Series 2 Episode 5: Nisha Khot on making a difference in obstetric care

Dr Nisha Khot

Dr Nisha Khot is a Melbourne-based obstetrician who trained in India and the UK before moving to Australia. She holds appointments across the full spectrum of health services including Royal Women’s Hospital (a tertiary centre), Western Health (in the growth corridor of Western Melbourne) and Bacchus Marsh’s rural maternity unit.

Synopsis: Nisha Khot’s experience of working in women’s health in India made her determined to make a difference in the field. Dr Khot’s working experience across various medical contexts around the world, from India and the UK to Melbourne and regional Victoria, brings perspective and depth to her practice. Her current roles see her working across rural and urban settings, moving between education, practice and leadership. She joins us for a chat about health literacy, perinatal rituals, quality and safety in the healthcare system and the need to address systemic racism in Australia’s health system.

Notes: Nisha kindly donated her speaker fee to support another speaker. Thank you! Just a note that the term “M&Ms” used in the podcast, refers to Morbidity and Mortality meetings. These are meetings where staff review deaths and complications in order to improve the quality of the care that is being provided to their patients as well as professional learning.
Please look after yourself, and access support if you need it, also see: SANDS Beyond Blue Lifeline
Music in this episode includes ‘Things Before Dawn’ by Floating Spirits, ‘For the Record’ by Daniel Birch and ‘Rabota’ by Victoria Darian and Alexei Kalinkin, used under a Creative Commons license from Free Music Archive.


INTRO — You’re listening to Birthing and Justice: a series of conversations about birth, racism and cultural safety. I’m Ruth De Souza. I’m speaking to you from the unceded sovereign lands of the Boonwurrung people of the Kulin Nations. I pay my respects to the traditional owners, and any Indigenous people listening. This land always was, and always will be, Aboriginal land. Today I’m joined by Doctor Nisha Khot. Nisha’s an obstetrician who trained in India and the UK before she moved to Melbourne. She currently works across urban and regional settings. Nisha’s interested in leadership, gender equity and diversity, and she’s a clinical educator at the University of Melbourne and Notre Dame University. A quick heads up: parts of this conversation may be distressing for some listeners. Alright, let’s meet Nisha.


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RUTH DE SOUZA (host) — So Nisha let’s get straight to it: why do you care about birth and birthing?


NISHA KHOT (guest) — I started out training in India, as you said, you know, I did my MBBS [Bachelor of Medicine, Bachelor of Surgery] in India, and then it came time to actually choose a specialty. At the time, my interest was pathology. I’d really loved looking down the microscope, looking at slides and looking at various organs and tissues. But the way the system is set out in India is that you have to actually do well in a particular subject before you can do post-graduation in that subject. And to my great surprise, I did well in obstetrics and gynaecology, not something that I had thought would be of interest to me during my undergraduate years. Having done well in the subject, I then thought, well you know, clearly there must be something here, so let me at least start out and see how I go. And I can definitely say that my first year of training in obstetrics and gynaecology in India was brutal. It was just nonstop, as most people can imagine. It was a big tertiary hospital, it delivered about ten thousand babies a year. When you worked there as a junior doctor, there was no time off, there was no rostered hours, there was nothing that said that, you know, once you’d done twenty-four hours you then got a break. Absolutely not. You just went on and on and on and on. And at sort of the six month mark of doing that, I thought, what have I got myself into? I am not strong enough for this. I can’t do this. I’ll never get to the end of this. And training in India is three years. And I thought to myself, I won’t survive the three years. And luckily for me, I found some really good mentors who were senior at the time. They were still training, but they were senior to me and they said, ‘No, no, the first six months is really awful, you’ve survived those. Things get better once you have survived the first six months.’ I didn’t believe them, honestly; I truly did not believe them. I thought they were having me on. I thought they were being selfish by saying, you know, ‘If she leaves now, then we won’t have anybody to do the work. And so we better keep her and we better tell her that it’s good.’ And, but I stayed on. And as things improved slightly—and I won’t say that they improved hugely, but they did improve slightly—and as I got to do more and more of it, I realised that actually there is a place for me here. Because in the first six months I thought this is not where I belong at all. So it took me those first six months to then realise that this was something I loved. And the more I did of it, the more I loved it. And especially in the cultural context of India, where women’s health is pretty much, I can’t even say it’s the Cinderella, it doesn’t even qualify to be part of, sort of, the sorts of things that were important from a healthcare provision point of view. And women’s health literacy was so poor. I’m talking now two decades ago, and so my hope is that things have changed for the better. But at the time I thought, if I’m going to make a difference to somebody’s life, I can do it best by staying in women’s healthcare.


