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9.3 Maintaining health in the first few days 10.5 Supporting mothers to formula feed 223
of life 193 Summary 225
Skin care and hygiene of the newborn 194 Key terms 225
Websites 226
Jaundice 196
References 227
9.4 Neonatal screening 199
Acknowledgements 229
The blood spot test 199
Newborn hearing screening 200
CHAPTER 11
Advice for parents 200
Detailed neonatal examination by Public health and health
the midwife 201
promotion 230
Summary 202
Introduction 231
Key terms 202
Websites 203 11.1 The concept and definition of health 231
References 203 11.2 Public health 234
Acknowledgements 204 Epidemiology 234
Demography 234
CHAPTER 10 The National Health Performance
Framework 235
Infant feeding 205 Health improvement: the midwife and
Introduction 206 health promotion 235
10.1 Why breastfeeding is important 206 Monitoring health 236
Factors influencing the initiation and duration of Health inequalities 237
breastfeeding 207 Determinants of health 238
Understanding the social–cultural context of Revisiting the midwife’s role in
infant feeding 207 public health 239
Supporting mothers to initiate breastfeeding and
11.3 The midwife’s role in health promotion 239
continue exclusive breastfeeding for longer 208
Maternal obesity 240
10.2 The way breastfeeding works 209
Control of infectious diseases 240
Physiology of lactation 209
Noxious substances (teratogens and
Prolactin releasing factor (PRF) 210
toxins) 241
Feedback inhibitor of lactation 211
Medications 243
Prolactin inhibitory factor 211
Cigarette and tobacco smoking in
Skin to skin 211
pregnancy 243
10.3 Supporting effective infant feeding 213
Alcohol consumption 244
Practical skills to support mothers to breastfeed 213
Illicit substances 245
Different positions for breastfeeding 214
Intimate partner violence (IPV) 246
Breastfeeding pattern 215
Summary 248
Biological nurturing: a different breastfeeding
Key terms 248
approach 215
Websites 249
Getting enough milk 216 References 249
Physiological delayed lactogenesis 216 Acknowledgements 252
Ankyloglossia (tongue‐tie) 217
Reasons for expressing breastmilk 218 CHAPTER 12
Hand expression 218
Equipment for breast pump expressing 220 Contraception and family
10.4 Identifying and managing common planning 253
breastfeeding problems 221
Introduction 254
Breast engorgement 222
12.1 Family planning and reproductive
Mastitis 222
health 254
Candida albicans 223
Appropriate timing of advice 255
When breastfeeding is not recommended 223

vi CONTENTS
12.2 Factors influencing a woman’s choice 14.3 The CAM philosophy 297
in contraception 256 The growth of interest in CAM 298
Psychosexual issues 256 CAM and patient satisfaction 299
Cultural and religious aspects 257 Women, midwifery and CAM 299
Providing advice 258 Promoting normality and reducing unnecessary
12.3 Methods of contraception 259 intervention 300
Barrier methods 259 14.4 Evidence for the safety and efficacy
Hormonal contraceptives 262 of CAM 303
Long‐acting methods 264 14.5 The role of the midwife in CAM
Natural methods of contraception 265 administration 304
Emergency contraception 266 Regulation 305
Sterilisation 266 Summary 307
12.4 Further advice and treatment 267 Key terms 308
Websites 308
Summary 268
References 309
Key terms 268
Acknowledgements 310
Websites 269
References 269
CHAPTER 15
Acknowledgements 269
Pharmacology and medicines
CHAPTER 13
management 311
Perinatal mental health 270 Introduction 312
Introduction 271 15.1 Medicines management 312
13.1 The importance of mental health 15.2 What to check before administration 314
in a maternity context 271 What to know before administration 314
13.2 Putting PMI into perspective 273 What to check during administration 314
Maternal mortality and morbidity 273 What to do after administration 315
Maternal deaths 273 What to check after administration 315
13.3 National Perinatal Depression Initiative 274 15.3 When and how mistakes can happen 316
13.4 Identification and assessment 275 What to do if an error is made 316
Identifying risk factors 276 Keeping up to date 317
Antenatal, postnatal or a continuum 277 Therapeutic Goods Administration (TGA) 318
Prevalence and incidence 278 15.4 What is pharmacology? 318
Categories of PMI 279 Pharmacodynamics 319
13.5 Care provision 285
Pharmacokinetics 320
Summary 286
Monographs 322
Key terms 287
Numeracy 327
Websites 287
References 287 Summary 330
Acknowledgements 290 Key terms 330
Websites 331
References 331
CHAPTER 14
Acknowledgements 333
Complementary and alternative
CHAPTER 16
medicines applied to maternity
care 291 Emergencies in midwifery 334
Introduction 292 Introduction 335
14.1 Definition of complementary and alternative 16.1 Assessment 335
medicines (CAM) 292 16.2 Shock 339
14.2 The field of CAM 293 Management of shock 340
Why is CAM important to know about? 296 Maternal resuscitation/maternal collapse 341

CONTENTS vii
 Basic life support 342 17.2 Perinatal death terminology and
Continuing resuscitation 345 supportive care 371
16.3 Predisposing factors, signs and symptoms of Stillbirth 371
key obstetric emergencies 346 Neonatal death 371
Bleeding 346 Supportive care following perinatal loss 372
Cardiovascular emergencies 352 Care at time of diagnosis 374
Shoulder dystocia 358 Care for labour and birth 374
16.4 Role of the midwife in the management of Care postpartum 376
obstetric emergencies 362 17.3 Midwifery care in specific situations 378
Summary 364 Early pregnancy loss 378
Key terms 364 Termination for fetal abnormality 378
Websites 365 Loss in a multiple pregnancy 379
References 365 Maternal death 380
Acknowledgements 367 17.4 Culture and religion 380
17.5 Self‐care 381
CHAPTER 17 Summary 382
Key terms 382
Bereavement and perinatal Websites 382
loss 368 References 383
Introduction 369 Acknowledgements 384
17.1 Bereavement terminology and theories 369
Theories 370

viii CONTENTS
ABOUT THE AUTHORS
Pauline Glover
Dr Pauline Glover is an Adjunct Associate Professor at Flinders University School of Nursing
and Midwifery, having retired in 2014. Prior to retirement Pauline was the Course Coordinator
of Midwifery at Flinders University, where she worked for 28 years. She has been a passionate
midwife for 48 years, and during that time has had the honour and privilege to work as a clinician,
educator, researcher and mentor. Pauline has extensive experience in curriculum design and devel-
opment, and has been instrumental in the establishment of several midwifery programs in Australia.
Her research has centred on midwifery student learning, and especially seeing how midwifery stu-
dent learning can be optimised through working in partnership with women in continuity of care.
Pauline is a consultant to many working parties and national committees related to midwifery. She is
an inaugural Fellow of the Australian College of Midwives and an inaugural Distinguished Alumni
of Flinders University.
Louise Lewis
Louise Lewis is a Lecturer in Midwifery at the Faculty of Health and Social Care of the University
of Hull, England. After qualifying as a registered nurse in 1995 Louise worked in medical, surgical
and intensive care nursing in Hull, before qualifying as a registered midwife in 1999, with a first class
degree. Louise is an experienced midwife and since June 2008 has been a midwifery lecturer at the
University of Hull, completing an MSc in Health Professional Studies and a Post Graduate Certificate
in Education.
Louise is the Equality and Diversity lead for the FHSC and has led the midwifery programs through
achieving Baby Friendly Accreditation, awarded in August 2014. Louise is also an external examiner for
Kingston and St. Georges University, London.
Liz McNeill
Liz McNeill became a midwife instead of having a midlife crisis, and therefore still calls herself an
‘old nurse/new midwife’. She is currently an Associate Lecturer in Nursing and Midwifery at Flinders
University. Her critical care background and subsequent specialisation in simulation has enabled her
creative and innovative sides to come out to play with her teaching, curriculum design and scholarship/
research areas in both the nursing and midwifery areas.
Liz teaches across the curriculums, including topics in science, clinical skills and research areas. Her
focus in simulation is on the integration of a scaffolded approach across the curriculum inclusive of all
levels of fidelity and technology, the effectiveness and application of simulation experience as it relates
to preparation for clinical placement, and student stress in simulation. Other areas of focus are diverse
gender, sexes and sexuality inclusivity and how PTSD affects veterans and their families.
Pauline Costins
Pauline Costins is the Course Coordinator of the Graduate Diploma of Midwifery and Lecturer at
the School of Nursing Midwifery and Paramedicine at Curtin University. Pauline has completed her
Graduate Certificate in Tertiary Education, Master of Health Law, and recently completed her Juris
Doctor and has been admitted as a lawyer in Western Australia. Pauline has many years’ experience as
a midwife working in the UK and Australia in a variety of teaching and clinical roles. She was one of
the first Endorsed midwives in Western Australia following government maternity reforms, and had a
successful private midwifery group practice for several years. Pauline’s legal interests include health law
and ethics. She has provided expert opinion reports on negligence matters and issues relating to unsatis-
factory professional performance. Her passion is protecting the role and scope of practice for midwives
through networks of strong professional and clinical support.

