Reclaiming ancestral wisdom through Birthing on Country in Australia – a special edition of Women and Birth journal

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For more than 60,000 years, Aboriginal and Torres Strait Islander families have lived and birthed on the country of their ancestors. In the last decade in Australia, much discussion has taken place nationally on reclaiming Birthing on Country for Aboriginal and Torres Strait Islander women. In a special edition of Women and Birth, the journal of the Australian College of Midwives, nine papers provide a snapshot of some of the innovative work that is changing the experiences for Indigenous Australian families.

In recent years commitments have been made by Australian Health Ministers to implement a national maternity services plan to develop of culturally competent maternity care for Aboriginal and Torres Strait Islander women but progress has been slow. Independently across Australia in the last five years, the momentum and community demand for Birthing on Country models of care has grown, with communities, clinicians and researchers leading the way forward. These discussions have sought to prioritise the critical socio-cultural and spiritual dimensions of Birthing on Country during the most important life event for Aboriginal and Torres Strait Islander families. 

Launched at the Australian College of Midwives national conference in September, the “Birthing on Country in Australia” special edition of Women and Birth reports on some of this work to revitalise the understanding of the importance of Birthing on Country as a model of care option for Aboriginal families and to refocus our commitments as we progress forward. 

“The special issue on birthing on country has been really well received with many positive comments. This just shows how critical this issue is in Australia and maybe also in other countries,” said Professor Caroline Homer AO FAHMS, Editor-in-Chief of Women and Birth.

  • In the first of nine papers, Wiradjuri and Ngemba Wayilwan author, Fleur Magick Dennis and her midwife share four compelling pregnancy and birthing journeys that give a unique insight into the cultural richness and healing that Birthing on Country can bring. These stories illustrate how important the transition during pregnancy and birth is for the ‘health’ of the baby, mother, father, family and community. The author also provides a rare insight into the vital role of Aboriginal fathers in the cultural and spiritual process of birth. It is a deeply personal journey. Critically, the stories highlight the importance of understanding and respecting the cultural choices for birthing that women make.
  • The authors of the second and third papers in this Special Issue highlight the lack of support for Aboriginal women’s cultural needs and experiences of discrimination in maternity care, and that there are still strong desires to maintain cultural practices associated with birth. These stories are consistent from Elders, and women in Western Australia, South Australia and Queensland, and highlight the need for improved cultural security in maternity care. 
  • The authors of the fourth paper report a scoping review of existing evidence related to cultural security in maternity care for Indigenous women in Australia, Canada, New Zealand and the United States. The review reinforces the need for improving cultural competence and security in maternity care, but also offers some promising models. The authors of the fifth, sixth and seventh papers report examples of culturally safe maternity care. 
  • The authors of the fifth paper provide an in-depth evaluation of a clinically and culturally safe model of care in NSW, the Malabar Service, demonstrating this was highly valued by mothers as well as providing improvements in health outcomes for both mothers and babies. 
  • The author of the sixth paper reports on acceptability of Group Antenatal Care for Aboriginal and Torres Strait Islander women among a group of Indigenous Health Workers. 
  • The authors of the seventh paper share their key learnings for establishing multidisciplinary teams for culturally safe maternity care that privileges Indigenous ways of knowing, being and doing. 
  • The authors of the eighth paper report on the implementation of safe sleeping strategies for Aboriginal and Torres Strait Islander infants. 
  • The authors of the ninth and final paper outline the RISE SAFELY framework to drive significant reform towards implementation of Birthing on Country models of care, with four ‘pillars’ for action: 1. Redesign the health service; 2. Invest in the workforce; 3. Strengthen families; and, 4. Embed Aboriginal and/or Torres Strait Islander community governance and control.

Women, supported by midwives, Aboriginal health workers, Aboriginal Community Controlled Health Organisations and researchers are clearly ‘reclaiming’ rich ancestral wisdom and bringing culture and spirituality back into birth to enrich our contemporary health care systems to foster a nurturing birth environment to support parents through this important transitional life event. 

Birthing on Country models of care are an important option for giving Aboriginal and Torres Strait Islander babies the best start in life. However, genuine challenges to this exist. Some Aboriginal and Torres Strait Islander women will not access any care and ‘go it alone’ if they do not have acceptable maternity care choices that are culturally and emotionally safe. Some Aboriginal and Torres Strait Islander women will continue to suffer ongoing racial discrimination in maternity care which compounds existing trauma and harm. And some Aboriginal and Torres Strait Islander women, men and families will continue to miss out on culturally and spiritually enriching traditions around pregnancy and birth that foster vital connections required for the social and emotional wellbeing of Aboriginal people. It should not be a choice between providing clinical safety for birthing OR the cultural experience of Birthing on Country.

With the community, clinical and research discussions that are taking place across Australia, the development of multidimensional, dynamic, and sustained solutions for the benefit of Aboriginal families and communities are a real possibility. But we need to maintain momentum and enlist champions within services. Stakeholders are well placed to co-design solutions for a maternity care system which promote the best possible outcomes and meet the diversity of Birthing on Country needs of Aboriginal and Torres Strait Islander women and their families. 

Edited extract from Women and Birth: R. Marriott and C. Chamberlain