I think that this passion for the underdog, or the least resourced, or the most vulnerable, is something that really comes through in, you know, your work. And it kind of explains your interests in these three spaces that you’ve chosen to work. Can you tell us about the similarities and differences in working across three very different kind of localities?


The similarities are that women still give birth to babies no matter where they are: whether they’re in a big tertiary hospital with the bells and whistles, whether they’re in a small, rural maternity unit, they are giving birth. And that experience is something that will stay with them forever. Wherever that baby is born, whatever happens, it’s an experience that mothers will never forget. And the role that someone like me as the doctor or a midwife or anybody who’s present in that place provides, is to make those memories for that person. And I think that is the one thing that keeps me going. The fact that no matter where you are, you are making a difference to the one person that you are with at that time. Of course, there are differences. The thing about working in a big tertiary place is that you are never alone, you always have a big team of people, whether they be your colleagues, colleagues who are senior to you, your junior doctors who you’re training, interns who are there just to learn, medical students and a whole big midwifery team. You have the anesthetist, the pediatrician, you have everything available that you could possibly want, including ICU and high dependency units—if you need them. In a smaller unit, you are mostly by yourself with a very small team. And so when you make decisions, you have to consider the fact that you are in a small place, that you don’t have everybody right there at that time, you have to be more proactive and you have to be more thoughtful and considerate in your decision making. And that is really important, because if you leave those decisions to the last minute, then that is the wrong thing to do in a small rural hospital. It’s the right thing to do probably in a big tertiary hospital, because then you are not intervening as much because you are able to push things along ‘till you get to the real point where intervention is necessary. But in a small rural hospital, if you get to that point, you then have an hour’s wait sometimes to get the whole team together. And that is the wrong thing to do in that situation. And so that is the difference of resourcing and the size of the team you have with you, and the consideration for where you are and who the right person is to do a particular task, and what the right time is to make the decision to do that task.


I’m wondering how your background, you know, as Indian has shaped how you think about birth. Could you tell us a little bit about that?


I was very fortunate to have my own first baby in India. And in a very traditional Indian family sense where you would get to about twenty-eight weeks or so, and then you would traditionally move from your husband’s house to your mother’s house, where you would stay with your mum, your grandmum, your aunts, for the third trimester of pregnancy. Your baby would be born into this cocoon of family, and you would stay there for the next six weeks before going back to your husband’s house. That is traditionally what happens in India, in most of the cultural situations, and that is what I had with my first baby. And I thought it was so lovely to have that. The fact that for any woman who is having a baby, I think when you are pregnant and when you are having a baby, you think of your own mum. You know, whether that relationship has been good, bad, ugly, whatever it has been like, you think of your mum, because you are becoming a mum. Even if you have never known your mum, you still think of who that person might have been, who gave birth to you. And so for me, it was really special at the time I had grandmum, I had my aunts, I had my own mother who were all there, who made sure that I ate well, slept well, you know, was surrounded by love and affection, made sure that I got out every day for a walk or whatever the case might be. It was really lovely. And then when I came home with my baby, after having had a normal birth, they were there to help with baby. They were there to look after her, if she cried in the middle of the night; they were there to, you know, make sure that I was eating and drinking well. There was no need for me to get up and cook and, you know, do all of the housework because they were there to do that. I was meant to rest, which was, you know, which I think is really important for women after they’ve had a baby, which doesn’t happen outside of that Indian context. Or, you know, many other communities also have similar cultural ways of doing birth, and that doesn’t happen outside of that context. And the really special thing that I describe to everyone is the fact that in India, a special person would be employed just to come home and make sure that I got a massage, that the baby was bathed, baby got a massage, all of those things. And now I acknowledge completely my privilege at having that experience. And of course not all women in India will have that experience. That experience is true usually of people who can afford to have that experience. But even within that, even if you don’t have the sort of pampering and being spoiled part of it, you still have the fact that you would go to your mum’s house. And I think even if your mum or you don’t belong to the sort of socio-economic strata where you’d be able to afford to have all of those things, your mum’s presence and the presence of your aunties and your grandmum and the entire clan, makes a huge difference to every mother’s birth experience. And so for me, that has shaped so much of what I kind of try and do. I have realised, both in the UK and in Australia, that that is not the norm. Women are expected to just magically be pregnant, carry on working during pregnancy, have a baby and return to work as if nothing’s happened. Even when they do have their first few weeks after a baby’s born, they’re expected to keep a clean house and they’re expected to cook for guests and receive guests and all of that. And I just think that that is not right. Women deserve to have time to be able to nurture the pregnancy, have time to process the birth and have time to bond with their babies. So it does take a village to bring up a child, but it takes a village to actually support a pregnant woman through her pregnancy, birth, and those first crucial few weeks after. And when I think about the sorts of statistics that get thrown around about mental health and depression and breastfeeding rates going lower and lower every year, my feeling is that all of that stems from a lack of that nurturing support. And if we were able to give women—all women—that nurturing support, then we would get much better results. Why wouldn’t we! Of course we would.