ABOUT THE AUTHORS ix

Jane Warland
Dr Jane Warland is an Associate Professor in the School of Nursing and Midwifery at the Univer-
sity of South Australia (UniSA). She worked as a midwife from 1988 to 2007. Jane gained her PhD
from the University of Adelaide in 2007 and has been an academic staff member in the School of
Nursing and Midwifery since early 2008. She teaches undergraduate midwifery students a range of
topics, including perinatal mental health, grief and loss, complications in pregnancy and childbirth, and
research methods. Jane has particular expertise in teaching stillbirth awareness, prevention and manage-
ment. Jane’s own program of research is STELLAR (stillbirth, teaching, epidemiology, loss, learning,
awareness and risks).
Clare Kew
Clare Kew qualified as a midwife in the UK in 1992 and has extensive clinical experience
across all midwifery disciplines and models of care. She acquired a Bachelor of Midwifery and
Master of Midwifery, while maintaining an interest in education. Opportunities arose in clinical
facilitation, staff development and lecturing at Curtin University, leading Clare in that direction. For
many years, she has provided academic and clinical support to undergraduate students and registered
midwives, with a particular focus on high-risk obstetrics, emergency skills, resuscitation assessments
and water births.
Zoe Bradfield
Zoe Bradfield is a Lecturer in Midwifery at the School of Nursing, Midwifery and Paramedicine at
Curtin University. Zoe’s career as a midwife has led to practise in rural and metropolitan settings in
Western Australia. Many of these positions have allowed her to combine her love of working alongside
women and their families with formal education roles. Zoe completed a Master in Midwifery, which
resulted in opportunities in lecturing and leadership of midwifery students. Zoe’s commitment and
excellence in the education of midwifery students has been awarded by Curtin University. She continues
to lecture in undergraduate and postgraduate midwifery courses while also conducting research towards
a PhD. Zoe’s areas of interest and research are breastfeeding, midwifery education, midwifery theory
and philosophy, simulation, midwifery in developing nations, empowering women and their families,
and labour and birth care.
Lesley Kuliukas
Lesley Kuliukas is the Course Coordinator of the Bachelor of Science Midwifery course and Lecturer
at the School of Nursing, Midwifery and Paramedicine at Curtin University. Lesley has completed
her Postgraduate Certificate in Education for Adults (Midwifery), Master of Midwifery and has
recently submitted her PhD for examination. Lesley is an Endorsed Midwife. Her 34-year career in
midwifery spans many models and areas of care in Europe and Australia, including home birth,
birth centre, midwifery group practice, high-risk referral centres and specialist care, interspersed
with posts in midwifery education, both undergraduate and postgraduate. Lesley’s areas of interest
and research include breastfeeding, simulation, labour care, childbirth anatomy and physiology and
models of care.
Lynette Staff
Lynne has been a practising midwife for 33 years, during which time she has worked in the public and
private sectors across all areas of maternity care. She established a private midwifery practice caring
for women in the community. Lynne helped to set up an innovative maternity unit in a private hospital
in Queensland, which she subsequently managed for several years. She has taught midwifery in hos-
pital-based programs and in the tertiary setting. She completed a Bachelor of Health Science, a Master
of Midwifery and undertook an Honours year. Lynne has been a midwifery consultant for the Health
Rights Commission (Qld), the Queensland Nursing and Midwifery Council and has been an expert
member of many panels working on issues relevant to maternity care. She was elected as member

x ABOUT THE AUTHORS

of the Risk Management Working Party. Lynne is currently the Course Coordinator for the Graduate
Diploma of Midwifery at the University of Tasmania, is a practising midwife and a Practitioner
Member of the Tasmanian Board of the Nursing and Midwifery Board of Australia. Until mid-2015,
she also lectured and facilitated midwifery skills workshops for Birth International both nationally and
internationally. Lynne currently co-facilitates Better Birth Workshops® in metropolitan, rural and
remote areas.
Virginia Burns
Virginia Burns is a Lecturer and Unit Coordinator for the Graduate Diploma of Midwifery at the School
of Nursing Midwifery and Paramedicine at Curtin University. Virginia is also a Clinical Midwifery
Facilitator for the Graduate Diploma of Midwifery, working alongside the students in their employing
maternity units. Virginia is a Registered Midwife and Nurse and has completed her Graduate Certificate
in Health Science (Clinical Education) and Master of Midwifery. As an Endorsed midwife, Virginia
has also worked privately in a one of the first midwifery group practices in Perth. Having many years’
experience as a midwife working in Western Australia and New South Wales in a variety of teaching and
clinical roles, Virginia remains passionate about the education of student midwives. Of particular interest
to her is the clinical support and welfare of midwifery students.
Trudi Mannix
Dr Trudi Mannix is a Registered Nurse and Midwife with qualifications in neonatal intensive care nursing.
Trudi holds a Doctorate in Education, and has a long history of teaching both special care and neonatal
intensive care nursing in major hospital settings. For the last decade, she has held a Lecturer position at
Flinders University teaching care of the newborn to undergraduate midwives. Trudi is a Past President of
the Australian College of Neonatal Nurses, and past Chairperson of the Journal Management Board of
the Neonatal, Paediatric and Child Health Nursing journal. In 2013, Trudi won a Churchill Fellowship
and toured the United Kingdom, United States and Canada investigating programs to reduce stress in
parents whose babies were in neonatal units. Trudi has volunteered in Vietnam and Papua New Guinea
teaching in the ‘Helping Babies Breathe’ program. She is a past executive member of the Council of
International Neonatal Nurses (COINN), and is a current member of the Expert Topic Group developing
standards for education for health professionals working with neonates, for the European Foundation for
the Care of Newborn Infants (EFCNI).
Ann Taylor
Ann Taylor is a sociology lecturer in the School of Humanities and Social Science at the University
of Newcastle. Ann’s research and writing has been around the organisation of health work, in par-
ticular the sociology of midwifery and childbirth. Ann is originally from the United Kingdom where
she studied Social and Political Sciences at the University of Cambridge. She has a longstanding
interest in social aspects of gender and health, including justice and inequality, and changing health
professions and practices around childbirth and parenting. Prior to returning to academia in 1992,
she was an advocate for women and supported women giving birth in public hospitals who had
no partner or family support. She has been part of the health consumer movement and represented
consumers on the New South Wales Health Practitioner Committee and Nurses and Midwives
Accreditation committee.
Nigel Lee
Nigel is a lecturer/researcher with the School of Nursing, Midwifery and Social Work and the Midwifery
Research Unit at the University of Queensland. He is also an Honorary Research Fellow with the Mater
Research Institute — UQ. He is a midwife with clinical, education, research and policy experience
encompassing a broad range of midwifery care provision including birth suite, continuity of care and
community midwifery. Nigel is an effective clinical leader with a track record for linking research
with clinical practice and effecting practice change. He completed a PhD in 2013 researching different

ABOUT THE AUTHORS xi

techniques for the administration of sterile water injections for the management of back pain in labour.
His research in this field is ongoing with two multicentre trials underway. Nigel’s other areas of research
interest include the duration and management of normal labour. Nigel has expertise in conducting
randomised controlled trials and mixed methods design. He is a strong collaborative researcher with
projects involving fellow academics from Australia, Sweden, the United Kingdom and the US.
Susannah Brady
Susannah is the Midwifery Lead for the Undergraduate Bachelor of Midwifery and Dual Degree at the
School of Nursing, Midwifery and Social Work at the University of Queensland. She is a midwife and is
focused on women-centred care.

xii ABOUT THE AUTHORS

CHAPTER 1

To be a midwife
LEA RNIN G OU TCOME S

After studying this chapter, you should be able to:

1.1 identify your personal philosophy of midwifery
1.2 outline the role and scope of practice of the midwife
1.3 understand the complexities of midwifery education
1.4 examine how midwifery, as a profession, is regulated in Australia and New Zealand
1.5 identify the personal qualities of the midwife
1.6 understand the demands of working within the midwifery profession.
 OPENING SCENARIO

You are a friend of a first‐year midwifery student who

is attending her first birth with a midwife mentor/
clinical teacher. She excitedly asks the parents if she
can pose for a photo with their baby, which they
agree to. She then posts the photo on social media
with the following statement: First birth. Amazing
experience. Definitely want to be a midwife.
Your midwifery mentor/clinical teacher sees the
post and speaks to your friend.

