During the 1960s there was a period of increased political activity within Indigenous communities. This led to the development of Community controlled services, in particular in the Northern Territory and Queensland. The movement that pushed for these services (including maternity services) grew from the push against racist policies such as protectionism and segregation which occurred from the 1890s to the 1950s (approx). The first Aboriginal community controlled health service was established by the local Aboriginal community in Redfern in July 1971.

Community controlled services were, and still are, vital for Aboriginal and Torres Strait Islander people to be able to participate in decisions and have overall control over all aspects of an organisation that serves them. At this time, the self-determination of the Indigenous population – which is where people have the right to freely determine their own social, cultural, economic and political views – was beginning to be understood.

Some Aboriginal and Torres Strait Islander women had access to small local hospitals – but services were limited, and in particular maternity services, that may have had non-Indigenous nurses (who may or may not have had midwifery experience/training), were in short supply. Often, Aboriginal and Torres Strait Islander people were denied access to these services, and women often felt safer to give birth in their own communities without accessing this care. Historically, traditional birthing practices were clan-based, and passed down between the generations of Indigenous women. Given the historical removal of children an dislocation of families instigated by the government at the time, many Aboriginal and Torres Strait Islander women and their families were suspicious of the maternity services, even if they did have access to them.

Community controlled health services are those where the Aboriginal and Torres Strait Islander people have ownership of the services, in a framework of self-determination, reconciliation, cultural safety and identity. Local communities have control of decision making, administration and service provision, control their own destiny, and exercise responsibility within the context of their broader community: the services are planned, managed, and controlled by the communities they serve. Like any large health care service they employ a large number and wide range of health care practitioners in multi-disciplinary teams, including midwives.

The Face of Birth

Chapter 10

The Face of Birth

Watch the video above to hear First Nations women talk about birthing on country, and how important it is for Aboriginal culture.

CATSINaM

Congress of Aboriginal and Torres Strait Islander Nurses and Midwives

CATSINaM

The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) is the peak advocacy body for Aboriginal and Torres Strait Islander Nurses and Midwives in Australia.

CATSINaM’s vision is that Aboriginal and/or Torres Strait Islander Nurses and Midwives play a pivotal and respected role in achieving health equality across the Australian health system for Aboriginal and/or Torres Strait Islander Peoples and communities.

 

ARTWORK: Logo © CATSINaM

Birthing on Country

Molly Wardaguga Research Centre

Birthing on Country

Birthing on Country is a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families, an appropriate transition to motherhood and parenting for women and an integrated, holistic and culturally appropriate model of care for all.

The Molly Wardaguga Research Centre is an initiative of the Charles Darwin University. It was established in April 2019 and is dedicated to the late Molly Wardaguga, Burarra Elder, Aboriginal Midwife, Senior Aboriginal Health Worker and founding member of the Malabam Health Board in Maningrida, Arnhem Land.

 

PHOTO CREDIT Image by Bobbi-Lee Hille, © the Milyali Art project. Bobbi-lee Hille is a newborn photographer and mother of three. She is a Ngarluma Kariyarra (Pilbara), Nyul Nyul and Yaw-uru (The Kimberley) woman. See more of her beautiful artwork here.

Waiting for baby...

Every year, hundreds of pregnant women from remote Northern Territory communities give birth in Darwin as part of a scarcely known and divisive health policy.

Waiting for baby by Emilia Terzon for ABC News

This ABC News article explores the impact of a lack of self-determination and community controlled resources.

“Few people know much about a Northern Territory health policy that sees hundreds of pregnant women travel to Darwin, Nhulunbuy, Alice Springs and Katherine to give birth every year.

Officially, this NT Department of Health policy only recommends that rural and remote-based women leave home a few weeks before 40 weeks’ gestation — baby time — to await the birth of their child in big towns with hospitals.