Yeah. It’s a big, big interest of mine. My PhD was about women who have a baby in a new country, you know, and the kind of tensions between different ways of framing birth are deeply interesting. I’m wondering if we can talk a little bit about your other experiences in terms of leadership and trying to change the culture of birthing. You set up the Maternal Mortality and Morbidity Committee at Werribee Mercy Hospital and at Bacchus Marsh Hospital [laughs]—now I’m gonna get those words mixed up [both laugh]—where you conducted serious incident reviews and made recommendations for improvement in practice. Can you tell us a little bit about those roles and why you are interested in quality?


And again, Ruth, that is something that goes back to training in India. So when I trained in India, there was just this overwhelming maternal mortality and morbidity, which didn’t always get the sort of in-depth review or the thorough investigation that it should have got. It was very much a way of thinking that these things happen and they’re beyond our control, and there’s nothing really that we can do. And so that always troubled me. And then I moved to the UK and learned about clinical governance. And I learned that since the 1940s, UK had been looking at all of their maternal debts and publishing a report at various times. It was called various names, but the one I remember is ‘why mothers die,’ which really struck me as being something that was so important. And from there, this thinking around the fact that when something goes wrong, there is a lesson to be learnt, there are often multiple lessons to be learnt and that we can all learn from each other. And we can put into place policies and procedures and ways of doing things that will make a difference and do make a difference. And so that longitudinal kind of exercise, in saying that in this triennium, so many mothers died of this condition, here’s a set of guidelines, policies, procedures that can make a difference. Let’s put them into place. Let’s look at the same thing—ten years down the track, or six years down the track—and see that it has made a difference. It really struck me that small things, little things could make such a big difference. And that is where the interest started. When I moved to Australia, this was 2010, 2011, and I started work at Werribee Mercy Hospital out in the Western suburbs, and I realised that M&M [morbidity and mortality] meetings weren’t a norm in all Australian hospitals, which came as a surprise to me because I thought that’s just what everybody does. And sure it was what everybody does, but it wasn’t true for the smaller metropolitan units or the rural or regional units. And that made me think that there was an opportunity here to do things differently. So that is how we started. We started small, we laid the ground rules that this was not about blaming anyone, not about finding out whose fault it was, because it can often come across as being sort of a witch hunt rather than anything else. And so it was very important to make it clear that it was focused around learning, and focused around what we could do to change how we do things to make outcomes better for everyone. And it was a place for personal reflection. So we started out by doing simple audits. So we’d do an audit of how many women, for example, bled more than a litre, and then look at each of those individual cases and think about what could have been done to prevent getting to a litre. And those small things then made a difference to what we were doing every day, when women were birthing. And people started to see the advantage in it. Also, that moving away from that individual hero narrative—the narrative that the doctor arrived and saved the mother’s life or the baby’s life. Actually, it’s the team that does it. And it’s the team response that does it. And it’s getting away from this narrative of, there needs to be someone who comes in to save the day. It’s actually all of us. It’s not just one person. And that sort of also changed the way people thought about themselves and about each other. And it became more of a culture of teamwork and doing things together, rather than us versus them—which can sometimes happen in any unit where there is this way of thinking of, you know, this is the person who does the good things and saves people’s lives, and this is the person who doesn’t. Which is really unhelpful for the women who are receiving care in that place. Then of course, what happened was the big events in 2015-16 around Bacchus Marsh Hospital where there had been a few poor outcomes and that forced the process of M&Ms to become the norm. And so there were regional M&M committees set up so that all the regional and rural hospitals participated in M&M. And usually someone from a tertiary hospital went down as a representative, and as someone who could provide expertise—which is a great concept. As it goes, it encourages teamwork, not just within your organisation, but for that rural, regional, across the little organisations that you work with and communicate with. It is meant to be a place where you get to know your colleagues who work in the town next to you, or you get to know your colleagues in the hospital that you refer to. So it has really good intentions behind it. What can sometimes happen is that the person who arrives from the tertiary hospital may not always have an understanding of what rural healthcare actually involves. If you have always ever worked in a tertiary hospital, you may not understand that when you say, ‘Oh, why didn’t you call the anesthetist?’ actually, there is no anesthetist to call. Or, ‘Why didn’t you just take her to theater?’ No, sorry, we don’t have a theater, we have to transfer a patient to another hospital if they need a theater. So those are the local knowledge nuances that I think are really important when we do this sort of work. And sometimes they can get lost, as with everything. Sometimes we choose the first in best dressed person who arrives and says, ‘Yes I’ll do it,’ who may not necessarily [laughs] be the right person with the right qualifications, or the right lived experience of having worked in a smaller unit. So with the best intentions, yes, we should set up the sort of platforms where we can talk to each other, get to know each other, get to communicate with each other, but it’s very important to have the right people in the right roles.