DISCUSSION QUESTIONS
1. What would you say to your friend about the social media post?
2. What policies does the Nursing and Midwifery Board of Australia (NMBA) or the Midwifery Council of
New Zealand have about the use of social media?
3. Do you believe that your friend has crossed a professional boundary?
4. Do you think there will be consequences for this action at this point of your friend’s career?
Australian students should refer to the NMBA (2014) social media policy: www.nursingmidwiferyboard
.gov.au/Codes‐Guidelines‐Statements/Policies/Social‐media‐policy.aspx.
New Zealand students should refer to the Midwifery Council of New Zealand (2010) Code of
Conduct 3.3 of professional behaviour: www.midwiferycouncil.health.nz/sites/default/files/documents/
midwifery%20code%20of%20conduct%20feb%202011.pdf.

Introduction
Midwifery is a dynamic profession that is responsive to change. In recent years, social, economic
and technological forces have altered the context of midwifery significantly. The scale of healthcare
provision has changed greatly; philosophies and values have been adjusted and the restructuring
of healthcare provision has been dramatic. There have been government and independent reviews
of maternity services and changes to midwifery education and the accreditation of programs of
study. In Australia, the latest of these was the publication of the National Maternity Services Plan
(AHMAC 2011), which presented a five‐year vision for maternity care in Australia. Its vision
included the following:

.  .  .  women will have access to high‐quality, evidence‐based, culturally competent maternity care in a
range of settings close to where they live. Provision of such maternity care will contribute to closing
the gap between health outcomes of Aboriginal and Torres Strait Islander people and non‐Indigenous
Australians. (AHMAC 2011, p. iii).

It is clear from this vision that there are many concepts that need to be considered and implemented.
Public expectations regarding involvement in care and opportunities for informed choice have increased,
and in many cases women and their families are seeking different models of maternity care where they
can work in partnership with their care providers. The partnership model of care has been in existence
in New Zealand since 1996 when midwives were autonomous practitioners with full prescribing rights,
with the ability to make referrals, order diagnostic tests and access hospital facilities and government
fee‐for‐services (Guilliland & Tracy 2015).
This chapter will provide an introduction to the midwife, midwifery education, models of midwifery
care, professional regulation and registration, professional organisations and personal qualities, which
will help students with their midwifery education and role as a qualified health practitioner.

2 Midwifery
1.1 Midwifery philosophy
LEARNING OUTCOME 1.1 Identify your personal philosophy of midwifery.
The International Confederation of Midwives (ICM) has a philosophy of midwifery care that states
that pregnancy and child-bearing are usually normal physiological processes that are profound experi-
ences with significant meaning for the woman and her family. It maintains that midwives are the most
appropriate care providers to attend to the woman offering care that promotes, protects and supports
the woman, while recognising ethnic and cultural diversity. Midwifery care is holistic and continuous
and takes place in partnership with the woman. It is ethical and competent, and informed by education
and application of evidence (ICM 2014). Midwives provide high‐quality professional care to women and
their families, and are autonomous, accountable and responsible within their scope of practice.

ACTIVIT Y 1.1

Write a short statement about your philosophy of midwifery and why you want to become a midwife.
Your statement should centre on your beliefs, concepts or ideas, and your attitude. This statement can
be written without any reading. It should focus on why you want to be a midwife and what you believe.
When you have written this statement, put it somewhere safe so that you can revisit it after each sem-
ester of study and reflect on where you are in your midwifery journey. If you are experiencing difficult
times within your program, refer to this statement of your philosophy. You may also want to develop
your own midwifery mandala. A mandala is a circle that can help to focus your philosophy in a visual
way, i.e. where are you in the circle, where are the women and families, where are the other health prac-
titioners and the support people who will be helping you on your journey to become a midwife.

1.2 The midwife

LEARNING OUTCOME 1.2 Outline the role and scope of practice of the midwife.
The word ‘midwife’ is mentioned in the Bible in Genesis where it is stated:
The time came for Rachel to have her baby, and she was having difficult labour. When her pains were at their
worst, the midwife said to her, ‘Don’t be afraid Rachel; it’s another boy’ (Genesis 35:16–17).

Midwifery, then, can be seen as a very old profession. In the past, the midwife would have been an auton-
omous practitioner, with or without education, and getting on with the job of assisting women. Now, the
midwife is a professional, educated person able to provide competent and safe practice at all times. However,
historically, midwifery, and consequently the midwife, had been subordinated by nursing and medicine.
Fahy (2007, p. 2) provides a historical analysis of the professionalisation of medicine from the nineteenth to
twentieth century when it was ‘inextricably linked to an obedient nursing profession which in turn was the
key player in the eradication of midwifery as an independent occupational group’.
To be a midwife is to understand the role, responsibilities and scope of practice of being a midwife.
The midwifery profession is recognised globally and is defined by the ICM (2011) as:
a person who has successfully completed a midwifery education program that is duly recognised in the
country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery
Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired
the requisite qualifications to be registered and/or legally licensed to practise midwifery and use the title
‘midwife’; and who demonstrates competency in the practice of midwifery.

This definition is complex as it includes areas such as education, regulation and practice. The pro-
fessional status and regulation of midwifery nationally and internationally is complex and varies in
different countries. Midwives in rural Cambodia practise differently to midwives in urban cities and ter-
tiary health centres. While we should recognise these differences, there is still an underpinning scope of
practice that all midwives should adhere to.

CHAPTER 1 To be a midwife 3
ICM scope of practice
The midwife is recognised as a responsible and accountable professional who works in partnership with
women to give the necessary support, care and advice during pregnancy, labour and the postpartum
period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and
the infant. This care includes preventative measures, the promotion of normal birth, the detection of
complications in mother and child, the accessing of medical care or other appropriate assistance and the
carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but
also within the family and the community. This work should involve antenatal education and preparation
for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics or health
units (Revised and adopted by ICM 2011. Due for review in 2017).

Midwifery, as a profession, is recognised globally, although there are wide variations in education and scope
of practice between countries. What is evident from the ICM scope of practice is that the midwife works in
partnership with women to provide support, care and advice during pregnancy, labour and the postpartum
period (Glover 2016). While midwives can provide independent care, they also have a legal obligation to work
with other health professionals. Midwives work in all kinds of settings which can include hospitals (public
and private), homes, community, clinics, rural and remote areas, and private midwifery services such as My
Midwives. The practice of the midwife will be specific to the context of where the care is being provided.

The professional status of midwifery began with the Midwives Act 1904 in New Zealand and a Midwives
Registration Bill in 1915 in Australia. Prior to 2010, each Australian state and territory had its own Nurses
Board. Today, midwifery practice in Australia and New Zealand is governed by the Nursing and Midwifery
Board of Australia (NMBA) and the Midwifery Council of New Zealand respectively. Both of these organ-
isations have developed codes of practice and ethics that give clear guidelines for midwifery practice.
Midwives have a legal obligation to ensure that they practise within professional and personal boundaries,
and as they begin to work with women in the partnership model, they will need to know where the boundaries
of their relationships begin and end. This also applies when working with other health practitioners.

4 Midwifery
 ACTIVIT Y 1.2

Take some time to watch an episode of Call the Midwife, or One Born Every Minute, and make some
notes about whether you can see the scope being practised by the midwives. Bear in mind that Call
the Midwife is fictitious and set in the 1950s and 1960s in London, and One Born Every Minute is an
observational documentary set mainly in the labour wards.

1.3 Midwifery education

LEARNING OUTCOME 1.3 Understand the complexities of midwifery education.
Midwifery education in Australia was a state/territory responsibility until 2009 when the Australian
Nursing and Midwifery Accreditation Council (ANMAC) was established to provide midwifery edu-
cation providers with a set of standards for midwifery programs. Prior to this, midwifery education was
offered by public hospitals that provided maternity care. Students were already registered as nurses and
midwifery was seen as a second certificate. In the 1980s nursing began to transfer its training from the
hospital‐based apprentice system to the tertiary setting and transferred fully to the university sector by
1993. At this stage, midwifery stayed in the hospital system as it was not seen as a profession in its own
right, but rather a specialty of nursing. There were postgraduate degrees offered but these were neither
prolific nor were they well subscribed, as they were expensive to undertake.
There are now three main education pathways in the higher education sector for midwifery: the three‐year
Bachelor of Midwifery; a post‐registration Bachelor of Midwifery, where the student is already a registered
nurse (the student can wait between degrees or they can enrol in a double degree and graduate with a
Bachelor of Nursing/Bachelor of Midwifery); or a postgraduate qualification such as a graduate diploma or
master’s degree, if the student is already registered as a nurse. The length of these programs varies; however,
they are all more than one year as students have to meet the strict accreditation requirements mandated by
ANMAC. These include mandatory practice experiences in which the students must meet the requirements
of continuity of care experiences; antenatal, labour and birth care; and postnatal and neonatal care.

