Sacred Earth, Sacred Birth: Birthing on Country

Welcome to Prepare. The Mercy Perinatal Podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth and early parenthood. Mercy Perinatal would like to begin by acknowledging there were undue, woe were und people, traditional custodians of the land on which we meet today, and also the traditional custodians of the lands on which you're listening from today. And we'd like to pay our respects to their elders past, present and emerging. We extend that respect to Aboriginal and Torres and Torres Strait Islander peoples listening today. So welcome back to Prepare. It's me, Ali, here with you today. Unfortunately, Rangi couldn't join us. However, I am so privileged to have Professor Sue Walker co-hosting with me today. Sue is the incredible co-director of Mercy Perinatal, a maternal fetal medicine specialist, an academic clinical researcher and has been awarded an AO for Distinguished Service in the field of obstetrics and gynecology. Wow, can I just say. And to top it all off, she's one of the nicest people I know. Wow, I'm not sure who you're talking about now, Ali, but I can't wait to meet her. So this episode is something that Sue and I are both really looking forward to. We totally are, Ali, and thanks so much for that warm introduction. And hi, everybody. I'm honored to be doing my very first Prepare podcast, but within this episode, as Ali has said, we're going to be talking about something that's really important to all of us at Mercy Perinatal, especially with the referendum being this Saturday. And this is the topic of birthing on country. And just with regard to the referendum, as many of you know, Mercy Perinatal have come out in strong support for the voice for Parliament. We know that unfortunately Aboriginal and Torres Strait Islander mothers continue to have three times the maternal mortality of non-indigenous Australians. And we know that they are one and a half times more likely to lose their babies. And we also know as clinicians in our workplace that the thing that makes a difference to how we design and deliver health care is having consumers at the table. And with our research, we also know that the thing that matters is having consumer advisory groups. In fact, you know, our funders, people like the NHMRC or MRFF, they kind of insist on it. So this is not really a new concept to us. We just know that if you want to ask better questions, get better answers, improve the implementation and translation of research, have the people who are impacted by sitting at the table with you. And that's what the voice is asking. So that's why we are really supportive of the yes vote to Parliament and we're really proud to endorse it. But today we're going to talk about some of those things that relate to birthing on country. And birthing on country can be sometimes a bit of a confusing phrase for people like, does that literally mean on a piece of soil? But birthing on country, I guess, is considered a bit of a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families, and a way of providing an appropriate transition to motherhood and parenting, and a really integrated holistic and culturally appropriate model of care. That's simply all that it is when we're talking about how do we support, how do we provide, how do we endorse, how do we champion birthing on country. And again, listening to the people impacted by it, Aboriginal and Torres Strait Islander women have advocated for many years, that birthing on country, that is receiving care in that sort of holistic, culturally appropriate way, will improve maternal and infant outcomes. And that's because of the integral connection between birthing, land and what all of us want, a place of belonging. And it needs to be recognised that birthing on country could for many thousands of years before women were removed to birthing other settings. So from a historical perspective, it's a relatively new phenomenon to not birth on country. And so how do we translate that to the models of care and the birthing that we have today? Well that is why we are so privileged to have Professor Kath Chamble and joining us today. That was so well said Sue, thank you so much. So we're so lucky that our guest today is Professor Kath Chamble and a renowned expert in Indigenous healthcare and a dedicated advocate for culturally sensitive birthing practices. Kath is a palatable woman of the trollway clan, a registered midwife and a public health researcher. Kath is research focuses on perinatal opportunities to improve health equity for Indigenous people. So with a wealth of knowledge and experience, Professor Chamble and is here to guide us through the concept of birthing on country. And why it is important to help reduce health inequalities in maternal health in Australia. So thank you Kath so much for joining us. We've got a whole range of questions here that I'm so excited to hear your insight and your expertise in this area. Yes, welcome Kath. As Ali said, we've only got a list of about 35 questions for you. But I might hand over to Ali the kickoff. Yes. So a first question is what does birthing on country actually mean and why is it essential for Indigenous communities? Well thanks Ali and Sue. And I think Sue, you covered it beautifully in your introduction about the what birthing on country is, as she say, it's a metaphor for the best start in life for Aboriginal and Torres Strait Islander families and which provides a really good transition to becoming a parent. And it's an integrated holistic and culturally appropriate model of care. So it is something that there's been over 2000 generations of Aboriginal and Torres Strait Islander families born in this country and there's a whole lot of cultural practices around that. So Kath, can I just pick up on that because I think sometimes it is a little bit confusing for people to understand exactly what it means. But I think what you're suggesting to us is whatever model of care or wherever someone births, we can all embrace the concept of birthing on country. So for me, I've worked in a high risk obstetric clinic. There's no alternative for some of my mums, but to deliver in a tertiary center and sometimes with intensive care units and all of the resources of tertiary obstetric care behind us. But I think what you're going to share with us today is about how I, my midwifery team, all of us can embrace the concepts of birthing on country for women no matter what anti-natal care, no matter what risk that they've got, we can all endorse it and get behind it. Is that right? Absolutely. And the College of Midwives and the College of Aboriginal and Torres Strait Islander nurses and midwives have endorsed a set of principles that I think are really can be used and applied anywhere, any setting. And the important things about those are the models of care or the care that you're providing has got the community input that you talked about, that's community designed based and governed, that it allows for the inclusion of cultural practices, which have really rich and that we can all learn and benefit from. It involves the connections to land and country, which is important, but we can do that and be really creative about the ways that that is done so that all women can benefit from that. It's about in evaluating Aboriginal and Torres Strait Islander ways