Holistic and healthy childbirth for Indigenous women

Australia is generally a good place to have a baby but there is a significant gap. Indigenous babies are more likely to be born prematurely and their mothers are less likely to attend medical appointments during pregnancy or be breastfeeding by the time they leave hospital. These are all factors that contribute to poor health of the baby down the track. It's a multilayered problem, but Aboriginal communities say part of the solution is culturally safe maternity care, a holistic approach that goes beyond just looking after a woman's physical needs. We will talk to Adrian Carson from Brisbane's Institute of Urban Indigenous Health in a minute, but Tegan, you've spoken to a mother who has given birth through a program that takes this approach. In fact she's an author on the paper.

Tegan Taylor: That's right, she now works at the centre. So in 2013, two Aboriginal controlled community health services teamed up with a hospital in Brisbane and started the Birthing In Our Community program which they call the BIOC program. And, as you say, the idea was to provide a holistic culturally-sensitive approach to childbirth. And Kristie Watego, she is a Bundjalung woman from Logan in south-east Queensland, she gave birth through the BIOC program and loved her experience so much that she now works at the service, and her birthing experience through the program was just a far cry from her experience with her second son who was born through a private obstetrician. She had been deemed high risk because of factors including her weight, but the model of care left her feeling disempowered and like she had somehow let her baby down.

Kristie Watego: It was nothing more than a transaction, but I then had the pleasure of joining the BIOC program, and for those who actually genuinely take the time to listen and hear and to be open to catch those thoughts, it was really, really empowering, and it allowed me to make healthier choices, to want to lean in to the right places to seek the appropriate support, which is a continual juggle, a journey of mine in my life and something that I don't want my children being a part of. It is all about me making healthier choices for them, and part of that healthy choice was about me engaging with this incredible service who weren't judging me and who were walking with me to ultimately provided a better solution, a better outcome for me and my family unit. And then I had the beautiful birth of my third boy, Lukey.

Tegan Taylor: So what was the birth experience like?

Kristie Watego: The birthing experience is always magical and it's always sacred, but it was fantastic in the fact that I was really looking forward to embracing this, and my family unit were with me by my side, all waiting out in a waiting room, but they openly celebrated with me. And what was even more exciting was back at the hub, they too also celebrated with me and my success of making healthier choices and leaning in to that vulnerability, to be able to seek support.

Tegan Taylor: Both times there were things that you maybe were being asked to do by your caregivers, but the first time it felt like a bit of a power imbalance and then the second time it felt collaborative.

Kristie Watego: Absolutely, it was an absolute power imbalance, it was a checklist that someone had to go through, she barely knew me, and I suppose categorised me as all of these things without even knowing what was in my heart and what a great mother I would be, regardless. That really knocked my confidence on so many levels, even though I was a mature mother.

Tegan Taylor: And so now you are part of this resource for other young mums, can you talk a bit about what work it is that you do now?

Kristie Watego: What we do know with our families is that there are so many other aspects to our life, social and emotional and spiritual well-being, that are just as important as our physical. And if we do not give the opportunity for the person that is sitting opposite from us to share what those challenges are, to also help them understand that there is an opportunity to seek support and that they are worthy, then we are robbing them of something. We allow that opportunity here at the hub where we see them for who they are, we do not make judgement, we support them on their journey of becoming strong black deadly families and raising a strong family unit that is healthy and continues to engage with healthcare.

Norman Swan: That was Kristie Watego, who actually works for the Institute of Urban Indigenous Health and also with association to the University of Queensland. Thanks for that interview, Tegan.

And Adrian Carson, who is the chief executive of the institute is on the line. And, just to explain, the institute is a massive Aboriginal medical service, community controlled, across greater metropolitan Brisbane. How many centres have you got now, Adrian, is it about 20?

Adrian Carson: 19 clinics at the moment, Norman, but 4 respiratory clinics as well.

Norman Swan: You'll soon be taking over the world here. So, tell me about this research that you did. What did you do?

Adrian Carson: Yes, as Kristie described, it's the BIOC model, and that model was developed in response to the fact that the existing service in place, so what was called the Mater Murri Clinic, despite 10 years of good work and it being particularly popular within the Indigenous community, research on the 10 years of effort, that basically demonstrated no significant improvement in outcomes for mums born through that program. In fact the research actually indicated an increase in preterm birth rates.