CHAPTER 1 To be a midwife 5
 In New Zealand, pre‐registration midwifery education has been offered as a three‐year Bachelor of
Midwifery since 1992. All programs in New Zealand are subject to approval by the Midwifery Council of
New Zealand and students must meet the competencies for registration as a midwife. Students graduate
as autonomous practitioners able to practise across the scope of midwifery (Gilkison et al. 2016). Their
Australian counterparts have to complete a one‐year Transition to Professional Practice Program (TPPP)
upon completion of their studies.
Midwifery education is underpinned by standards, guides, codes and competencies (see figure 1.1).
By accepting and implementing these documents, it is clear that midwifery education (and ultimately
regulation) is becoming more universal. This control will assist education providers in preparing the
global midwife for the future.

FIGURE 1.1 Australian national midwifery education and practice standards, guidelines, codes and
competencies

Accreditation standards
• National Guidelines for the Accreditation of Nursing and Midwifery Programs Leading to Registration
or Endorsement in Australia (ANMAC 2015)
• Midwife Accreditation Standards 2014 (ANMAC 2014)
• Programs Leading to Endorsement for Scheduled Medicines for Midwives Accreditation Standards
(ANMAC 2015)
Codes: ethics and professional conduct
• The Code of Ethics for Midwives in Australia (NMBA 2008)
• The Code of Professional Conduct for Midwives in Australia (NMBA 2008)
Competency standards
• National Competency Standards for the Midwife (NMBA 2006; under review)
Decision making frameworks
• National Framework for the Development of Decision Making Tools for Nursing and Midwifery Practice
(NMBA 2013)
• Midwifery Practice Decisions Summary Guide (NMBA 2010)
• Midwifery Practice Decision Flowchart (NMBA 2013)
• Safety and Quality Framework for Privately Practising Midwives Attending Homebirths (NMBA 2010)
Professional boundaries
• A Midwife’s Guide to Professional Boundaries (NMBA 2010)
Professional practice guidelines
• National Midwifery Guidelines for Consultation and Referral 3rd edn (ACM 2013)
• Guidelines for Professional Indemnity Insurance Arrangements for Midwives (NMBA 2012)
• Guidelines for Advertising Regulated Health Services (AHPRA 2014)
• Nursing and Midwifery Guidelines for Mandatory Notifications (AHPRA 2014)
Registration standards
• Registration Standard Continuing Professional Development (NMBA 2016)
• Registration Standard Criminal History (NMBA 2015)
• Registration Standard English Language Skills (NMBA 2015)
• Registration Standard Professional Indemnity Insurance Arrangements (NMBA 2016)
• Registration Standard Recency of Practice (NMBA 2016)
• Registration Standard for Endorsement for Scheduled Medicines for Midwives (NMBA 2017)
• Eligible Midwives Registration Standard (NMBA 2010)

Source: ACM, AHPRA, ANMAC, NMBA. Adapted from Pairman & Donnellan‐Fernandez 2015.

Midwifery education is a shared responsibility between the higher education sector and the clinical
venues where students undergo their midwifery practice experience. It is important that these partners
work together to ensure students are able to complete their clinical requirements. Most programs of study

6 Midwifery
have a 50:50 distribution of theory and clinical placement. These hours are suggested by the higher edu-
cation sector; however, there needs to be enough time for the student to meet the clinical requirements.
A conceptual framework and underlying philosophy should be evident in all courses. There should be evi-
dence of a woman‐centred approach to midwifery along with a continuity of care model. Primary health-
care principles should also underpin the curriculum, and the curriculum should prepare graduates to be
able to work to the full scope of practice as a midwife. Billett and Henderson (2011) suggest that any
curriculum that is developed should promote professional learning, and integrate theory and practice. Stu-
dents need to be self‐directed in their learning and able to reflect on their practice. Most curricula have
integrated the concepts of the biophysical and social sciences, and there is an ideation that evidence‐based
practice is integrated into all teaching. Cultural respect and safety are included in curricula with reference
to Aboriginal and Torres Strait Islander peoples in Australia and Maori people in New Zealand.

Continuity of care experiences

An exciting component of the midwifery curriculum is the need for students to undertake a required
and mandated number of continuity of care experiences (COCE). COCE provide midwifery
students with the opportunity to ‘establish, maintain and conclude a professional relationship while
experiencing continuity with individual women through pregnancy, labour and birth, and the postnatal
period regardless of model of care’ (ANMAC 2014, p. 24). This is a student‐centred activity in that
the student needs to identify women to recruit for this experience and manage the workload that the
experience entails, while under the direct supervision of a midwife. The COCE is a core component
of the curriculum. Sweet and Glover (2011, p. 85) identified three purposes for this workplace‐based
experience: students will engage with and reflect on the world of midwifery work; they will under-
stand and develop their individual capacity for the profession; and they will understand the nuances
of the many and diverse instances of midwifery practices and birthing women’s trajectories. While
the COCE is done in the students’ own time, they will have the opportunity to develop an awareness
of the role of the midwife and their own midwifery identity, and change their language from lay
to professional.

ACTIVIT Y 1.3

1. Create a table and make notes about the following.

• How will you develop your awareness of the role of the midwife?
• How will you recognise your own midwifery identity? Does it relate in any way to your personal
philosophy previously identified?
• How will you recognise the change in your language from lay to professional. Here are a
few examples:
–– the water broke (lay language)
–– the water was green (lay language)
–– the baby is flat (lay language that can be very scary as the mother believes her baby is flat)
–– lost her first baby (lay language) (Glover & Sweet 2016).
2. Read the following quote from Michel Odent, a famous French obstetrician, and consider the effect
of language in a childbirth context.
So many words commonly used to describe childbirth — support, patient, management, delivered by,
coached, helped, guided — suggest that a woman does not have the power to give birth without being
dependent on somebody else. This isn’t the case at all.

Midwifery knowledge
There are three kinds of knowledge gained through COCE and midwifery practice placements: con-
ceptual knowledge, procedural knowledge and dispositional knowledge. Conceptual knowledge is the

CHAPTER 1 To be a midwife 7
‘development of facts, information, propositions, assertions, and concepts for practice and is developed
over time from integration between theory and practice’ (Sweet & Glover 2011, p. 88). This knowledge
can start off as basic and increase in complexity to a more sophisticated and deeper level. A student
may start off knowing there is a clamp for the baby’s umbilical cord when it is born and then learn it
is a Black’s clamp. The COCE assists students to develop this level of sophistication as they work in a
triad situation with the woman, the midwife (or other health professional) and themselves. This is the
‘knowing about’ midwifery. The student will then reflect on these experiences to identify what they have
learned from the COCE.
As midwifery is a practice‐based profession, there needs to be the development of skills for safe
practice. This is procedural knowledge and demonstrates the ‘knowing how’ to be a midwife (Sweet &
Glover 2011). Midwifery students may undertake skills development in a simulated practice setting at
university and then apply these skills in a real‐life situation. The research conducted by Sweet and
Glover (2011) found that midwifery students enjoyed task learning, but were also open to opportunistic
learning when unplanned situations arose. When midwifery students embrace all learning opportunities,
their confidence grows and they are able to reflect on their experiences.
The final knowledge is dispositional knowledge. This knowledge relates to the values and attitudes
required to ‘be a midwife’ (Sweet & Glover 2011). It is through observing other midwives and their
practice that midwifery students can identify how they want to be as a midwife. Developing awareness
of the midwife role will begin as soon as the student commences the course of study. The midwifery
student will identify good and bad role models, while developing their sense of agency and becoming an
agentic learner. What this means is that the midwifery student will be an active, directive and intentional
learner (Billett 2011). The student is the learner and the teachers, both in the university and clinical
setting, support their learning and guide the student in active engagement. Sweet and Glover (2011)
describe ‘hot learning’ which occurs when the student gets the opportunity for an unplanned learning
experience, such as a rapid birth. The student can then reflect on the experience in collaboration with
the midwife and the woman. ‘Cold learning’ occurs when the student is guided through debriefing and
critical reflection on the same experience.
The midwifery student must be prepared before, during and after the COCE and the midwifery place-
ment experience. This responsibility belongs with the university teacher, clinical teacher/facilitator,
midwife/mentor and student (see table 1.1). The woman will also become a partner in these experiences.
Learning responsibilities prior to, during and after the COCE and midwifery
TABLE 1.1 practice experience

Teacher Student

Before the COCE or • Prepare student for concepts, practice • Know their professional and personal
midwifery placement and language they may encounter in boundaries.
experience their initial experience. • Identify learning objectives.
• Roleplay some anticipated experiences • Know the requirements for their
in the classroom. This could be as midwifery practice portfolio.
simple as taking an antenatal history.
• Develop a level of proficiency in some
basic skills such as taking blood
pressure and listening to a fetal1 heart.
• Discuss the reality of midwifery work,
e.g. a labour can be considered normal
one minute and an emergency the next,
or a fetal heart may be heard and then
not heard an hour later.
• Prepare the student for reflection in and
on practice.