Your experience is so broad and so deep, you know, with having worked in different settings, as well as different countries. And I’m kind of interested in your passion for leadership as well. So there’s something about you that’s committed to trying to make healthcare, and specifically birthing care, of very high quality, for all birthing people. But then there’s also this kind of trend in your career that you’ve had, to be a leader and take up leadership roles. Can you tell us a little bit about that?


So again, leadership was not something that was remotely on my playbook at all. [Laughs] I was going to be an academic and I was going to do, you know, clinical work with a little bit of research work and things like that. But as so often turns out with careers, especially with women who kind of, you know, mould their careers around the family, around what else is happening in their lives, around their spouses, around their children. It so happened that I got to this place where I was doing a regular clinical role. And then when the leadership role at Bacchus Marsh Hospital came up, I took it up. And once I had taken it up, I recognised that I enjoyed that role. I enjoyed making a difference from a different perspective, and that is what got me interested in leadership. The other thing that I had found very interesting looking around me when I was in the UK, and similarly when I moved to Australia, was that when I went to conferences, or when I went to meetings, the people speaking at the meetings were a completely different demographic from the people who sat in the audience listening to them. And that really made me think that all of us who are sitting in the audience listening, are equally qualified—because we went through the same training program, we had the same qualifications, the same sets of letters of the alphabet with our names. But it seems to me like nobody wants to hear from a large section of us who are doing the work, providing the healthcare. And so when the WHO [World Health Organization] put out that report that said ‘healthcare delivered by women led by men,’ that struck a note with me. Because I thought not only is that true, but actually it is also disproportionately delivered by people of colour, but led not by people of colour. And that can’t be right. If we look around us, those tricky problems of disproportionate mortality, morbidity, poor health outcomes, poor health literacy among women, among people of colour, among minority ethnicities have not changed for the last, we can go back fifty years, sixty years, eighty years, whatever number of years we want to go back to. Why might that be? Is it because we don’t actually listen to them? We don’t get to hear what they have to say. If they are not at the table where the decisions are being made about their health, then how can we be possibly doing the right thing, giving them the right tools? We don’t even know what those tools are because we have never asked them. And so that was where it started. Once again, I will acknowledge that I am not representative in any way, shape or form of the vast majority of people who suffer from those disproportionately bad outcomes and health literacy and all of those things. But my hope is that if people see someone like me in this role, it will be that trigger to say, ‘If she can do it, I can do it.’ And so for me, it’s just like Julia Gillard said: ‘It’ll be easier for the next and the next and the next.’


