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Birthing On Country is a Sovereign Right For Indigenous Parents

21 Feb 2022

Indigenous maternal and neonatal outcomes are disappointing, given that Australia prides itself on the delivery of safe clinical maternity care. Indigenous women are disproportionality disadvantaged when it comes to culturally safe maternity care, and often experience racism when accessing mainstream services, which forms distrust and disengagement in mainstream maternity services.

Indigenous women have been birthing since time in memorial, when the lands were pure, and the dreaming stories were a reality. Birthing is the first ceremonial journey we go through to leave the spirit world to come into the physical world. Our connection to our ancestors and our culture provides our people with a sense of belonging and grounds our ways of knowing, being and doing.

For thousands of years Indigenous women have used traditional birthing medicines and methods while caring for women in labour, birth, and postpartum periods. A continuation of thousands of years of knowledge that has been diluted and overtaken by the western medical models of care. The dispossession of traditional Indigenous birthing methodologies has led to the loss of cultural birthing practices, languages and self-determination of the oldest living peoples on the planet. But we are still here and not defeated!

The lack from the Australian government to implement a midwifery-led continuity of care (CoC) model has a profoundly negative impact on the outcomes of mothers and babies. Many of these outcomes can be prevented.

Indigenous neonates are twice as likely to die within the first year of life than non-Indigenous babies due to premature and low birth weight. The Australian Institute of Health and Welfare (2020) reports that Indigenous mothers are 3 times more likely to die in childbirth, which is equivalent to 17.5 per 100,000 births compared non-Indigenous women at 5.5 per 100,000 births.  Australian Institute of Health and Welfare (2021) Pregnancy and birth outcomes for Aboriginal and Torres Strait Islander women: 2016–2018, AIHW, Australian Government, accessed 17 February 2022.

Nationally, Indigenous midwifery is in crisis, with less than 300 practicing midwives. The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives are working with national bodies and government to highlight the urgency and work towards increasing the number of Indigenous nurses and midwives across the country. Kelly et al. 2012, states that Indigenous women felt more comfortable and were more likely to access maternity care when they were being cared for by an Indigenous midwife. Indigenous women preferred their maternity care to be provided by an Indigenous midwife as they felt a deeper connection and understanding which can be linked to our shared inter-generational trauma from invasion.  – “‘She knows how we feel’: Australian Aboriginal and Torres Strait Islander childbearing women’s experience of Continuity of Care with an Australian Aboriginal and Torres Strait Islander midwifery student”: https://www.sciencedirect.com/science/article/pii/S1871519214000559

Indigenous women have expressed their personal experiences across mainstream services as “racist, judgemental and not safe”. If women are feeling this way about mainstream services, then this is a systemic problem, not an Indigenous problem. If systems are not safe and are not approachable, we cannot continue to blame women for not accessing crucial maternity care and their outcomes. Racism within mainstream services exists, and this preventative contributing factor is why our women refuse to access services that treat them so defectively, which then lead to poorer outcomes.

The gap in health disparities between Indigenous and non-Indigenous people remains substantial, and this is largely due to the lack of understanding and investment in Indigenous ways of knowing, being and doing. The need to acknowledge and truly invest in Indigenous led initiatives, including organisational holistic models of care, to eliminate the existing historic disparities is vital to improve outcomes for Indigenous people.

The good news is, there are Aboriginal community control health organisations across the country, leading the way regarding best practice, and culturally led holistic care for their communities. In New South Wales, Waminda South Coast Women’s Health and Welfare Aboriginal Corporation have been caring for community for over 37 years and work from an Indigenous strengths-based perspective and embed culture as the foundation of health and wellness. Our goal is to work alongside community members by providing access to cultural, spiritual, physical, and emotional wellbeing programs that have been developed and informed by community. We address the social determinants of health, which directly and indirectly impact a person’s wellbeing and ability to live thriving and empowering lives that create strong communities, strong women, and strong families.

Our birthing on country model is embedding within our broader model of care. This allows a complete wrap around, whole of life approach that is individually tailored. We have been advocating for birthing on country for more than five years and it’s now time for action and investment to give our mothers and babies the opportunity for a cultural birth guided by ancient traditional ways.

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