1This title has adopted the accepted medical spelling of ‘fetus’, rather than the common usage spelling of ‘foetus’.

8 Midwifery
Another Random Scribd Document
with Unrelated Content
"I shall tell him that Basil and that infernal girl are engaged, and he'll
give her notice to quit. And I shall tell him that you intend to run
away with that beastly little Japanese."

"Oh, I haven't made up my mind what to do," said Mara, retreating

to the door. "And if I decide to go with Akira, I shall do so, in spite of
father or anyone else. But you won't tell, Theo; you're only too glad
for me to go. You look like a great toad lying in bed."

Theodore caught up one of his slippers. "Will you clear out?"

"Mum! Mum! Mum!" jeered Mara, with an elfish laugh. "You can't do
anything. And even if I do go, even if Basil does marry Patricia, you
won't get Beckleigh. Mum! Mum! Mum!" And she closed the door
just in time to escape the slipper which Theodore threw with all his
strength.

The doctor duly arrived and put the Squire's leg in splints. The old
man had recovered his senses, and considering his pain, behaved
himself very well. The doctor approved of his patient's fine
constitution and cheerfully said that he would soon be on his legs
again. "You're not dead yet, sir," he remarked, when Colpster had
been made comfortable for the night.

"I don't intend to die," said the Squire coolly. "Quite other plans are
in my mind. But while I lie here I shan't have anything disturbed in
the house. Patricia remember that. Should Akira's yacht arrive, you
and Mara and Basil, together with Theodore and the servants, can
go to his entertainment."

"Oh, we couldn't leave you like that, Mr. Colpster," said Patricia
quickly.

"You can and you shall. I hate a lot of fuss." And then the doctor
took Patricia out of the room to explain that the patient must be
kept very quiet, else he would work himself into a fever.
"Humour him, Miss Carrol, humour him," said the doctor, as he took
his leave. "To-morrow I shall come over and see him. Don't worry."

But Patricia did worry, not so much over the Squire, who was getting
along fairly well considering his age, as over the fracas with
Theodore. She dreaded lest he might speak to the Squire. "And then
I should have to leave," said Patricia, much distressed.

"I don't see why, dearest," replied Basil, twining his brown fingers in
her hair and wondering if God had ever created a more perfect
woman.

The two were seated, as usual, in the smoking-room, deeming that

the safest place, since Theodore since the quarrel had carefully
avoided entering it. It was now three days since the accident, and
since Basil had been driven to disclose his feelings. They had the
house to themselves almost entirely, for Mara rarely troubled them.
Theodore, although he had risen from his sick-bed with a more or
less discoloured eye, kept to his own rooms, and did not even
present himself at meals. He cherished a deep anger against Basil,
and was sullen with Patricia as the original cause of his humiliation.
The elder Dane had not a forgiving nature. Nor, indeed, did his
brother feel inclined to welcome any advances. He was too much
disgusted with Theodore to pardon him readily.

"I don't see why, dearest," said Basil again, and slipped his arm
round Patricia's waist. "Uncle George can't kill us."

"He could turn me out of the house, and I have nowhere to go."

"There is no reason why he should turn you out. He loves you like a
daughter. I'm certain of that."

Patricia sighed. "You are wrong, Basil. He loves me, certainly, but not
like a daughter."

"What!" Basil scowled with a brow of thunder. "Does he dare to----"

"He dares nothing," interposed Patricia hurriedly, and placed her pink
palm over his mouth to prevent further speech. "But I am certain
that he wants to marry me."

"At his age. Ridiculous!"

"Why ridiculous? Older men than the Squire have married."

Basil's arm grew loose round her waist. "Do you admire him, then?"

"Of course. I both admire him and love him. Look how good he has
been to me. I hadn't a shilling when he took me from The Home of
Art."

"Patricia, do you mean to say----"

She stopped him again, and this time his mouth was closed with a
kiss. "I mean to say that you are a dear old stupid thing, darling. I
can't help myself if your uncle admires me."

"It shows his good taste. All the same----"

"All the same, I'm going to marry you, my dear. But we'll both be
turned out of the house, I'm sure of that."

Basil hugged her again. "I knew you would never marry for money,
dearest," he whispered.

"And if we are turned out we can live on my pay. I have to join the
Mediterranean Fleet when my leave is up in a couple of months from
now. My ship will be always at Malta--always calling in there, you
know. We'll get a tiny flat, and you shall stay there when we're
married."

"Oh, darling, that will be heaven!"

"It will be poverty," said Basil ruefully; "not what you're used to."
"My dear," she put her arm round his neck and looked into his hazel
eyes, "what nonsense you talk. Since my father died I have been
desperately hard up in every way, and if your uncle had not taken
pity upon me, I really don't know what I should have done. I can
cook and sew and look after a house splendidly. I'm just the wife for
a hard-up sailor."

"You are, indeed," said Basil fervently, and would have embraced
her, but that a knock came at the door. "Oh, hang it! here's Sims."

"I must attend to my duties," said Patricia, as Sims entered. "It's the
butcher, of course. Go on, Sims. I'm coming to the kitchen." And
Sims discreetly departed with a knowing smile, while Patricia
remained for a last kiss.

The Beckleigh Hall servants saw very plainly what was taking place,
and even although they were old and jealous retainers, did not
resent it. Basil was an immense favourite with one and all, while
Patricia during the short time she had acted as housekeeper had
captured all hearts with great ease.

In the days which followed Patricia was kept closely in attendance on

the Squire, since Mara would do nothing, and Colpster objected to
being attended to wholly by the servants. She became rather pale
and thin, which only made her the more adorable in Basil's eyes,
and, unfortunately, in the eyes of her patient also. The Squire had
made up his mind to ask Patricia to be his wife, notwithstanding the
difference in their ages. Since Mara resolutely refused to marry
either of her cousins, Colpster's pet scheme for the family to be re-
established, now that the emerald had returned, fell to the ground.
Failing this, he wished to make Miss Carrol his wife, and hoped that
she would give him an heir in the direct line of descent. The more he
thought of the scheme, the more he liked it, as he was extremely
fond of Patricia, notwithstanding he had been so rude to her on the
night when the Mikado Jewel had arrived so mysteriously. It never
struck him that she might fall in love with a handsome young man
like Basil.

Patricia saw how devoted the old man was becoming to her, and at
times she was quite embarrassed by the youthful fire of his eyes.
Colpster was now getting well rapidly, as it was a fortnight since the
accident and the leg was mending. He remained, of course, in bed,
and received various visits from the various members of his
household. Theodore and Mara did not pay many visits, as the
former knew that his uncle disliked him, and the latter was entirely
without affection. The Squire never did expect much from Mara, as
he looked upon her as weak-minded. She certainly was not, but her
father never took the trouble to see what qualities she possessed. It
was little wonder that Mara did not give affection, seeing that she
never received any.

Mr. Colpster worried a great deal over the continued absence of

Harry Pentreddle, and had frequently sent Jarvis to Hendle to inform
him that he was wanted at the Hall. But Pentreddle had gone away
from his lodgings without leaving any message behind, and no one--
not even Isa Lee--knew where he was to be found. This absence
and silence made the Squire quite uneasy, especially when he
remembered that Harry had seen the emerald. He had stolen it
before and--as the Squire, without any grounds to go upon,
considered--he might steal it again. Haunted by this thought,
Colpster gave Patricia the key of the safe and made her bring him
the Jewel. He slept with it under his pillow and hugged it to his heart
every day, talking meanwhile about the good luck it would bring.

"It has not brought any good luck yet, Mr. Colpster," said Patricia one
evening, after her lovemaking with Basil in the smoking-room.

"How do you mean, my dear?"

"Well, in the first place, you have broken your leg; in the second,
you have lost that lawsuit which----"
The Squire groaningly interrupted her: "Yes, I have lost it, worse
luck, my dear. The land has gone, and my income will be diminished
to eight hundred. Yes, I admit that bad luck. And the weather is
really terrible too," he added, looking at the streaming window-pane.
"It so rarely rains here, yet it has poured ever since my accident."

"And before then," Patricia reminded him. "The rain, by making the
road slippery, caused your accident. If I were you, Mr. Colpster, I
would send back the jewel to Japan with Count Akira. He is quite
right: the good luck it brought to your family centuries ago has
changed to bad."

"How can you believe in such rubbish!" groaned the Squire, hugging
his gem.

"You believe in it," said Miss Carrol, wondering at his want of logic,
"or you would let the Mikado Jewel go."

"The luck will change now," insisted Colpster, trying to persuade

himself into a kindly belief. "Everything will come right."

"I hope so," said Patricia, poking the bedroom fire, before which she
was kneeling. "You must write and tell me if it does."

The Squire sat up in bed and gasped. "Write and tell you?"

"Yes. I am going away."

"Nonsense! Why should you go away?"

