Aboriginal and Torres Strait Islander women have been safely giving birth on country for more than 60,000 years.
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And there's a growing body of evidence that when cultural safety is embedded into care for expectant mums and new bubs they are healthier and much more likely to thrive.
The president of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives Marni Tuala, a Bundjalung woman, says Birthing on Country is the optimal model of care for pregnant First Nations women.
"What that means - and I think there is some confusion around what is Birthing on Country - is being cared for throughout your pregnancy journey by a midwife who is known to you in ways that meet your cultural needs," she says.
"Birthing on Country is the way forward for our women and our families, and having that led by Aboriginal communities and Aboriginal nurses and midwives is the best way to achieve that."
Almost nine in 10 Indigenous babies have a healthy birthweight, with numbers steady between 2005 and 2020, according to a recent Australian Institute of Health and Welfare report.
The study explores the demographics, risk factors and health outcomes for Indigenous mothers and babies and is the first of its kind in more than 15 years.
It found Aboriginal and Torres Strait Islander mothers are increasingly attending antenatal care, which is an important part of ensuring babies are born healthy and strong, however reduced access in disadvantaged or remote areas contributes to poorer health outcomes.
Birthing on Country is an international movement that aims to return control of birthing services to Indigenous communities to enable a healthy start to life.
Its agenda relates to system-wide reform and is perceived as an important opportunity in 'closing the gap'.
In 2012, the Australian Maternity Services Inter-jurisdictional Committee in collaboration with the Central Australian Aboriginal Congress held the first national Birthing on Country Workshop to progress Australia's commitment to the movement.
Southern Cross University has secured a $3.6 million federal grant to scope and design an innovative program for Birthing on Country with three Aboriginal community-controlled health organisations.
The project will be led by Professor Gillian Gould and Australia's first Aboriginal obstetrics and gynaecology specialist Dr Marilyn Clarke, a Worimi woman.
"Birthing on Country encompasses a holistic view of the woman's journey to motherhood and recognises the importance of Indigenous ways of knowing," Dr Clarke says.
"I'm very excited to be part of this successful research grant, which will allow the Birthing on Country movement in Australia to be further explored and integrated with culturally competent smoking cessation care."
The AIHW report has shown Aboriginal and Torres Strait Islander mothers have higher rates of smoking, obesity and pre-existing diabetes, and lower rates of induced labour, caesarean section birth and episiotomy than non-Indigenous mothers.
However when adjusted for socioeconomic and demographic factors, the differences are vastly reduced, meaning that if disadvantage and poverty are addressed outcomes for Indigenous mums and babies should improve.
Professor Gould leads iSISTAQUIT, a program for pregnant Indigenous women who want to stop smoking.
"We know Birthing on Country has a very powerful impact on Aboriginal women and that quitting smoking is one of the most important things they can do for their own health and the health of their babies," she says.
"Coupling the already successful iSISTAQUIT with a long-term plan to facilitate safe Birthing on Country will create a holistic pre-natal health plan for Aboriginal women living remotely."
Factors that contribute to low birthweight for Indigenous babies are maternal smoking and the mother being underweight pre-pregnancy and not having access to antenatal care in the first trimester.
The National Agreement on Closing the Gap includes a target to increase the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to 91 per cent by 2031.
The 'gettin em n keepin em n growin em' report released by CATSINaM last year provides a blueprint for increasing the number of Indigenous nurses and midwives, which have only grown 0.7 per cent in the past 20 years.
Ms Tuala believes more needs to be done.
"It's crucial to the wellbeing of Aboriginal families to have access to culturally-safe care throughout their antenatal, birthing and postnatal journeys," she says.
"We can't have culturally-safe care, in essence, without having an Aboriginal health workforce.
"The main reasons are around the lack of cultural safety that exists in our hospital settings, our health services and our educational settings."
Ms Tuala says it's the responsibility of the profession to to improve the cultural safety of nursing/midwifery but it needs to be led by Indigenous people and organisations like CATSINaM.
"The time for action is now," she urges.
"We know what the gaps are and we know how that translates into poorer health outcomes."
Thanks to First Nations advocacy over decades, things are starting to change for the better.
In the past two years there have been significant improvements including legislation supporting cultural safety, the Council of Deans of Nursing and Midwifery issuing a national apology for the harms to Indigenous families and better understanding of the importance of cultural safety in educational and health settings.
"And then, in terms of models of care, Birthing on Country is 100 per cent the optimal standard and we want it to become the status quo for Aboriginal and Torres Strait Islander women," Ms Tuala says.
Australian Associated Press
