Niyith Niyith Watmam (the quiet story): Exploring the experiences of Aboriginal Women who give birth in their remote community

Objective: to investigate the beliefs and practices of Aboriginal women who decline transfer to urban hospitals and remain in their remote community to give birth. Design: an ethnographic approach was used which included: the collection of birth histories and narratives, observation and participation in the community for 24 months, field notes, training and employment of an Aboriginal co-researcher, and consultation with and advice from a local reference group. Setting: a remote Aboriginal community in the Northern Territory, Australia. Participants: narratives were collected from seven Aboriginal women and five family members. Findings: 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, the care of their other children, and designated men with a helping role. Key conclusions: narratives described a breakdown of traditional birthing practices and high levels of non-compliance with health-system-recommended care. Implication for practice: standard care provided for women relocating for birth must be improved, and the provision of a primary maternity service in this particular community may allow Aboriginal Women's Business roles and cultural obligations to be recognised and invigorated. International examples of primary birthing services in remote areas demonstrate that they can be safe alternatives to urban transfer for childbirth. A primary maternity service would provide a safer environment for the women who choose to avoid standard care. � 2010 Elsevier Ltd.