First Nations mothers are more likely to die during childbirth. More First Nations midwives may close this gap

While Australia is one of the safest places in the world to give birth, First Nations women are three times more likely to die during childbirth than other Australian women (17.5 versus 5.5 per 100,000 women in 2012). -2019).

And First Nations babies are nearly twice as likely to die in the first month of life (16% versus 9% per 1,000), with premature birth the leading cause of death.

The causes of these gaps in life expectancy are complex and stem from colonization, including:

• racism and lack of cultural security in hospitals and healthcare providers

• pregnant First Nations women avoiding antenatal care for fear that child protection services will take their children. It is a legacy of the “stolen generations” with persistently high rates of child abduction

• closures of regional and remote maternity services that require more First Nations women to leave home and travel long distances to give birth, often alone. Some women choose to give birth without a midwife, which can be very difficult for both mother and baby.

Ensuring that First Nations children are born healthy and strong is the second Closing the Gap target – a critical foundation for “everyone who enjoys long and healthy lives”. A much-needed step to ensure this is to increase First Nations health workers, especially midwives and nurses.

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Addressing the health impacts of colonization

Before colonization, in some First Nations, new parents were supported using the principles of “Grandma” legislation. It is traditional fertile knowledge possessed by senior community women. Children’s development is nurtured through extensive kinship and community care.

These holistic care systems have been disrupted and Western maternity services are being informed by research being done “on” First Nations people instead of in collaboration with or by First Nations people. This has led to a focus in the medical literature on the “five D’s” – inequality, deprivation, disadvantage, dysfunction and difference, rather than evidence that reflects the strengths of First Nations people and culture.

This is reflected in Australia’s policies, health and education systems that strengthen the legitimacy of “Western” knowledge over First Nations knowledge. This leads to ongoing failures to improve First Nations people’s health and maternity services.

Western maternity services are often too busy and task-oriented with rigid structures unsuitable for providing holistic women-centered maternity care that allows flexibility for cultural birth practices.

The “Birthing in Our Community” study showed that culturally safe models that enable care of a well-known midwife throughout pregnancy, childbirth and up to six weeks after birth can significantly improve health outcomes for First Nations women and babies.

This research found women were about 50% more likely to attend the recommended number of antenatal visits, 38% less likely to give birth prematurely, and 34% more likely to breastfeed “exclusively” when they leave the hospital.

The key to this success was leadership and care provision that included First Nations midwives. Similar improvements in access for women have been reported from similar models, including the Baggarrook Yurrongi program, Waminda South Coast Birthing on Country program, and Waijungbah Jarjums program.

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The Important Role of First Nations Nurses and Midwives

First Nations midwives and nurses promote a sense of cultural security and trust in maternity services for First Nations women. In addition to Western midwifery education, First Nations midwives use cultural and community knowledge systems, including understanding the importance of including key family members and cultural practices specific to that community.

First Nations nurses and midwives currently represent 1.1% of the workforce. If we want to close the gap in outcomes and ensure a culturally safe birth experience for First Nations women, we need a much larger share of First Nations midwives.

Read more: First-generation children are still being removed at exorbitant rates. Cultural assumptions about parenting need to change

How can we increase the number of First Nations midwives and nurses?

Universities must increase their proportion of First Nations students by:

• providing better support to First Nations students from application to graduation

• implementation of all 32 recommendations of the Gettin em and keepin em report in First Nations nursing education, which includes integration of First Nations health issues into core obstetrics curricula and streamlined application and enrollment procedures

• promotion of scholarships to attract students.

Maternity services should increase the number of First Nations midwives employed by:

• implementing the government’s women – centered care strategy to ensure that Australian maternity services are fair, safe, women – centered, informed and evidence – based; that women are the decision-makers in their care; and maternity care reflect women’s individual needs

• leading cadetship and graduate midwifery programs with First Nations nurses

• supporting career development in midwifery, leadership roles and representation at all levels of management.

Both universities and maternity services must:

• improve cultural security, according to National Aboriginal and Torres Strait Islander Health Work Strategic Plan

• ensure that midwifery academics undertake cultural safety training as part of professional development

• regularly assess healthcare providers’ behaviors and parenting experiences to ensure that cultural safety training results in a culturally safe workplace.

Now is a good time for First Nations people to think about a midwifery career. Let’s work on a future where every pregnant First Nations woman has access to a First Nations midwife so that they and their baby can have the best possible start in life.