With her own preterm birth journey inspiring her advocacy for stronger representation of First Nations voices in maternal health, Marisa Smiler-Cairns understands the difficult situation mothers in regional and remote Australia face.

A proud Yolŋu and Wardaman woman, Ms Smiler-Cairns is a third-generation Aboriginal Health Practitioner, trained by the same Aboriginal medical service that supported generations of her own family.

As a first-time mother to be, she enjoyed a problem-free pregnancy with her own background in health education guiding her journey.

"I had always felt incredibly fortunate with how healthy both my pregnancy and I had been. I didn't smoke and had never smoked, and I attended all my antenatal appointments. Like the many health professionals I had seen throughout my journey, I was confident that I would carry to full-term," she said.

That would all change one evening when on the way to dinner, Ms Smiler-Cairns noticed a slow leak. Initially, clinical staff at the hospital believed it wasn't amniotic fluid. However, after testing, it was confirmed Marisa had a hind water leak and doctors and midwives made the decision to admit her overnight for further monitoring.

"I remember sitting in the hospital bed after my partner had gone home to get my hospital bag, feeling scared, upset, and completely out of control," she said.

"All of my plans for the birth suddenly felt like they had been swept away. I was deeply concerned for my unborn baby and overwhelmed by a sense of uncertainty."

Shortly after her partner returned, Ms Smiler-Cairns's waters broke completely, and labour began soon after.

"I had heard the term premature baby and knew that some babies were born too early, but I didn't have a deep understanding of what preterm birth really meant or how serious and life-changing it could be for some families. And yet here I was experiencing it first-hand."

In September of 2019, Jacqueline-Rose was born at 36 weeks weighing 2.68kg.

Since Ms Smiler-Cairns had given birth at Katherine Regional Hospital, there had been talk of flying her to Royal Darwin Hospital.

"Thankfully doctors decided being transported to Darwin wasn't necessary and that other than a heart murmur that lasted a few weeks after birth, Jacqueline was doing well," she said.

However, from around one year old, Jacqueline was diagnosed with Chronic Suppurative Lung Disease. This led to multiple care flights to Darwin due to how severely unwell she would become.

"The first four years of her life were incredibly challenging; filled with hospital stays, uncertainty, and constant worry," Ms Smiler-Cairns recalled.

"Despite all of this, there have been many beautiful moments and milestones we've celebrated with Jackie. She's shown so much strength and resilience, and today, you would never guess that she was born preterm."

In 2021, Jacqueline-Rose would become a big sister as the family welcomed Mathew Ronald born at 37 weeks.

Marisa's personal journey of preterm birth has led her to a transition into research, a field she has been dedicated to since 2022 with the Maternal Health Team at Menzies School of Health Research.

"Preventing early birth matters to me because every child deserves a strong, healthy start in life. I think about how fragile and formative those first moments are, and how much of a difference it makes when a baby is born full-term," she said.

"I've spoken with and worked alongside many women who have been flown from regional hospitals to major city hospitals for urgent medical care. While some have shared moments of hope or brief positives from the experience, many describe it as deeply frightening and overwhelming.

"Beyond the emotional toll, these women frequently deal with cultural disconnection, financial stress, and discrimination within the healthcare system. These challenges are real, and they deserve to be recognised and addressed."

Ms Smiler-Cairns is now a key part of the Commonwealth-funded Every Week Counts National Preterm Birth Prevention Program which is helping to improve pregnancy outcomes for more women with particular emphasis on First Nations mothers.

This national program, a partnership between the Australian Preterm Birth Prevention Alliance and Women's Healthcare Australasia, brings together obstetricians, midwives, GPs, sonographers, neonatologists with consumers and quality improvement experts from maternity hospitals across the country, to safely reduce rates of early birth.

More information and resources are available online.