Birthing on Country could deliver healthier babies and communities

Inuit women carrying their kids in traditional hooded parkas. Indigenous midwifery programs have expanded across Canada and are linked to excellent health outcomes. Spencer/Flickr, CC BY-NC-SA

Tony Abbott spent most of this week in North East Arnhem Land, part of his long-held hope “to be not just the Prime Minister but the Prime Minister for Aboriginal Affairs”. In the final of our Abbott in Arnhem Land series, we asked our experts: what stories does the PM need to hear?

Imagine you are 36 weeks pregnant and about to have your third baby. But coming from a small community, you can’t give birth at your local hospital because the maternity ward has closed down. Instead, you’re told you have to go to a hospital in a big city you’ve never been to before, hours away from anyone you know, which feels as foreign as being sent to another country.

Doctors say it’s safer in the big city hospital where they have lots of specialists if anything goes wrong. But your partner, children and other family members are not able to come because you can’t afford to pay their travel and accommodation.

You don’t speak the language. You didn’t choose to come here. You are all alone. You are so uncomfortable and so stressed – so how could this be good for baby?

This happens regularly to Aboriginal women across Australia. In many cases, being sent into a major city a long way from home to birth is equivalent to being sent to a foreign country.

But it doesn’t have to be this way.

We could reduce the number of babies being born too early and dying before they reach their first birthday. We could make a difference to every stage of life – reduce chronic disease, improve mental health, reduce drug and alcohol abuse and reduce community violence.

We could save our health system millions of dollars. And the benefits could extend beyond health, strengthening parenting roles and restoring skills and community pride.

And we know that all that can be done, because it’s already been shown to work in Canada.

Having babies closer to home

In Australia, we call it “Birthing on Country”, which is about bringing birth closer to home. Birthing on Country is about real jobs and education. It’s about local Aboriginal midwives. It’s about shaping a healthier health system; one that is both medically and culturally safe for all.

Birthing on Country has been recommended in many government reports over 30 years. Even our current National Maternity Plan says that Birthing on Country programs need to be set up and tested.

We need to see if Birthing on Country really can make a difference here, as it has overseas. We can’t keep having Aboriginal mums and bubs being two to three times more likely to die in childbirth than other Australians; it’s time for change.

Aboriginal Australians talking about birthing on country, from “The Face Of Birth” DVD. (http://www.faceofbirth.com/)

So why has there been no investment in Birthing on Country?

There is a general fear of birthing in Australia, with some people concerned about women having babies in places that don’t have 24/7 access to an emergency caesarean operation. Instead, when surgery cannot be provided, we tend to close the whole maternity service.

But the further women have to travel for birth, the worse their outcomes. Establishing birth centres, even in remote areas, could be a safer option, yet only 2% of women in Australia give birth in a birth centre.

Learning from the Inuit

In Canada, what began as the Inuit “experiment” is now referred to as the jewel in the crown of Inuit achievements.

The experiment started in 1985 in a place called Nunavik. It was in response to a high number of young people committing suicide.

Women, sitting around a sewing circle, linked the social dysfunction in the community to the dislocation that occurred during birth. They agreed they would no longer be flown eight hours away from home to have their babies in a “safe” hospital in Montreal. Instead, they set up a birthing centre in their remote community, without local access to a doctor or caesarean.

Even when people tried to close them down, warning “mothers and babies would die”, they stayed open. The elders knew that “to bring birth back to the communities is to bring back life”.

One Aboriginal Canadian doctor was quoted as saying:

Culturally appropriate health care requires respect for the choice of community based child birth and may also challenge the world view of medically trained health professionals who are concerned with access to medical technologies and medico-legal liabilities.

Today, the birthing centres have on-site midwifery training and have expanded across Nunavik and into other remote communities in Ontario, North West Territories and Nunavut.

TV Show Video Clip - Inuit Midwife Apprenticeship Program, Nunavik from Inuit Tuttarvingat on Vimeo.

They have developed as a sustainable model and are linked to excellent health outcomes, increased education levels, reduced family violence, the restoration of dignity and self-esteem, community healing and greater social functioning.

The model allows inter-generational learning and support while promoting respect for traditional knowledge and building local capacity.

In the words of Jusapie Padlayat, elder and chair of the Inuulitsivik Health Board:

I can understand that some of you may think that birth in remote areas is dangerous. And we have made it clear what it means for our women to birth in our communities. And you must know that a life without meaning is much more dangerous.

When you walk into the birthing centres you can immediately see the impact it’s having on the community. You can see it when watching an Inuit midwife providing care to an Inuit women, in her own language. Better still is the smile on her husband and young children’s faces, knowing she will not be leaving family to have her baby.

The model is so successful it is creeping into the cities, with an Aboriginal birth centre opening in Toronto last year. (You can read more at Canada’s National Aboriginal Council of Midwives website.)

Returning birth to Country in Australia

The first National Birthing on Country Workshop, held in Alice Springs in 2012, recommended we set up Birthing on Country sites here in Australia, including in some remote communities. But to do that, they must be funded for long-term success.

In her closing speech at the event, award-winning Yolŋu elder Djapirri Mununggirritj from Yirrkala in North East Arnhem Land (where the Prime Minister visited this week) declared:

birthing is the most powerful thing that happens to a mother and child … our generation needs to know the route and identity of where they came from; to ensure pride, passion, dignity and leadership to carry us through to the future … We need to put together a strong voice, and one of us can report this in Canberra

Yolŋu elder and Reconciliation Australia board member Djapirri Mununggirritj Reconciliation Australia

The report from the National Birthing on Country Workshop has gone to Canberra and been given to government – but we don’t yet have Birthing on Country sites.

Queensland is probably the closest, with a state-wide workshop held in December 2013, but sites are yet to be chosen. Funding has not been allocated. We can’t let it stall again.

We know it will be challenging and we know it is controversial. But we know it can be done successfully, across the country. Birthing on Country programs can be set up in urban, rural and remote areas.

As Djapirri Mununggirritj also said:

if Indigenous people and non-Indigenous people come together, there is power … We need to create that connection … connection that comes from the grassroots … and I know you around the tables are very very smart people.

To quote another wise woman, award-winning Aboriginal health worker and Malabam Health Board member Molly Wardaguga from Arnhem Land (who has passed away): “Hey you mob – it’s time to listen.”


Further reading in this Abbott in Arnhem Land series:
Welcome to my Country: seeing the true beauty of life in Bawaka
‘PM for Aboriginal Affairs’ Abbott faces his biggest hearing test
Australia’s 7 Up: the revealing study tracking babies to adults
Well-connected Indigenous kids keen to tap new ways to save lives
Indigenous Australia’s rapid rise is shifting money and votes
How crowded homes can lead to empty schools in the bush
Would you risk losing your home for a few weeks of work?
Listen to your elders: inviting Aboriginal parents back to school
Indigenous Australians need a licence to drive, but also to work
Keeping Indigenous teens in school by reinventing the lessons
Explainer: Can a DNA test reveal if you’re an Indigenous Australian?
Explainer: what Indigenous constitutional recognition means

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