Traditionally, Aboriginal and Torres Strait Islander mothers may have given birth to their children on the lands of their ancestors. Today, however, pregnancy complications or access to healthcare means this isn’t always possible, so non-Indigenous midwives often work together with community elders or traditional midwives to ensure a new mother can maintain a spiritual connection to country - wherever she chooses to give birth.
Birthing on country
There are a number of definitions around birthing on country and what it means to Indigenous women. In April 2016, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the Australian College of Midwives and the Council of Remote Area Nurses of Australia (CRANA) released a joint position statement on birthing on country. They describe it as “a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families”. It provides “an appropriate transition to motherhood and parenting, and an integrative holistic and culturally appropriate model of care for all”.
Captured in that are the essential elements for not only women who are birthing on country, but also services that are providing antenatal care or care during the birthing process need to be aware of. While giving birth is a physiological process, it does require a valuing of culture, however that can be supported and maintained, in order to for the baby to have the best start in life.
Many women don’t have the opportunity to birth on country, either because there are no maternity services available in their region or they have pregnancy complications. So there’s the opportunity for what we call ‘birthing off country’.
One midwife working in a large tertiary maternity service told me about assisting with the birthing for a woman who had been transferred from a remote region due to complications. English wasn’t her first language, but she had family with her that could explain. The woman had brought with her a small jar containing some dirt from her country, and wanted that to be the first thing her newborn baby came into contact with after birth.
We need to ensure that we do our best clinically for the best possible delivery, but we also need to make sure, wherever possible, we honour these spiritual connections.
While the doctor present was very concerned about maintaining the sterile area, the midwife had to work very hard to be an advocate for the mum. This is what she wanted, and it was incredibly important for her. We need to ensure that we do our best clinically for the best possible delivery, but we also need to make sure, wherever possible, we honour these spiritual connections.
We tend to look at healthcare through one lens, so maternity services are striving in varying ways to ensure Aboriginal and Torres Strait Islander women don’t feel alienated during a clinical maternity experience. There is an increased awareness on both sides of the patient-healthcare relationship of what cultural traditions are possible to be accommodated.
Giving birth is traditionally women’s business, but contemporaneously, there is an expectation that men will be present during the birth, so we need to treat that sensitively. Other things to be considered include having family members present; women can also ask for to take the placenta home to ensure it’s buried on country. While you can’t perform a smoking ceremony for the baby [a ceremony welcoming the child in its early life] in the hospital, those rituals can be performed once the family returns home.
(Image courtesy of Flickr/Kristy)
There are many, many nations of Aboriginal and Torres Strait Islander peoples. So what you might find in Cape York is not going to be the same as what you find in Alice Springs or in Perth. As midwives, the fundamental thing we need to do is communicate. Ask the woman and her family what her needs are, and how those can be sensitively accommodated. That’s the key to culturally sensitive care.
While the physiological transition of childbirth is one thing, as midwives and health professionals we have a limited understanding of spirituality and what that means. But for Indigenous families, it’s important to have a sense that the good spirits are present at the time of the birth. It’s not something we can quantify or scientifically measure, but we know that the health of the baby is going to be very impacted by the mental health of the parents and what they feel.
A senior researcher with expertise in Aboriginal maternal and child health, Professor Rhonda Marriott is a Professor in Aboriginal Health and Wellbeing in the School of Psychology and Exercise Science at Murdoch University. Born in Derby, Western Australia, Rhonda is descended from Kimberley Nyikina people. She has been a registered nurse and midwife for more than 40 years and in 2003 was invited to become the inaugural Head of the School of Nursing at Murdoch University; becoming the first Indigenous Head of a University School of Nursing in Australia.