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Njikena Jawuru professor Yvette Roe shines light on need for culturally appropriate maternity care

Jess Whaler -

Dr Yvette Roe, a proud Njikena Jawuru woman, aims to dismantle colonial models of maternity care, with a message for the medical world :"You've had your turn, now give us a go!"

As part of a lecture series for the highly regarded Feared and Revered exhibition at the National Museum of Australia, Dr Yvette Roe, a proud Njikena Jawuru woman and PhD Scholar with 25 years of experience working in health, presented her knowledge of culturally responsive maternity care for First Nations mothers.

Speaking to a full house, Dr Roe shared her passion for developing holistic cultural and clinical models of care, whilst educating the audience on the vastly disproportionate outcomes for Indigenous mothers and babies as compared with non-Indigenous.

Dr Roe shared how she considers research as activism.

"As an Aboriginal scholar, research is about our survival, our resistance, our representation, our knowledge and preservation. Colonial disruption has disrupted so much of our lives, and for me research is the tool, the mechanism that I can provide sound robust evidence of how we can rectify some of these situations. For me, research is about justice and human rights. We have to understand the colonial systems that are hurting us," she said.

Painting a devastating picture, Dr Roe presented data which told a sad story of too many mothers and babies dying.

Compared to non-Indigenous figures, Aboriginal mothers and babies were vastly over-represented in areas of still birth, preterm, perinatal deaths and infant mortality, with Aboriginal mothers in the Northern Territory showing even higher rates of these incidences.

"It's easy to blame the individual, but the system is not designed for us, it does not accommodate the way we understand the world" she said.

Dr Roe, who is a Co-Director of the Molly Wallaguga research centre, spoke on how the centre supports birthing on country and returning birthing centres to Aboriginal communities for the best start in life. The centre is currently working with communities in Arnhem Land and Galunku, she emphasised that they only work with communities if they are invited by the community.

While speaking on reconciliation, Dr Roe stressed to the audience that it is not a matter of simply displaying Aboriginal flags or artworks, but that it is about dismantling the system. Warning that if we fail to take action now, the story is going to get worse and worse - on our watch.

"Contemporary Aboriginal and Torres Straight Islander knowledge and practices and western medicine, these are at competition with each other. We want to bring them together. We want to ensure that Aboriginal and Torres Strait Islander voices are at the forefront of what we do. Aboriginal women want healthy babies," she said.

Dr Roe described how the colonial system imposes practices on women and demands assimilation with a "this is how we have always done it" approach. She provided an overview of what this system expects of remote First Nations women, which sounded trauma inducing and far from a mother centred or culturally adept approach.

At 36 weeks a pregnant mother will travel alone to birthing hospitals which are far from her Country to then wait for the birth. There are significant language barriers, as english may be the mothers third language and yet the medical staff are only equipped to speak to the expectant mothers in english. On some occasions if the mothers get home sick, they are unable to go home because they have missed a postnatal or paediatric appointment and are then deemed as non-compliant.

"Birth is our first ceremony when we come to earth, it is the most sacred thing. Women and their bodies carry a sacred process that we have been gifted with that allows us to bring this baby into this world into a song line into a kinship into a story line into land connection into family connection. It is your connection into the ecology of who we are," Dr Roe said.

Dr Roe said the solution lies with the implementation of a governance model which is designed by communities, encompassing the woman's aspirations, with their voice being at the centre of the design.

Birthing on Country Services should; incorporate traditional practices, involve a connection with land and Country, value First Nations and non-Indigenous ways of knowing, learning risk assessment and delivery, and are both culturally and clinically safe.

As part of a study titled Indigenous Birthing in an Urban Setting (IBUS), Dr Roe and a team of highly regarded researchers determined that mothers in urban settings faced many similar challenges that compromise healthy pregnancies. Issues such as systemic racism, hospital overcrowding, housing and food insecurity and difficulty accessing appropriate health care.

The team established a 'Birthing in Our Community Service' which included a First Nations workforce, caseload continuity of midwifery care, cultural safety framework and coordinated care integrating primary health and tertiary services.

With the implementation of strategies such as cultural safety, access to antenatal care, social and emotional support and First Nations governance and control, the team saw significant decreases across the board in areas of; pre-term birth, epidural pain relief in labour, caesarean sections, third stage labour interventions, neonatal nursery admissions, overall cost and unborn notifications.

The service also provided a community-based hub where there were cultural activities and a space for women to be themselves.

"The women felt black, they didn't feel like they were under surveillance by the house system they could be who they were they could laugh and cry together. Having a space where they weren't the disease, or the problem was so important for them to create a community," she said.

There are currently several Aboriginal birthing centres scattered throughout Australia, within existing hospitals, however a major development is currently underway with the Federal Government investing $22.5 million over three financial years from 2022-2025, for the construction and implementation of a Birthing on Country Centre of Excellence at Waminda, an Aboriginal Community Controlled Health Service in Nowra, NSW where the Aboriginal population is 10%.

It is expected that the Birth Centre should be operational in 2025-26 and plans are already underway to ensure a maternal workforce is ready.

The development promises a positive economic impact, by offering growth in the employment sector and opportunities for First Nations community members to undertake study and or careers in areas of health such as nursing and midwifery.

More information on Dr Roe's research and the Molly Wardaguga research centre is available online.

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