I was reading this tonight and began thinking about Aboriginal and Torres Strait Islander birthing women in Australia.
Aboriginal and Torres Strait Islander women are marginalised in the care that they have access to if they live remotely, and also if they don’t live remotely in many respects. These women have to relocate to larger towns that have midwifery and obstetric care a few weeks before their baby is due. This is a massive inconvenience for all sorts of reasons and the women do not like it. They don’t like to leave their community, their partners and their land. It’s important for these women to birth on their own land. This radio segment that I put on my last blog explains why. It’s worth a listen. Also have a look at This.
Rather than me bang on about it, I found these articles/papers that explain some of these issues better than I could! I’ve added the references in case you want to look them up.
The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants are significantly poorer than they are for other Australians; they worsen with increasing remoteness where the provision of services becomes more challenging. Australia has committed to ‘Overcoming Indigenous Disadvantage’ and ‘Closing the Gap’ in health outcomes. Issues: Fifty-five per cent of Aboriginal and Torres Strait Islander birthing women live in outer regional and remote areas and suffer some of the worst health outcomes in the country. Not all of these women are receiving care from a skilled provider, antenatally, in birth or postnatally while the role of midwives in reducing maternal and newborn mortality and morbidity is underutilised. The practice of relocating women for birth does not address their cultural needs or self-identified risks and is contributing to these outcomes. An evidence based approach for the provision of maternity services in these areas is required. Australian maternal mortality data collection, analysis and reporting is currently insufficient to measure progress yet it should be used as an indicator for ‘Closing the Gap’ in Australia. A more intensive, coordinated strategy to improve maternal infant health in rural and remote Australia must be adopted. Care needs to address social, emotional and cultural health needs, and be as close to home as possible. The role of midwives can be enabled to provide comprehensive, quality care within a collaborative team that includes women, community and medical colleagues. Service provision should be reorganised to match activity to need through the provision of caseload midwives and midwifery group practices across the country. Funding to embed student midwives and support Aboriginal and Torres Strait Islander women in this role must be realised. An evidence base must be developed to inform the provision of services in these areas; this could be through the testing of the Rural Birth Index in Australia. The provision of primary birthing services in remote areas, as has occurred in some Inuit and New Zealand settings, should be established. ‘Birthing on Country’ that incorporates local knowledge, on-site midwifery training and a research and evaluation framework, must be supported.
Kildea S; Kruske S; Barclay L; Tracy SAffiliation:Australian Catholic University and Mater Mothers Hospital, Women‘s Health and Newborn Services (Maternity), Mater Health Services, Brisbane, Queensland, AustraliaSource:Rural & Remote Health (RURAL REMOTE HEALTH), Jul-Sep2010; 10(3): 1-18. (18p)
Traditional birth attendants can teach us so much.
Providing healthcare in remote areas is challenging. If you are a health care worker and get a chance to do an elective or a stint in a remote area please do. It really helps in your practice and brings awareness to these issues.
Something else I bang on about is the need to train more aboriginal midwives. So here’s something on that….
One of the strengths of an Aboriginal and/or Torres Strait Islander midwifery student providing COC to Aboriginal and/or Torres Strait Islander women is the dual role she plays in the provision of culturally competent, evidence based clinical midwifery care, as well as the ability to understand the woman’s social, cultural and practical health care needs.31Aboriginal and/or Torres Strait Islander midwives bring to the woman-midwife partnership a unique skill set that non-Aboriginal and non-Torres Strait Islander midwives do not possess. This skill set includes a shared understanding of the lived experience of being an Aboriginal and/or Torres Strait Islander woman in a mainstream culture. An Aboriginal and/or Torres Strait Islander midwife is able to act as a bridge between the two cultures and relate to other Aboriginal and/or Torres Strait Islander childbearing women in a culturally appropriate way.34Women in our study all spoke of the ways in which the Aboriginal and/or Torres Strait Islander midwifery student helped them to understand the complex health information that the doctors and other health staff gave them. The way the students translated the medicalised language into terms that the women could easily understand was highly regarded by the women in this study. While the role of translator is indeed an important one and evidence from our study indicates it makes a difference to the woman’s experience of maternity care, it is not the only benefit of having Aboriginal and/or Torres Strait Islander midwifery students provide COC to Aboriginal and/or Torres Strait Islander childbearing women.
Aboriginal and/or Torres Strait Islander health professionals are able to advocate for Aboriginal and/or Torres Strait Islander women within the hospital and other medicalised settings. An evaluation of a successful Aboriginal Maternal and Infant Care (AMIC) program in South Australia highlighted the crucial role played by the Aboriginal AMIC workers.30 In this programme, the AMIC workers took a lead cultural role and participated in all aspects of perinatal care.15 These workers were able to advocate for the Aboriginal women in the hospital and develop relationships with the hospital midwives. Initially there was reported resistance to the AMIC workers and the programme, however, as rapport developed between the AMIC workers and the hospital midwives, the resistance decreased. The employment of Aboriginal and/or Torres Strait Islander midwives would play a crucial role in the provision of culturally appropriate care to Aboriginal and/or Torres Strait Islander women and may improve the understanding and cultural awareness amongst non-Aboriginal and/or Torres Strait Islander midwives.
Women and Birth,Volume 27, Issue 3, September 2014, Pages 157-162
There is quite a commitment in this area from a midwifery perspective. I’d like to think that we will train more Aboriginal and Torres Strait islander midwives and then leave them to it.