With IUIH becoming active, and obviously in partnership with ATSICHS Brisbane, our first and oldest Aboriginal medical service in Queensland, and partnered also with the Mater, we pressed reset. We opened up a conversation with the community, with elders, with mums and dads and key leaders within the system and allowed community to describe what it is they wanted from a birthing service which, despite the good efforts of the Mater, was very different and was a shift from hospital to community. It was about a shift from clinical care provided by midwives to wraparound support, particularly supported by Aboriginal family support workers and within the context of a broader comprehensive primary healthcare setting.

Norman Swan: So, essentially you were looking after people in place in a culturally appropriate way.

Adrian Carson: Exactly, and as Kristie described, actually allowing mums to be part of the design process. It wasn't just Kristie, I think our first and even our current manager, the last three managers of BIOC have all actually met BIOC as mums, so who best to design and get the model right but Aboriginal mums themselves that have birthed through the service. So, it's an outstanding outcome.

And if you look at what the research has actually reported, Norman, it represents a 50% reduction in preterm birth rates, so to the extent that we are talking now about bubs born through the BIOC program having preterm birth rates actually better than the non-Indigenous average. So when people talk about closing the gap, here's an example of a model which has actually closed the gap in a really key outcome, that of birth. We've actually started to turn things around. When we've got high rates of preterm birth, we are actually birthing our babies into a gap, and here's an example of a program which has been designed by local communities and particularly empowering of Indigenous mums but also dads within the context which is southeast Queensland, this whole system of care that is wrapped around to provide the best clinical care, but also the best social support care and advocacy.

Norman Swan: And they are more likely to breastfeed exclusively after discharge as well.

Adrian Carson: That's it. And again, I think the key again, Norman is that here we celebrate an international publication in the Lancet, the fact that we have actually produced preterm birth rates of 50%, demonstrating an actual closing of the gap and preterm birth rates between Indigenous and non-Indigenous mums, this is what closing the gap looks like. I think the concern for IUIH now is the silence from government.

Norman Swan: Really?

Adrian Carson: Where the mad rush is, everyone is so keen and committed to close the gap of Indigenous health, a gap which we have committed to closing by 2031, which is 10 years away from where we are now, and here you've got a program that is producing these fantastic outcomes.

Norman Swan: Is it replicable? If you go to Townsville or rural New South Wales, can you replicate it?

Adrian Carson: This research forms part of a broader partnership, part of a birthing on country kind of movement nationally but I think, again, you look at southeast Queensland, Norman, it's something that we continue to stress to government is, yes, these kind of programs can be transferred but you've got to look at the specific context within which they have been developed and that is unique…

Norman Swan: So you've got to design it from scratch for a different community.

Adrian Carson: You do. But again, I think also the fact that urban Indigenous communities and particularly southeast Queensland, which is home now to over 100,000 Aboriginal and Torres Strait Islander people representing over 11% of the country's Indigenous population, I think we need to be focused on immediately transferability within southeast Queensland.

Norman Swan: So white Australians get birthing underwater, dimmed lights, soft music, they get what they want, what's the excuse the governments give for not doing this more widely?

Adrian Carson: It would be good if they would let us know what the excuse is because at the moment it's deafening silence, Norman. And again, this whole thing about closing the gap, we acknowledge the commitments, we acknowledge the investment. It isn't always about new money either, it's also maybe about considering where existing investment is and redirecting it to programs like this that actually produce outcomes. And if government hasn't got a track record of producing these kind of outcomes in a timely manner, if we're are closing the gap by 2031, then perhaps government is best to step back and allow community controlled organisations to step up.

Norman Swan: So the government talks about translational research all the time, putting research into action, just as an example. Has it been sustained beyond your National Health and Medical Research Council funding?

Adrian Carson: It has. So we have built it in as part of a CQI program for the actual service itself, so I think we had the luxury of having an NHMRC research grant kicking it off and underpinning it from the get go, it's a luxury we don't have with the vast majority of the services that we deliver across southeast Queensland, but we were obviously very smart to ensure that what we did have is being built into the system so that we can continue to actually reflect on outcomes. We are still partnered with our Charles Darwin University to look at how things continue to improve, but most importantly we are actually not waiting for the Lancet to tell us that things are changing, we are actually systematically looking at progress and outcomes as we go. Again, it's just a shame that…it's a good thing that the Lancet produces some amplification of the message and people might listen. The reality is that we've actually had these outcomes demonstrated for the last four or five years.

Norman Swan: Thanks Adrian. Adrian Carson is the Chief Executive of the Institute for Urban Indigenous Health in Brisbane.