my partnership with a group of Victorian women, during these past eighteen months. The beauty and intensity of human love, expressed in the conception, birth, and nurture of a child, is surely one of life's timeless mysteries. The midwife who is with woman often glimpses the opening up of that mystery in the hearts of the women she attends.

Yet I need to close this Journal on a note of sorrow, not triumph. The work is unfinished. The midwife longs for the day when every woman has the opportunity to birth her baby in safety, with respect and dignity. In my vision there are midwives in every town and district. Not wonder-women, just ordinary midwives, members of the community, guardians of the next generation. Each midwife functions within a network that supports her, and in which she supports others. When a woman requires a level of care that is best given in hospital, the midwife continues on in a partnership that is centred on the woman.

My vision includes women who believe that they have authority for their own bodies, and who will jealously guard that role. Women who are ready to engage in the processes of life's great journey. Women who listen to their bodies, and listen to their babies. Women who want to be mothers.