[music plays]


And I’m hoping that there are so many women of colour who have so much to contribute, to not just healthcare, but overall policies, decision making. They are really clever, smart, intelligent, articulate women. And my hope is that seeing me in this position will make them feel that they can do it too.


This issue of race is really important Nisha. And I’m wondering if you could tell us a little bit about the poor health literacy and poor health outcomes. Can you tell us a little bit about who this effects and what are the impacts? You know, who are we talking about when we say that women of colour are overrepresented in some of these negative maternity health statistics?


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So if we look at the UK, because the UK has for a very long time published its maternal mortality and morbidity statistics, they are very clearly showing that Black women have worse outcomes—whether they be maternal mortality, whether they be maternal morbidity. And that gives me food for thought, because here is a system, the NHS [National Health Service] is a system that in theory gives everybody the same treatment, because that’s how it’s set up. It’s set up to be this, you know, egalitarian system where you turn up to hospital with a condition and you’ll be treated no matter who you are, where you come from. So how come women who have Black minority ethnicity have disproportionately poor outcomes? Similarly, if you look at Australia, the outcomes for our Indigenous women are some of the worst in the world. They are equivalent to Third World outcomes, which should give us really a reason to think about how we provide healthcare. And then if we look at the next layer of women who are of migrant origin, their health outcomes—things like stillbirth rates, things like, you know, major perinatal trauma rates—are all worse for women who are of migrant origin. And even if you take away the literacy side of things, so if you look at educational achievements and you standardise for educational achievements, you still find that that difference stays. So there must be something there that we as healthcare professionals, and as healthcare providers, are not willing to acknowledge. And I think part of that has to be racism. We have to acknowledge that there is racism within how we do things. And unless we acknowledge it, we can’t deal with it; we can’t deal with something that we are not willing to even name. And unless we name it, how are we going to find the solutions to it? So that really is something that I feel we need to talk more about. And by and large, most healthcare professionals will say that ‘That’s not true, I am not racist,’ which is absolutely right. We don’t, you know, turn up for work, making this thing of, ‘If I see this particular woman, I’m going to do this differently for her.’ But it is that, what lies just beneath the surface, things that we are not conscious of, those unconscious implicit biases that we all carry with us. And if we don’t recognise them, we can’t address them. And so that is where I think we should be focusing, at least some of our attention, at making sure that we as individuals recognise our implicit biases and that we learn to correct them. And if we can’t correct them, we learn to work around them so that it doesn’t affect the care we provide, and the advice we provide to women, or the way we look after women.


I’m interested, I’ve just come back from camping last night, and I believe you’ve been away in regional Victoria as well. A nice break for us in this COVID time…


Yeah, mmm.


to finally have a little capacity to move. But I went camping near Mallacoota to a place called Shipwreck Creek. And I saw some Muslims walking past and I yelled out Salaamalaikum, you know, [giggles] and it turned out that three of them were specialist international medical graduates, you know, hilarious. One of whom was actually a GP on Instagram who I’d started following the day before, because he had nice pictures of Mallacoota. But this is an area that you’re very interested in. And I wonder, what your thoughts are about the number of obstetricians in rural and regional settings being from these international backgrounds? What do you think are the pros and cons of this kind of diversity for them and for the health systems in those places?


