A cultural tradition that heralds back thousands of years, Birthing on Country is when Australia’s first peoples embrace traditional practices to connect pregnant women, birthing, and newborns with their ancestors’ land, known as Country.

There is no singular approach to Birthing on Country. Aboriginal and Torres Strait Islander communities right across Australia vary in their cultural values and the way they approach Birthing on Country.

In a joint position statement, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the Australian College of Midwives (ACM) and CRANAplus, describe Birthing on Country as ‘“a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families”, which provides an appropriate transition to motherhood and parenting, and an integrated, holistic and culturally appropriate model of care for all’.

Rhonda Marriott, Professor of Aboriginal Health and Wellbeing in the School of Psychology and Exercise Science at Murdoch University and a descendant of the Kimberley Nyikina Aboriginal people, says Birthing on Country is traditionally considered a model of birth in a remote community, outside of a hospital, with a traditional midwife in attendance.

But Professor Marriott, who has a joint appointment with the Nursing and Midwifery Office at the WA Health Department and is also co-chair of the WA Health Aboriginal Nurses and Midwives Council, says there is no one-size-fits-all approach to models of Birthing on Country.

In fact, Birthing on Country can be implemented in any setting - from remote areas to major cities.

“It’s not just about the Birthing on Country in a remote setting, because there are many women who are Birthing on Country who live in the city, and they are Birthing on their Country,” she says.

“It might be that Birthing on Country is a remote community where there’s minimal supports in the traditional sense of medical support.

“It might be at-home birthing experiences and it might be birthing in a maternity service, whereby the cultural supports are there.”

Closing the Gap

Birthing on Country provides not only important cultural elements but also a range of health benefits for Australia’s first peoples.

Pregnancy, birth and early childhood are known to be critical periods for the health of mothers and their babies.

Maternity services that support Aboriginal and Torres Strait Islander women and their families to have a birth that meets their cultural standards will work to improve health outcomes and Close the Gap.

Indigenous babies are almost twice as likely to be born at a low birthweight than non-Indigenous babies.

The Closing the Gap - Prime Minister’s Report 2016 shows infant mortality rates for Aboriginal and Torres Strait Islanders stood at 6.4 infant deaths per 1000 live births in 2014, compared with 3.6 per 1000 live births for non-Indigenous people.

From birth, Indigenous Australians also have a lower life expectancy that non-Indigenous Australians.

Life expectancy for Indigenous males stands at 69.1 years compared to 79.7 for non-Indigenous males. Indigenous women can expect to live to 73.7 years while life expectancy for non-Indigenous women is 83.1.

Professor Marriott says more culturally-centred pregnancy and birth experiences will lead to better clinical outcomes.

“The best birth experience without any complications is a right that every woman has and therefore our services need to provide for that,” she says.

“They also need the best cultural experience that can be ensured around the time of birth.”

Studying Aboriginal births

Professor Marriott is leading a four-year NHMRC Partnerships Project Grant involving 11 local partners, two international partners and a team of 20 researchers to examine the cultural security of Aboriginal women birthing in Perth’s maternity services.

Professor Marriott says the project involves speaking with midwives and midwifery educators to investigate the understanding of midwives who support Aboriginal women through birth.

Researchers are interviewing Aboriginal women, to identify their needs, and are also speaking with elders about traditional birth supports.

“What we are finding is there really needs to be some recommendations around changes to practice and education,” Professor Marriott says.

“In that, we are really keen to ensure that there’s better education around midwives for their understanding about Aboriginal people and the differences between Aboriginal people - that there are so many groups across Australia.

“Secondly, to increase the number of supports that are available - like Aboriginal maternity group practices by a specialist group, that could be trained to provide support during pregnancy and continuity of care through the birth experience and into the infant care and parenting.”

Woman-centred care

Professor Marriott says maternity services should be open to choice and truly woman-centred.

“If a woman wants her aunty or grandmother or mother to be far more involved in the birth, then we should have moved to a point where that’s welcomed and accepted,” she says.

“It can be quite a fearful event if you’re young and you don’t know what’s happening - mum’s not there, aunty is not there, grandma is not there, and they are not allowed to come in - because you are not allowed to have too many people in the room.

“We need to try and reduce some of that fear and concern and turn it into positive support.

“If you allowed aunties and grandmas and mums into the room, sure there will be extra people in the room, but heavens - if you then have an excited young girl who is delivering her baby, isn’t that better, instead of someone who is terrified?”

While some traditions, such as Welcoming a Baby to Country through a smoking ceremony, using leaves and wood from Country, are unable to occur in hospitals, Professor Marriott says the important tradition can still take place - in the first few days following the mother’s discharge from hospital.

Professor Marriott says midwives can provide culturally-appropriate care for women by returning to the heart of midwifery, and embracing woman-centred care.

“All you need to do is ask and to be there and be willing to support the woman in whatever her stated needs are,” she says.

“As long as you are working in a supportive environment that then says - if the woman wants a vial of dirt present, and it’s the first thing that her baby’s head touches in that delivery, then we’ll support that.

“As much as possible, it’s being able to ask an Aboriginal woman exactly what it is they would like to experience during their stay in the hospital, and providing those opportunities to be around Aboriginal staff during the pregnancy in the lead up to delivery is really important.”