"Mr. Colpster," said Patricia, who had brought the conversation round
to this point that she might thoroughly explain herself, "you have
been very good to me, and I have been very happy here. But your
nephew Theodore has been rude to me; in fact, he has insulted me;
so I cannot remain under the same roof with him."
"What?" the Squire's scanty hair bristled and he trembled with rage.
"Has that dog of a Theodore been rude? He shall leave my house at
once."

"No. That would not be fair. He is your nephew. I shall go."

"I shan't let you go, child. I love you too much to let you go. How
did he insult you--what did he say? Tell me and I'll--I'll----" Rage
choked his further utterance, and he sank back on his pillows.

His nurse came forward and smoothed the bedclothes. "Don't worry
over the matter, Mr. Colpster. It's not worth it."

"It's worth everything when you want to leave. How did Theodore
insult you?"

Patricia looked down and sketched out figures with the tip of her
bronze shoe. "He is angry because I am engaged to Basil."

Colpster flung himself forward and caught her wrist. His sunken eyes
filled with angry fire. "You are not engaged to Basil?" he said
fiercely.

"But I am. Leave go my wrist, Mr. Colpster, or I shall go away at

once."

He still held her tightly. "You shan't marry Basil. You shall marry me."

Patricia was greatly indebted to the old man, as she had admitted,
and was sorry for his misplaced passion. But she was also a woman,
with a woman's feeling, and did not intend to allow him to dictate to
her. With a dexterous twist, she freed herself from his grip and
retreated to a safe distance. "If you behave like this, I shall leave the
room and never enter it again," she exclaimed, angry at his want of
self-control.
The threat brought the Squire to his knees. "No! no! Don't go!" he
cried in piteous tones. "I can't live without you. I wish to marry you.
See, Patricia, dear, I shall settle Beckleigh on you, and when the
emerald brings back the good luck you shall----"

"The emerald will only bring bad luck," said Patricia, interrupting
coldly. "And if you had millions I would not marry you. I love you as
a daughter, and I thought that you loved me in the same way. Basil
and I are engaged and intend to get married in a few months."

"He has no money," wailed the Squire, clutching the sheets; "no
money."

"I don't care. He is the man I love."

"He has no right to ask you to marry him."

"If he had not asked me, Mr. Colpster, I believe I should have asked
him," was the girl's quick answer. "Can't you understand that he is
the only man in the world for me? If you don't, then the sooner I
leave this house the better. You have no right to dictate to me, and I
won't allow it."

"I'll cut Basil out of my will. I shall leave the property to Theodore."

"That is a matter for your own consideration," said Patricia coldly.

"Now it's time for your beef-tea, and I must go and get it."

"I shan't take it," cried the Squire childishly.

"Mr. Colpster, for a man of your years you are very silly."

"My years--my years; you reproach me with those!"

"I reproach you with nothing," said Miss Carrol, tired of the futile
argument. "Can't you see that if you go on like this I must leave?"

"No, don't," he implored, with wild eyes. "I'll be good."

"Very well," she said, in a matter-of-fact tone. "Now I shall get your
beef-tea," and for that purpose she left the room.

Left alone, Mr. Colpster whimpered a little. He was old, he was sick,
and he was very sorry for himself. He had sought to woo a girl who
was young enough to be his daughter, and his wooing had taken the
fashion of trying to bribe her with house and land and money. To
this insult she had retorted by showing him the mother that is
hidden in every woman, married or unmarried. He felt like a naughty
boy who had been put in the corner, and at his age he did not like
the new experience. He could have kicked himself for having gone
on his knees to be whipped, for that was what it amounted to. In
the darkness--it was evening, and there was no light in the big bed-
room save that of the fire--he flushed and burned with shame. How,
indeed, could she, having found her mate in a young man of her
own age, beautiful and ardent as she was, be expected to accept his
Philistine offer of beeves and land?

The Squire, with all his oddities, was a gentleman, and as he came
from a brave race he was a man. His age, his fantasy about
refounding the family, his sickness, had all landed him in this slough.
It behoved him, if he wished ever again to look his ancestors'
portraits in the face, to get out of the quagmire and reassert his
manhood as well as his good breeding. Patricia should marry Basil
and become his niece-in-law. Mara could be given an income to
indulge in her fantasies, and he could live at Beckleigh with Mr. and
Mrs. Colpster, which was to be the married name of the young
couple. In the middle of these visions, Patricia returned with the
beef-tea and a lamp. The naughty boy came out of his corner to beg
pardon.

"My dear," he said, in an apologetic voice, "I'm an old fool."

"Oh, no," said Patricia kindly; "you are just one who has cried for the
moon."
"I give the moon to Basil," said the Squire, holding out his hand.
"And he will be my heir. Forgive me."

"Willingly," said Miss Carrol, and they shook hands gravely.

"But I agree with you," sighed Colpster, ending the scene; "the jewel
has brought bad luck."

CHAPTER XVIII

PLEASURE

Count Akira did not return so soon to Beckleigh as he had promised,

for he wrote that official business still detained him in London. But
during the third week after his departure, his yacht, The Miko,
steamed into the fairy bay and cast anchor a quarter of a mile off
shore. It was Basil who espied her first immediately after breakfast,
and he ran up a flag on the pole erected on the lawn. The Miko
dipped her ensign in reply, and shortly a boat put off, which
doubtless was bringing Akira on his return visit. Basil walked down to
the beach to meet him.

There was a tiny pier on the right of the beach which ran into deep
water, and the boat made for this. Basil, with his hands in his
pockets, stared at the yacht. She was a graceful boat of some two
thousand tons, and her hull was painted white while her one funnel
was darkly blue. The chrysanthemum flag of Japan streamed from
one of her mast-heads, and she looked a singularly beautiful object
as she rocked on the blue waters of the bay. Basil judged from her
lines that she was swift. But he had little time to take in much, as
the boat which approached at a furious pace was a small steam
launch. She came alongside the pier in a few minutes.

"And how is my good friend Dane?" asked Akira, hoisting himself up

like a monkey and removing his cap. "You see, I am here as
promised."

They shook hands, and Basil thought that Akira looked very
workmanlike in his smart blue yachting dress. A wiry brown lithe
little man was the Japanese, keen-eyed and alert. The most casual
observer could see that, if necessary, he could make himself very
disagreeable.

"I am glad to see you again, Akira," said Basil; "come up to the
house."

The Count gave a few directions to the officer in charge of the

launch and then placed himself at his friend's disposal. "All are well
in your family, I hope?" he remarked, as they strolled up through the
woods.

"My uncle has broken his leg, I regret to say."

"Indeed!" Akira looked shocked. "I am very sorry. How did it

happen?"

Basil gave him a hasty description of the accident. "In fact, Akira,"
he added, with a puzzled look, "since you went away everything has
gone wrong."

"What do you mean?" asked the Japanese quietly, and his face
became entirely devoid of emotion.

"What I say. My uncle broke his leg and has lost a lawsuit, which he
hoped to gain. Theodore and I have quarrelled, and the house is as
dull as tombs."
"I hope Miss Carrol is not dull?" observed Akira politely.

Dane turned swiftly to observe the expression of the little man's

face. He had said more than he meant to say on the impulse of the
moment, and now that he had said so much, he deliberately said
more. Apparently Akira, who was very sharp, had noted, during his
visit, symptoms of lovemaking. It was just as well to let him know
how matters stood, for, after all, the Japanese was not a bad little
fellow. "Miss Carrol is engaged to marry me," said Basil, drawing a
deep breath.

"I congratulate you, but I am not surprised. I saw much when I was
here on my visit"--he paused; then went on shrewdly, "I do not
wonder that you have had a quarrel with your brother."

"Never mind that, Akira," said Basil hastily; "I really did not intend to
tell you that. It slipped out."

Akira nodded. "You must permit me to send you and Miss Carrol a
present from my own country when I reach it," he remarked,
changing the subject.

"It is very good of you. I am sure Miss Carrol will be delighted. When
do you sail for the East?"

"To-morrow. I have secured an excellent appointment at Tokio."

"It is very good of you to anchor here, and delay your journey," said
Basil cordially; and Akira gave a little laugh as the young man spoke.

"Oh, I had a reason," he said coolly. "I never do anything without a

reason, Dane. I shall tell my reason to Mr. Colpster, if he is to be
seen."

"Oh, yes. He is out of bed, although he has not yet left his room.
The leg is mending splendidly, and he lies mostly on the sofa in his
bedroom. I am sure he will be delighted to see you."
"And Miss Mara? Will she be delighted?"

Basil again gave a side glance, but was far from suspecting why the
remark had been made. "Don't you make her dance any more," said
Dane, nervously.

"No, I promise you that I won't do that," answered Akira, his face
again becoming so unemotional that Basil could not tell what he was
thinking about; "but you have not answered my question."