I think before we talk about pros and cons, we should talk about the fact that this is systemic. If you are an international medical graduate and you want to work in Australia, it is highly unlikely that you would get a job in a tertiary city based hospital. The only jobs—and the visas attached to those jobs—available to you would be in rural and regional Australia. And so it’s not a question often of choice, it’s a question of you take what you can get. And then as an international medical graduate, I think most of us come to a country with the acceptance that I will take what I get and I will work from there. And so it’s very important to acknowledge that we are not working rurally and regionally because we had a choice. And some of us will choose to remain in rural and regional roles because we enjoy them. Others will not, and will want to move away from them and then where are the pathways for people to move away from them as well. Because ultimately we should do the things that make us happy, that use our skills to the maximum. And we shouldn’t be forced into doing things that don’t make us happy, that then become a tick box exercise. Because then we are not useful to the people whose healthcare depends on us, and we are not useful to the system where we could have contributed a whole lot more. So that is one side of it. I personally have loved working in rural and regional Victoria, and I continue to love working there, which is why I was up in Wangaratta for the weekend, because I thought, you know, actually I do love the rural units because they are usually warm and friendly units. When you turn up in a rural hospital, people appreciate your presence there because, you know, it’s not like a big city hospital where if you don’t turn up, they’ll find someone else because they’ve got twenty other people. In a rural unit, if you are not there, then there’s no one there. And so you are appreciated, you are warmly welcomed, and your skill and expertise is really making a difference in the lives of the people who you see. What does diversity do for a small town? From my point of view, diversity is always great because it brings not only a different person, it brings everything that goes with the person, which is food—as you know, food is one of my passions [laughs]—and what would we be with just one kind of boring food? I mean, you know, life would be so monotonous if we had to eat the same thing every single day. And so there is that side of the culture—the food, the festivals, the colour, the different languages—and that is really good for any community to have, that sort of a different way of doing things, a different thing to celebrate, a different kind of opportunity to engage with each other. Of course, it is difficult if you are the only sort of different person in a small rural town, because then you don’t have people who look like you, talk like you, behave like you. And so you might then be singled out for special treatment, which is not always good. And so there is the downside of the sort of social… your social life. But there’s also the fact that when you are in a rural unit, you are very isolated. So you are an international medical graduate, you’ve come to Australia, so you don’t have any connections with local doctors and you don’t have any connections with the local hospitals. Not like local trainees who have grown up here and gone through the various hospitals. So their friends are the ones who are consultants in different hospitals, and they can talk to each other. You actually have no one whom you could pick up the phone to and say, ‘Hey, this is who I am.’ And when you do pick up the phone and say, ‘This is who I am,’ you are met with suspicion of ‘Who are you?’ and ‘You don’t speak English the way I’m used to hearing it spoken.’ And you are in this place that I’ve never heard of. So there is that really isolating feeling of being on your own and not getting help when you ask for it. And that is something that a lot of IMGs [international medical graduates] face. And, you know, we hear about cases of where things went wrong and where awful things happened. And that’s rarely up to one individual. It’s usually a system, a system that has not supported that individual to do the best they can in the circumstances that they’re in. And so yes, there are lots of advantages to working in rural communities, but we need to support those IMGs who go into rural and regional communities better—we need to engage with them better. And, you know, often again, when you look at organisations that represent doctors, most of the leadership in the organisations that represent doctors doesn’t look like any IMG. And so IMGs feel like ‘Mmm I’m not sure whether I belong to this organisation, which is meant to be my organisation.’ And that again goes back to that leadership and the diversity in leadership, and wanting to welcome everyone, no matter where you come from—you belong to this health system, and so we are all colleagues.


[music plays]


Sometimes well-intentioned things backfire. So this is my own college, RANZCOG [The Royal Australian and New Zealand College of Obstetricians and Gynaecologists]. Because IMGs had been struggling, RANZCOG made a decision that they would put into place a mentorship program to mentor IMGs and that the IMGs would be put in contact with a mentor by the college.


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And they were told that this is, you know, unbiased and confidential. And the relationship is between you and your mentor, and the college really is only putting you in touch, nothing to do with the college, nobody’s reporting back. But forgetting that actually IMGs come from countries where this is not the norm. For most IMGs, or for many IMGs, the countries they come from, the regulatory bodies are actually the bodies that are quote unquote, keeping an eye on them. And so, as an IMG, when your representative body tells you they’re going to provide you with a mentor, the IMG’s impression of that is also, ‘You are having someone keeping an eye on me just in case I slip up.’ And so that relationship then doesn’t work, becomes dysfunctional, because of the way it is set out, and the way it is perceived. And that is the importance of having the right people there to put things into place, because had an IMG been in that position of putting this in place, they would’ve probably said, ‘Well hang on, that won’t work.’ [Laughs] And as it turned out, it didn’t work very successfully. Whereas if we had said to every single doctor, the college wants to provide mentorship for anyone who needs it, we are not here to, you know, keep an eye on you, we are just putting you in touch with someone who will be a good mentor for you. And that’s it, we step back. Then that would’ve been inclusive for everyone, and not singling out a particular group of people who would then think, ‘Oh, I’m being targeted.’ So, you know, it’s just getting the right people to have the right conversations and make the decisions.