But sparse remote health services, restrictions on home birthing, and the reality of medical risk means that, for most women, there is no other choice…”

First posted Updated

Growing Deadly Families

Growing Deadly Families: Aboriginal and Torres Strait Islander Maternity Services Strategy 2019 – 2025 (Qld)

Aboriginal and Torres Strait Islander Maternity Services Strategy 2019 – 2025 (Qld)

“Every Aboriginal and Torres Strait Islander baby and their mother in Queensland has the right to safe, culturally appropriate care… but more needs to be done to close the gap in maternal health outcomes for Aboriginal and Torres Strait Islander babies and their mums. To get there we must take a woman-centred approach that meets the cultural, spiritual, physical, and emotional needs of every mum, every bub and every family. The voices of Aboriginal and Torres Strait Islander mothers guided the development of the Growing Deadly Families Aboriginal and Torres Strait Islander Maternity Services Strategy 2019–2025, and we will continue to work closely with Aboriginal and Torres Strait Islander communities to implement the Strategy. Aboriginal and Torres Strait Islander people must be equal partners in decision-making, planning, delivery and governance of maternity services across Queensland.

Nothing is more important than ensuring our future generations have the best start to life. That’s why child and maternal health is so important…”

Growing-Deadly-Families-Strategy

ARTWORK: Elaine Chambers-Hegarty of Cultural Edge Designs. 

The artwork I created shows the centre area using the symbol of the start of life and the baby in the mother’s belly, with symbols around representing ancestors and extended family, because family is integral to Aboriginal and Torres Strait Islander people. READ MORE about this artwork in the Growing-Deadly-Families-Strategy

Cultural Birthing Kits

The Mungabareena Aboriginal Corporation and Albury Wodonga Health Birthing Suite Project

Cultural Birthing Kits: The Mungabareena Aboriginal Corp & Albury Wodonga Health Birthing Suite Project

The Indigenous cultural birthing kit was designed in consultation with women who access the Koori Maternity Service (KMS).

It is portable so it can easily be carried in a box and erected and dismantled in the birthing rooms by the midwives.

The cultural birthing kit includes: two pieces of Artwork; a drop-down wall covering of a birthing tree; native scented essential oils; ochre; a coolamon and grass tiles; possum skins; pillow cases, baby wraps, and blankets for hospital beds; and candle holders

Heland, S. (2021). Cultural Birthing Kits: The Mungabareena Aboriginal Corporation & Albury Wodonga Health Birthing Suite Project. Australian Midwifery News, 25(1), pp16-18.

NACCHO

National Aboriginal Community Controlled Health Organisation

NACCHO - National Aboriginal Community Controlled Health Organisation

“Aboriginal health in Aboriginal hands”

“Aboriginal and Torres Strait Islander people enjoy quality of life through whole-of-community self-determination and individual spiritual, cultural, physical, social and emotional well-being.

The National Aboriginal Community Controlled Health Organisation (NACCHO) is the national leadership body for Aboriginal and Torres Strait Islander health in Australia. Our organisation provides advice and guidance to the Australian Government on policy and budget matters while advocating for community-developed health solutions that contribute to the quality of life and improved health outcomes for Aboriginal and Torres Strait Islander people.

We represent our members – 143 Aboriginal Community Controlled Health Organisations (ACCHOs) that operate in over 300 clinics across Australia, delivering holistic, comprehensive and culturally competent primary healthcare services. These ACCHOs are initiated and operated by local Aboriginal and Torres Strait Islander communities. The sector is the largest employer of Aboriginal and Torres Strait Islander people across Australia, with well over half of its 6,000 staff being Aboriginal and Torres Strait Islander.”

ARTWORK: Logo © NACCHO

Yatdjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care

Best, Odette, & Fredericks, Bronwyn. (2021). Yatdjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care (3rd ed.), Cambridge University Press.

Yatdjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care

fundamentals of health care of Indigenous Australians, encompassing the perspectives of both the client and the health practitioner. Written for all nurses and midwives, this book addresses the relationship between Aboriginal and Torres Strait Islander cultures and mainstream health services and introduces readers to practice and research in a variety of healthcare contexts. This new edition has been fully updated to reflect current research and documentation, with an emphasis on cultural safety. Three new chapters cover Torres Strait Islander health and wellbeing, social and emotional wellbeing in mainstream mental health services and quantitative research. Chapter content is complemented by case study scenarios, author reflections and reflection questions. These features illustrate historical and contemporary challenges, encourage students to reflect on their own attitudes and values, and provide strategies to deliver quality, person-centred health care.

  • Author team comprising leading Aboriginal and Torres Strait Islander academics, researchers and practising nurses and midwives
  • Encompasses both nursing and midwifery practice as well as the roles of Indigenous health workers and practitioners
  • Emphasises principles of cultural safety and culturally safe practice throughout

Available October 2021 from Cambridge University Press

Joint statement on culturally safe care

Nursing and Midwifery Board of Australia (NMBA) and Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM)

NMBA and CATSINaM joint statement on culturally safe care

Racial discrimination is well documented as a contributing factor to poor health outcomes for Aboriginal and Torres Strait Islander Australians1. The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) and the Nursing and Midwifery Board of Australia (NMBA) are committed to addressing racism and demonstrating leadership to nurses and midwives to ensure they value the needs of Aboriginal and/or Torres Strait Islander peoples, and promote and provide culturally safe care. In order to effect change CATSINaM and the NMBA know that regulations and codes establishing health professional standards must clearly communicate the requirement for cultural safety… CATSINaM and the NMBA believe that cultural safety and respectfulness is the responsibility of all nurses and midwives. By embracing this principle nurses and midwives provide leadership in building a health system free of racism and inequality, that is accessible for all.

NMBA-CATSINaM Joint-statement on culturally safe care

Pregnancy care for Aboriginal and Torres Strait Islander women

Clinical Practice Guidelines: Pregnancy Care

Clinical Practice Guidelines: Pregnancy Care - Pregnancy care for Aboriginal and Torres Strait Islander women

Department of Health. (2020). Optimising pregnancy care: Pregnancy care for Aboriginal and Torres Strait Islander womenClinical Practice Guidelines: Pregnancy Care. Canberra: Australian Government Department of Health
“The Clinical Practice Guidelines: Pregnancy Care (the Guidelines) continue the process of providing high quality evidence-based guidance to maternity service providers and the consumers of their care… The Guidelines were developed to help ensure that women in Australia are provided with consistent, high- quality, evidence-based maternity care. The Guidelines are intended for all health professionals who contribute to pregnancy care including midwives, obstetricians, general practitioners, Aboriginal and Torres Strait Islander health workers and allied health professionals.”

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Sue Kildea, Sally Tracy, Juanita Sherwood, Fleur Magick-Dennis and Lesley Barclay

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Kildea, S., Tracy,S.,  Sherwood, J., Magick-Dennis, F., and Barclay, L. (2016). Improving maternity services for Indigenous women in Australia: moving from policy to practiceMed J Aust, 205 (8): 374-379.  doi:10.5694/mja16.00854
“The disparities in health outcomes between Aboriginal and Torres Strait Islander (hereafter called Indigenous) and non-Indigenous Australians are well established, with the life expectancy gap being among the worst in the world. There is growing evidence that the chronic diseases that are prevalent in Indigenous Australian adults (diabetes, hypertension, cardiovascular and renal disease) have their genesis in utero and in early life. One of the greatest medical threats to the wellbeing of Indigenous children is being born preterm or at a low birthweight (LBW). Australian Indigenous babies are almost twice as likely to be born LBW than Australian non-Indigenous babies or Indigenous babies from similar countries. Other contributors to poor outcomes include the enduring effects of colonisation, social exclusion, sustained institutionalised racism, and stark inequities across many of the social determinants of health, including income, employment, education, and access to goods, services and health care.”