"Here is Mara to answer for herself," said Dane, and he spoke truly,
for as they advanced towards the front door of the house, it opened
suddenly and Mara flew out with sparkling eyes.

"Count Akira. I am so glad to see you again. Is that your boat? What
a nice boat she is. When did you arrive and what are----"

"Mara, Mara, Mara!" remonstrated Basil laughing, "how can the man
answer so many questions all at once?"

"I would need Gargantua's mouth as your Shakespeare says,"

observed Akira with a quiet smile, and his eyes also sparkled at the
sight of the girl.

"Come inside, Akira, and I will tell Miss Carrol," said Dane hospitably.

He stepped into the house, but Akira did not follow immediately. He
lingered behind with Mara, and, after a glance at the many windows
of the house, he gave her hand a friendly shake. But his words were
warmer than his gesture, for they were meant for Mara's private ear,
while the handshake was for the benefit of any onlooker.

"I have come, you see. You are glad?" and his black eyes looked
volumes.

Mara nodded, and from being a pale lily became a dewy rose. "Of
course. Did I not promise to love you for seven lives?"
"Your father will not understand that," said Akira dryly.

Mara started. "Will you tell him?" she asked anxiously.

The Count bowed stiffly. "I am a Japanese gentleman," he said in

cool and high-bred tones, "and so I can do nothing against my
honour. I cannot take you with me unless your father consents."

"But he will not," breathed Mara, becoming pale with emotion.

"He will. Already this morning he has received a long letter from me,
which I sent from London. It explains how I love you, and asks for
your hand."

"But you are not of my religion!" whispered Mara distressed; "he

may object to that."

"I think not, as your father, from what I saw, is of no particular

religion himself. I have a special license in my pocket. We can be
married to-day in your own church and by your own priest. When we
reach Japan we can be married according to Shinto rites."

"But your family?"

"I have my uncle in London. On hearing all about you, he has

agreed. There will be no trouble with my family."

Mara, still nervous, would have asked further questions and would
have put forward further objections, but that Patricia made her
appearance at the door. She looked singularly beautiful, although
she was not so in Akira's eyes. He preferred the small features and
colourless looks of Mara. Patricia's face was too boldly cut and too
highly coloured to be approved of by an Oriental.

"How are you, Count?" said Miss Carrol, shaking hands.

"Very well; and you? But I need not ask, Miss Carrol." Akira laughed
in a very sympathetic way for him. "Dane has told me."

"Oh!" Patricia blushed.

"I wish you all happiness, and may you be united for seven lives."

"What does that mean?"

"I know! I know!" cried Mara, clapping her hands and jumping; "in
Japan we all believe in reincarnation, and lovers promise each other
to love during seven earth-seasons."

"But you are not a Japanese, Mara," said Patricia, wondering that
the girl should so boldly couple herself with Akira.

"Yes, I am," Mara asserted decidedly; "my body is English, but my

soul is Japanese. I know now that I was a Miko in the Temple of
Kitzuki three hundred years ago, and that I loved him," she pointed
to Akira, who smiled assentingly.

"Oh, what nonsense!" said Miss Carrol, rather crossly; "it is your
imagination, you silly child!" and then, before Mara could contradict
her, she turned to the Count. "Mr. Colpster wants to see you," she
remarked. "Will you follow me?"

"I want to come also," said Mara; and grasping Akira's hand she
went into the house. They looked at one another adoringly and
smiled.

At the bedroom door Patricia left them, as the Squire had intimated
that he wished to see Akira privately. Miss Carrol therefore desired to
take Mara downstairs with her, but the girl refused to go. "I have to
speak to my father also," she declared obstinately, "and I must do so
while the Count is present."
"As you please," replied Miss Carrol, finding it impossible to move
the girl, and knowing Mara's obstinate disposition of old, "you will
find me in the library when you come down."

"With Basil!" cried out Mara mischievously; and Patricia looked back
to give a smiling nod. Then the two entered the bedroom.

Mr. Colpster was lying on the sofa near a large fire, wrapped in his
dressing-gown, and looked thin, since his illness had rather pulled
him down. He also appeared to be somewhat cross, and shook at
Akira several sheets of blue paper with an angry air.

"I received your letter this morning," he said sharply, and without
greeting his visitor in any way.

"That is good," said Akira politely, "it will save me the trouble of an
explanation, Mr. Colpster."

"I think not," growled the Squire. "I must know more, and in any
case I do not intend to consent."

"Oh, father, you must!" cried Mara, indignantly.

"Go down stairs, child," said her father quickly; "I wish to speak
alone with this--this gentleman."

But Mara stood her ground. "What the Count has to say concerns
me," she declared obstinately. "I shan't go!"

Colpster stormed vainly, while Akira looked on passively. But nothing

would move Mara from the position which she had taken up. She
simply laughed at her father, and in the end he had to yield a
grudging consent to her remaining in the room.

"And now, sir," he said, when this was settled and again shaking the
sheets of blue paper at Akira. "I understand from this that you wish
to marry my daughter Mara. Of course, it is quite impossible!"
"Why?" asked Akira calmly, and holding Mara's hand.

"Because you are not an Englishman," spluttered the Squire.

"If I was a Frenchman, or a German, you would not object!" retorted

the Count coolly. "Why not say that it is because I am not a
European!"

"Very good then, I say it. You are of the yellow race, and Mara is of
the white. Marriage between you is ridiculous."

"I don't think so, sir."

Mara looked at her father disdainfully. "I don't know why you talk
so," she said with a shrug. "I intend to marry Count Akira to-day,
and go away with him to-morrow, to Japan in our yacht."

"Our yacht, indeed!" echoed the Squire angrily, and then stared at
the pale obstinate face of his daughter, framed in a nimbus of
feathery golden hair. "Oh you are a minx! You never loved me!"

"I can't help that," said Mara doggedly; "I never loved anyone until I
met with the Count. I couldn't understand myself until I danced that
night in the drawing-room. Danced the Miko-kagura."

"What is that? What is she talking about?" Colpster turned to Akira.

The Count explained politely. "When I came here, sir, I noticed that
Miss Colpster was greatly interested in what I had to say about my
own country. And often, when I told her of things, she said that she
remembered them."

"How could that be when she has never been out of England?"

"That is what puzzled me, until I, one night--by way of an

experiment and to convince myself--placed on the fire some incense
used in the Temple of Kitzuki, and played on a flute the music of the
Miko-kagura, which is a holy dance. Miss Colpster rose and
performed it perfectly. Then all the past came back to her, as she
told me later."

"What past?" demanded the Squire, much bewildered.

"The past of her life in Japan, three hundred years ago."

"Oh, that is rubbish!"

"It is true!" cried Mara in a thrilling voice, and raised her arms. "I
was a Miko of the Kitzuki Temple three hundred years ago. That is
why I remembered about the emerald, when Theodore sent me into
a trance. And for the same reason I could describe the shrine. I
loved the Count then, when we wore other bodies, and promised to
love him for seven lives. This time I have been born in England, but
he has come for me here, and I am going with him to my native
land."

"Oh, you are quite mad!" said Colpster furiously.

"Mad or sane, let me marry her, Mr. Colpster!" pleaded Akira. "From
my letter you can see that I am going to occupy an excellent official
position at Tokio, and that I am of very high rank in Japan, besides
being wealthy. I love your daughter, because, I truly believe--strange
as it may seem to you--that we loved three hundred years ago. I
have a special license in my pocket, and if you consent we can go to
your church this day and get married according to your religion.
When we reach Japan we shall be married according to mine. Do
you consent?"

"No! It's ridiculous! You have only known Mara a few weeks."

"I have loved her for three hundred years!" insisted Akira, smiling.

"I don't believe in that rubbish."

Mara seized her lover's hand. "I am tired of all this," she said in her
old fashion, "why can't you leave me alone. I marry the Count!"

Colpster saw that, whether he gave his consent or not, she would
certainly do so. And, after all, as he asked himself, what did it
matter? Mara had never displayed any affection for any single
person, since she had always lived in a dream-world of her own.
Now that he had decided to leave the property to Basil and Patricia
on condition that they assumed the name of Colpster, Mara was
unnecessary. Finally, it was certain that she would be happier in
Japan than in England, since there was evidently no future for her in
the West. The Squire did not believe in reincarnation. All the same,
he admitted that Mara's many oddities suggested that she was a
soul born out of time and place. But that his daughter should marry
one of the yellow race offended the old man's pride. He was just
about to open his mouth and refuse permission again when Akira
spoke blandly.

"If you consent," said Akira, "I will send you someone who can tell
you who killed your housekeeper."

"How do you know?" asked Colpster, startled.

"I have been making inquiries in town. Consent, and you shall know
all."

"And consent," said Mara, stepping up to her father and bending to

whisper in his ear, "or I shall tell the Count that you have the
emerald."

Colpster turned white. "How do you know?" he whispered back.