[Laughs] Yes, when good things go bad, right? [Both laugh] I’ve got a last question for you before I let you go back to your day. And that is, I’m really interested in what made you take up social media with such gusto? [Nisha laughs] And kind of, what you’re trying to do with social media?


I started social media just as a fun thing. That’s where it started, it was a fun thing. And I didn’t even know about Twitter, let me be very honest. I was on Facebook. It was a way of keeping in touch with the extended family across the globe, you know, posting pictures so everybody could see them, rather than sending individual pictures to individual family members. That was where it started. Then along came the same-sex marriage plebiscite in Australia. And that really struck me as being something that I just could not believe, that a progressive country like Australia was asking individual people whether they agreed or not about two completely or unrelated people should get married or not get married. I just could not get my head around it. And I knew a lot of my colleagues, friends, who were in same-sex relationships, I knew kids at school whose parents were in same-sex relationships, and I thought, oh my god, this must be so terrible to have this spotlight on your relationship. Why, why should it be so? If two people love each other, why does the rest of the world have anything to say about it? And so that is where the activism started. And that is how the activism on social media started. And I slowly came to realise that social media, Twitter, and such like, is a place where you can find people who can think like you, support you with what you do, and you can hear different voices, which you may not always have thought of. And you may not have the time to find out about. And so what I have found now is that a quick scroll on Twitter tells me more than anything on the news or on anywhere else. And so that is where I get my news from these days, because it gives me both sides of the story, if you like. The other thing I find really interesting is that all the research that is published by various journals, is posted on social media. And the experts who have done the research, or who have similar interests, will put their views under it. So I don’t need to go and read a paper, understand the paper, understand the nuances of what it’s trying to say, and I get it all in one nice bite sized scroll [laughs], which is great. And so my presence on social media is basically raising awareness about the issues that face women of colour, specifically, in various fields, and getting my news and all of my kind of research that I need to know about, via social media.


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OUTRO — Nisha, thanks so much for sharing the depth and breadth of your work with us. I’m so thrilled we connected on Twitter, and now we finally get to have a proper chat, especially about the impressive work you’re doing to try and improve obstetric healthcare for birthing people, and in particular, people from Aboriginal and migrant communities. I’m also really impressed by the way you’re trying to make your profession accountable to those communities that are the most marginalised. You truly are a leader.


Thank you very much for having me, Ruth, it’s been an absolute pleasure.


You can find more episodes, transcripts and links at I’ll add some links to Nisha’s work there as well. And if you got something out of this podcast, please leave us a rating or review wherever you listen. Next time on Birthing and Justice:


HELEN NGO (guest) — I think there’s a much more reciprocal relationship between the personal and the structural. And I guess this is where I see habit as potentially doing some of that in-between work.


I’ll be talking with philosopher Helen Ngo about bilingual parenting, the embodied experiences of parenting and race, and the fundamental relationality of birthing. Birthing and Justice with Doctor Ruth De Souza is written and hosted by me, and recorded at my home on the traditional lands of the Boonwurrung people of the Eastern Kulin Nations. Sound design and mix by Jon Tjhia, artwork by Atong Atem, design by Ethan Tsang, theme music by Raquel Solier and produced and edited by Jon Tjhia. This podcast is supported by funding from the RMIT University Vice-Chancellor’s Fellowship Program. Thanks so much for listening, look forward to catching you again very soon.


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*Just a note that the term “M&Ms” used in the podcast, refers to Morbidity and Mortality meetings. These are meetings where staff review deaths and complications in order to improve the quality of the care that is being provided to their patients as well as professional learning. Please look after yourself, and access support if you need it, also see: SANDS Beyond Blue Lifeline.


END NOTES — Audio transcript edited and designed by Abbra Kotlarczyk, 2022. Note: t­­­­he purpose of this audio transcript is to provide a record and pathway towards accessing all Birthing and Justice conversations. Editorial decisions around the omission of certain words and non-verbal utterances have been made purely for stylistic purposes towards greater legibility, and do not infer a desired ethics of speech.