An Advocate for Women from Birth

"The meaning of the word 'midwife' is 'with woman' — the word is perfect because women are the centre of everything we do," says Dr Hannah Dahlen AM, Professor of Midwifery at the School of Nursing and Midwifery at Western Sydney University. "I respect every single person I care for, regardless of their background. I can never step into anyone else’s skin, that’s not my job. My job is to listen to each individual’s needs and optimise their birth experience accordingly." 

Dahlen was born in Yemen during the 1960s, where her mother worked as a midwife. Dahlen’s mother was originally from the UK, and had worked as a midwife in St Frideswide’s Mission House in London’s Docklands, which was the inspiration for the popular BBC series, Call the Midwife.  

"My very earliest memories are of being in a playpen at the Yemeni clinic where my mother worked, and watching her care for all these women," says Dahlen. "I grew up surrounded by women and birth, and listening to my mother’s stories of cycling around the London docklands to support pregnant women. When I was ten years old, I begged my way into one of the births. I was astonished that women can produce these tiny, perfect human beings from their bodies. It was spellbinding."  

A true moment of revelation came for 12-year-old Dahlen two years later, as she attended another birth in a tiny room in the home of a local family. Just before dawn, Dahlen helped deliver a baby girl and presented the child to the mother who simply said, 'take it away'.  

"I realised that her whole identity and future was hinged around the birth of a son, and this was her third daughter," Dahlen recounts. "I remember feeling some very powerful emotions then, which have really defined my entire career since. One was pure awe of all that women can do. The other was fury and disbelief — that because of the sex you are at birth, you are somehow a lesser human being."  

Dahlen has held fast to these fierce emotions, and they have shaped her career. She is a strong feminist, and advocate for women’s rights, particularly women’s rights to be seen and heard. Secondly, she has devoted her research to support women to have the best births possible, physically, psychologically, culturally and spiritually.  

Dahlen’s career as a midwife and researcher spans more than 30 years. She is renowned as an expert in perineal care, including promoting methods to prevent pain and tearing of perineum tissues during vaginal birth.  

She also pioneered research into the importance of babies coming into contact with the microbiome in their mother’s vaginal canal during birth. Her team showed that this has a significant influence on the development of a healthy immune system in infants.  

She is also passionate about preventing birth trauma. The 'Birth in the time of COVID-19' (BITTOC) study has been running since 2020, under Dahlen’s supervision. It is a longitudinal cohort study of child-bearing women from across Australia, who were recruited during the pandemic. The aims of the study include tracking women’s mental health throughout pregnancy, birth and beyond in light of the stress of the pandemic, and the impact on child development up to two years following the birth.   

"Our findings hinted at high numbers of women experiencing trauma during birth and that trauma having long-term impacts, even in modern Australia," says Dahlen. "As a direct result of our work in this area, we were asked to conduct a wider survey of women’s experiences of birth in Australia, which we co-designed with consumers and through mentoring a wonderful early career researcher (ECR) who was my Masters and then PhD student: Hazel Keedle. The Birth Experience Study (BESt) received responses from over 8,800 women, and the results were shocking." 

The BESt team found that 28% of women experience birth trauma in Australia today. One in ten women are experiencing what is termed ‘obstetric violence’: mistreatment and disrespect of women, including physical and emotional abuse from health care providers during births. This data and many other studies over the past 20 years, led by Dahlen and her PhD students and ECRs, have resulted in a Senate enquiry in New South Wales into birth trauma, which is ongoing.  

"Birth has long been seen as 'women’s business' and yet I still see a patriarchal dominance over approaches in obstetrics," says Dahlen. "Sadly, many working within obstetrics still behave as though the baby is the only focus and ignore the importance of respecting women’s bodies and autonomy."

"Having shouted about these problems for more than 20 years in the media and through our research, it’s a relief to finally see it being listened to and taken seriously," Dahlen continues. "There’s a great sense of satisfaction that these women’s voices are truly being heard."

Another of Dahlen’s passions is mentoring and training the next generation of leaders in midwifery. She hopes to inspire people to take up where she leaves off when she retires, and there is still much work to do to ensure every woman has access to high-quality midwifery care. "I am committed to replacing myself with 20 more great leaders before I retire." 

Dahlen regularly engages in public speaking and outreach, working closely with the Australian College of Midwives. She was awarded a Member (AM) of the Order of Australia in the Queen’s Birthday Honours list in 2019 for her services to midwifery, nursing and medical education and research. 

"Hannah has always been, and continues to be, a fantastic researcher, advocate and practitioner, and her work is widely used and cited around the world," says Professor Caroline Homer, a leading midwifery expert at the Burnet Institute, Melbourne. "She is fearless at calling out injustices and especially where services and systems do not meet the needs of women and families. She is a brilliant communicator and has done so much to make the work of midwives visible, meaningful and valued."