"I saw you slip it under your pillow one day. It is there now. If you
don't let me marry the Count he shall take it from you now."

The Squire breathed heavily and dark circles appeared under his
sunken eyes as Mara stepped back to stand beside her lover. He
knew that his daughter did not love him, or anyone else, but he had
never believed she would have spoken as she had done.
Undoubtedly the theory of reincarnation was a correct one. She was
an Eastern soul in a Western body. "I consent to the marriage," he
said in cold, dry hard tones. "You can go to the church on the moor
and get the affair settled. I cannot come myself, but Basil and
Patricia can go with you. Mara, you had better tell your maid to pack
your clothes, since you leave to-morrow."

"Everything is already packed," said Mara, turning at the door and

looking cool and white and more shadowy than ever. "I shall come
and say good-bye."

"No, don't!" shuddered the Squire, as she went out. "You go also,
Akira."

The Count smiled blandly and walked to the door. "I shall keep my
promise, sir, and to-night you will receive one who will be able to tell
you the whole truth of what has puzzled you for so long."

When Akira disappeared, the Squire tore up the blue letter and
threw the pieces into the fire. He had done with Mara: she was no
longer any daughter of his. And, indeed, she never had been. Always
cold: always indifferent: a very shadow of what a daughter should
have been. He was well rid of her, this traitress, who would have
surrendered the emerald. Colpster felt under his sofa pillow and
pulled out the gem. It was wrapped in paper, and he unfolded this to
gaze at it. A knock at the door made him hastily smuggle it away
again. Basil entered immediately and looked worried.

"Is it true, uncle, that Akira and Mara are to be married?" he asked
abruptly.

"Quite true. Akira has brought down a special license. Go with

Patricia and see that all is shipshape."
"But, Uncle George, surely you don't want Mara to marry a
Japanese?"

"What does it matter? Whether I give my consent or not, Mara will

do what she wants to do. There is some rubbish about reincarnation
between them--about loving for seven lives, or for three hundred
years. I don't understand these things. But what I do understand,"
cried Colpster with cold fury, raising himself on his elbow, "is that
Mara does not love me, and that I intend to cut her out of my will.
Send Jarvis to Hendle and tell Curtis the lawyer to come over at
once. You will have the property, Basil, and then can marry Patricia.
Theodore can go away. I won't have him in the house after the way
he has insulted your future wife. As to Mara, she can go to the devil!
or to Japan. I never wish to set eyes on her again!"

"But what has she done?" asked Basil, bewildered.

The Squire could have told him, but did not intend to, since that
would mean revealing that the Mikado Jewel was under the sofa
pillow. "Never mind; I am well rid of her, and so are you, and so are
we all. Only see that this Japanese marries her properly."

Dane argued, implored and stormed, but all to no purpose. His uncle
vowed that if Mara remained, he would turn her penniless from the
house, and Basil was sufficiently acquainted with his obstinate
character to be certain that he would keep his word. Under the
circumstances it seemed reasonable that Mara should lie on the bed
she had made and the young man, making the best of a bad job,
went away to get Patricia. He would act as Akira's best man, and
Patricia could follow Mara as her solitary bridesmaid. Whatever
might be the outcome of this sudden arrangement, Basil determined
to see that the marriage was legal. And when he saw the joy and
delight of Mara and the lover-like attentions of Akira, he began to
think that his uncle had acted for the best. In the face of Mara's
obstinacy, nothing else could be done, although Basil, being a true
Englishman, did not relish the Japanese as a cousin-in-law. All the
same, he approved of Akira's fine qualities, and knew that from a
worldly point of view Mara was making a brilliant match.

Obeying instructions, he sent Jarvis for the Hendle lawyer, when,

with the prospective bride and bridegroom, he and Patricia were on
their way to the quaint old church on the moor, where so many
Colpsters were buried. The clergyman could not disobey a special
license, so that was all right, and he hoped to return later with the
pair married. Indeed, had Basil possessed a special license himself,
he also would have stood before the altar with Patricia, but such
things were far beyond the means of a poor lieutenant of His
Majesty's Navy.

Meanwhile, the Squire received Curtis and made a new will, which
made no mention of Mara and Theodore, but left the entire Colpster
estates to Basil, provided that he took the family name and married
Patricia Carrol. When the testament had been duly signed, sealed
and delivered, the Squire decided to keep it in his possession until
the morrow, so that he could show it to the young couple. Curtis
wished to take it with him, but Colpster refused, and finally departed
without even a copy of the document. However, he promised to call
the next day and take it with him for safety. Just as the lawyer
departed, Theodore entered the bedroom.

"What's all this about?" he asked sharply.

His uncle looked at him with a frown. "What do you mean entering
my room without knocking?" he demanded in his turn.

"I beg your pardon," said Theodore with forced politeness, "but
everything seems at sixes and sevens since that infernal yacht came
in. All the servants are getting themselves ready to go to the
entertainment to-night, and I can't get anyone to answer my bell."

"Wait until Miss Carrol returns and she will see to things," said
Colpster indifferently. "I can't be bothered."
"Where is Miss Carrol? I have been in my room all day, and when I
came down I couldn't find anyone."

"Basil and Patricia have gone to attend the marriage of Mara and
Akira."

Theodore stepped back and then stepped forward. He could scarcely

believe his ears. "Have you allowed that?" he asked in consternation.

"Yes. Akira is a good match, and Mara loves him."

"But he's a Japanese?"

"What does that matter?"

"I don't believe in marriages between members of different races."

Colpster looked at him cynically. "What the devil does it matter what
you believe! I agreed to the marriage for two, or rather, for three
reasons. In the first place, Mara would have married in any case had
I not consented. In the second, she threatened, if I did not agree, to
tell Akira about the emerald, which he would then have taken from
me. In the third place, Akira said that if I agreed, he would send
someone to-night to tell me all about the murder of Martha and
reveal the name of the person who did it."

"It was the priest with the scar on his cheek who did it," said
Theodore in vigorous tones. "Will he--Akira that is--send him?"

"I don't know. Don't bother me!" said the Squire, turning over on his
pillows. "I'll see him when you are all out of the house."

"I'm not going to that infernal entertainment," said Theodore

snappishly, "as I don't approve of Mara marrying that yellow man. I
shall stay here and listen to what this emissary of Akira's has to say."
"Oh, do what you like; do what you like; only don't bother me!" said
Colpster again, and very sharply. "Clear out, please!"

"All right!" Theodore went towards the door; "only I want to say one
thing. Curtis has been here. Have you cut Mara out of your will?"

"Yes; although it is no business of yours. When she marries Akira,

she will have plenty of money."

"Well, then, I suppose," said Theodore, shooting his arrow, "you

know that Patricia and Basil are engaged?"

"Yes, I am aware of that, and I wish them joy."

"Aren't you angry, uncle?" Theodore was astounded.

"No. Why should I be? I like Patricia."

"I fancied you loved her and wished to marry her."

Colpster rolled over and glared fiercely. He was annoyed that his
secret should have been discovered by Theodore, of all people, since
he hated him so ardently. "I never did wish to marry Patricia," he
said furiously, and telling a smooth lie. "I look upon her as a
daughter. I have always looked upon her as a daughter. When Basil
told me that she had consented to be his wife, I was delighted. I am
delighted."

"Oh!" growled Theodore, wincing and thrusting his hands deep into
his pockets; "so you brought Curtis over to alter your will!"

"Yes! I have left everything to Basil and Patricia!"

"What about me?" Theodore by this time was ghastly pale.

"Oh, you can go to the devil!" said his uncle carelessly. "You insulted
Miss Carrol, so I pay you out. The will cutting you off is here," he
patted his pocket.
Before Theodore could express the rage which consumed him, there
came the sound of advancing feet and the laughter of happy people.
The door was suddenly thrown open by Basil, and Patricia entered,
followed by the bridegroom and the bride, arm-in-arm English
fashion.

"Allow me," said Patricia gaily, and in a ringing voice, "to present to
you, Mr. Colpster, the Count and Countess Akira."

CHAPTER XIX

THE TRUTH

With the early darkness of February came a spectacle to delight and

astonish the home-staying folk of Beckleigh. Suddenly at eight
o'clock, when the entire household were gathered on the beach for
transport in the launch to the yacht, The Miko became outlined in
coloured fire. Radiant and weird against the gloom in red and blue
and yellow and green, she flashed into being like a spectral Flying
Dutchman. Never before had such a sight been seen in that quiet
Devonshire bay, and loudly sounded the amazed voices of the
servants, praising the gorgeous illumination. It was like magic to
them, and several were heard to express a hope that the devil was
not on board the ship of light. However, the Japanese officer in
charge of the launch which puffed up spoke sufficient English to
reassure them, and they all embarked for an evening's revelry.

The bride and bridegroom, with the two who had witnessed the
marriage, had long since gone on board. Mara did not intend to set
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