This research is set in the remote Aboriginal community of Wadeye in the Northern Territory (NT), Australia. After a transition from mission to state provided health care, women were no longer offered the choice to give birth in their community. Routine practice in all remote Aboriginal communities across the NT is to transfer pregnant women before the baby is due into regional centres, to wait for labour and give birth in a hospital. However, perinatal statistics show that some women still give birth in their communities. This research is a retrospective descriptive study. A mixed methods approach was used which included: a clinical chart audit of the years 2003-2007 (n=342); sub-group analysis of maternal and neonatal outcomes (n=32); the collection of birth histories and narratives from women (n=7); family member narratives (n=5); observation and participation in the community (18 months); field notes; training and employment of an Aboriginal co-researcher; and the consultation and advice from a local reference group. Qualitative data findings showed that women, through their previous experiences of standard care, appeared to make conscious decisions and choices about managing their subsequent pregnancies and births. Women took into account their health, the baby’s health, their access to a skilled birth attendant (modern or traditional) and designated men into a helping role. Narratives described a breakdown of traditional birthing practices and suggested that community births may allow Aboriginal Women’s Business roles and cultural obligations to be recognised and invigorated. Quantitative findings showed that over the five-year period 2003-2007: 32 women gave birth to babies in the community; eight women had no antenatal care; 33 women attended less than five antenatal care visits; and 36 women presented in the last three months of pregnancy when antenatal care has limited benefit. Women in Wadeye have a high rate of birth outside of hospital compared to the rest of Australia (9.35% versus 0.7%) and have no access to health system sanctioned community-based birth services. Several recommendations to improve the quality of maternity health services available to Wadeye women have come about from this research. They include recommendations for further research and specific measures applicable at institutional, clinical and community levels.
|Publication status||Published - 2009|