News site of the year

National
  1. Home
  2. News
  3. Health
Save
Print
License article

'Terrified they will take their babies': Aboriginal midwives break cycle of distrust in health services

Kate Aubusson

James Burns has been to every prenatal appointment with his fiancee Kelly Jenkins. She's three days past her due date and her little boy is kicking away inside her swollen belly as she sits next to James in a hospital consulting room.

The couple are surrounded by images of maternity scenes intimately more familiar to James than the ubiquitous stock images of white pregnant women and babies.

Up Next

Drug bust seizes one tonne of cocaine

null
Video duration
02:16

More NSW News Videos

null
Video duration
01:59

Aboriginal midwife breaking cycle of ...
null
Video duration
02:16

Drug bust seizes one tonne of cocaine
null
Video duration
00:29

Police chase Audi through Sydney
More videos

Aboriginal midwife breaking cycle of distrust

Midwife and Woronora woman Vanessa Smith is working against a legacy of distrust to engage Aboriginal families with health services.

Like James, they are all Aboriginal. And most importantly, so is the woman sitting with them: their midwife, Vanessa Smith.

"I wanted the best for Kelly and the baby," James said. "We're just more comfortable having Vanessa and knowing she identifies with us and understands the culture".

Mrs Smith – originally from the Woronora nation near Singleton – could not overstate the role she and other Aboriginal health workers play in breaking the cycle of distrust Indigenous families feel for health services.

The legacy of the stolen generations has had a deeply traumatising effect and damaged the relationship between Aboriginal families expecting a child and the institutions tasked with safe delivery, Mrs Smith said.

Advertisement

"There is massive fear among these women when it comes to giving birth," said the dedicated Aboriginal midwife at Sutherland Hospital in the South East Sydney Local health District (SESLHD).

"I still see families who don't come to services because they are terrified they won't get to take their baby home," she said.

More Aboriginal children have been removed from their families today than there were two decades ago, national data shows.

The landmark 1997 Bring Them Home report revealed 20 per cent of Aboriginal and Torres Strait Islander children were living in out-of-home care.

In 2016 the rate of removal increased to 35 per cent, according to the Australian Institute of Health and Welfare.

Over 15,000 Aboriginal and Torres Strait Islander children currently live out of home, and the number is expected to triple by 2040, according to the peak national non-government body advocating for Indigenous Australian children, SNAICC.

Aboriginal and Torres Strait Islander children are 10 times more likely to be in care than their non-Indigenous counterparts.

"Lots of my clients have psychosocial issues, whether it's massive trauma, housing problems, domestic violence issues, their own health problems. They have not engaged with health services before or have engaged and totally lost trust and all faith in those services," Mrs Smith said.

"I've literally had to go pick up clients, knock on their front doors to get them to the clinic. I had to literally pull one of my girls out of bed to get her to an appointment.

"Those things I do is about gaining trust and getting them to engage with services and we've seen great outcomes when we succeed," she said.

Mrs Smith is less hampered by the usual time restraints of her profession, allowing her her to build a rapport with clients, take a thorough history and give them the space to open up.

"Pregnant Aboriginal women have completely different health outcomes [to the general population]. They are more prone to diabetes, having smaller babies, domestic violence and anaemia. All these things add up," she said.

She has culturally appropriate material, including maternity books and diaries.

"It's about seeing photos of people that look like them. It's knowing 'OK, this is referring to me'," she said.

If she succeeds she opens the door for other health workers to engage with patients as the child grows.

"We're building support networks around them," she said.

The SESLHD Early Parenting Program links the Aboriginal Maternal, Infant and Child Health Services with the Narrangy-Booris Aboriginal Early Childhood and Midwifery Health Service, which offers free care to Aboriginal families through pregnancy and the first five years of the children's lives.

The services include midwives, speech pathologists, occupational therapists, a social worker and a women's health nurse.

"Before this service we had a lot more women who didn't book in until they were over 20, 25 weeks along ... if they came in earlier and had good antenatal care they would have had better outcomes, like bigger gestational age. We might have been able to get them to quit smoking or drinking alcohol," she said.

CEO of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Janine Mohamad, said nurses and midwives had been integral to the policies that created the stolen generations.

"It manifests in so many ways today and is one of the main barriers to pregnant women accessing appropriate care," Ms Mohamad said.

"Having Indigenous midwives sends the message that this is a culturally safe environment and ultimately women will be more likely to access that service," she said.

There are roughly 230 Aboriginal and Torres Strait Islander midwives in Australia, the 2015 AIHW showed, about 1 per cent of the total midwifery workforce. To reach population parity the number needs to rise to roughly 2 per cent.

There was a "cookie cutter approach" to birthing that often excluded Aboriginal women, Ms Mohamad said.

But some hospitals were helping Aboriginal women to give birth in culturally inclusive ways.

"The term 'birthing on country' often conjures image of going bush and digging a hole, but it's more about having a place of our own. A birthing centre with Indigenous governance and continuity of care within the Indigenous community. A sense of place," she said.