of knowing, doing and learning and it's about having really culturally safe care. So I think we're going to talk a bit about the matter as well. Yeah. Fantastic. Can you just flesh out for us a little bit more the concept of country and how it relates to Indigenous people's cultural and spiritual connections. So Aboriginal and Torres Strait Islander people are one of the longest continuing cultures on the planet and there's so much evidence that around the time a colonisation that the health of Aboriginal and Torres Strait Islander people was among the best in the world at the time. And this didn't happen but accident. It happened because we had these concepts of connectedness that is really central to a concept of country. So Aboriginal and Torres Strait Islander understandings of well-being include connections to ourselves, being connected to our family, to our community, to our spirit now ancestors and really importantly to country where we've been part of for so long and that's a really important part of our culture. So feeling connected to a place or country is really a critical element of feeling well and really important for our kids to be able to have and particularly the important times of life, birth and death, which are really spiritual times. Yeah, yeah. Gosh, I just get slightly prickly eyes hearing you talk about it like that. We have so much to learn about that importance of connection, you know, to family and to ancestors and communities and land and yeah, it was just so beautifully put, thanks. And I'm just wondering if you can maybe just flesh out a little bit more that you've just talked about there about just the historical context about birthing practices among Indigenous communities in your area. So there's so many different practices and yeah, I'm from Tasmania. We don't actually have a lot of knowledge that we know about the traditional birthing practices there because it was lost so quickly. So I'm from around the Bay of Fire's area that was called the Bay of Fire's because when the ships came in those bays were full of the fires of our ancestors burning brightly but it was within a very short time we lost a lot of that cultural knowledge and practices but I can share a little bit of some of the more general things so we know across Australia we've had over 300 distinct language groups and there's a lot of practices around birth that are designed to foster the safety and the connectedness that starts before birth and it continues through until after death two those important elements of family community ancestors and countries. There's Michelle McMarn in her PhD talks about you know babies being a gift from the ancestors and that children when they're coming to the world. that they're bringing these gifts to us and we honor that wisdom that babies have. There's a real connection between so beautiful. I love that. So beautiful. I love it too. So there's all these complicated systems and laws that have been part of culture for a while and a lot of us are re-learning those. Marcy Langton and Aaron Corn have published some of this stuff in a book called Law just in the last month or so that talks about how our systems were grounded in relationality and designed to foster the connectedness and everybody in communities in that system were then accountable to somebody. So we couldn't have had you know single powerful families like monarchs in this system and new parents were supported using the principles of grandmother's law so that was the important part of bringing up children and fostering those systems of you know kinship and community care. And so children were brought up having you know multiple mums so that it wasn't just dependent on one person there was a lot of support around the families for that. Some of the examples that I think that are good to possibly share are Professor Laup on Alpilima. She's a young you professor up in Northern Territory in Arnhemland and she's really generously shared a lot of the ancient knowledge that is able to be shared on their website growing up, young you and a lot of the practices draw on the senses that babies have which I think is really you know when you look at it it's a fun it really really fascinating and really important. So first of all thinking about the sounds that a baby hears that babies often be sung to before birth and building up that connection and we know that babies can hear and they're in the womb. Being sung into the world at birth and sometimes fathers will be involved in that and that has been talked about quite a bit using cluppsticks and music and Professor Laupil talks about how babies when they're born into the world there's an order that babies are introduced to family and community and there'll be familiar sounds that people would develop so it helps to build up those connections really early on with family and community and the important roles that people have. That's great they sound like things that could be very easily implemented even in a hospital setting such as singing like in a birthsweed or order of introducing a baby to maintain Indigenous cultural traditions like I mean that's not that difficult to encourage. It's not difficult at all. But it just is up to us to understand and know the importance of those things so that we can ensure we provide that sort of supportive birth environment like everyone should be able to do those things. In fact all Australians would love to be able to have put that sort of thought and care into how our babies received in the world. We've got things to learn as well but no matter where or how a baby is born it would be so useful for us to know that they are important practices that we should be trying to actively perhaps asking people about what we're probably doing birth plans a lot already. What things would be really significant for you at the time that your baby enters the world and how can we facilitate that and that should be birth planning for everybody but it's so important to understand maybe some of those prompts are there important people that you need to be there or that you would like to share this news with first that our birthing suites can be accommodating and welcoming and culturally safe environments for people to birth. And I loved the idea of grandmother's law is that what you called it which is the idea around a village that it takes a village to care for a baby and I think that in our western society non-indigenous people we really lack that community everything is placed on the direct parents to really raise and nurture that child there's so much that we can learn from that that does take extended family it takes your community and I think that's something that's really important that we can learn from from Indigenous culture. Yeah big shout out to all the mothers and grandmothers out there. I know. I can see my mum all be listening to this going yes grandmothers lower I told you. So Kath my next question is how have colonisation and western maternity models impacted Indigenous birthing practices and traditions? That is a really big question. I was thinking that it's so loaded there's so many ways. It is really loaded and I think you know the European colonisation has been really devastating for every John Torres Strait Islander people so in just over 200 years we've gone from having among the best health in the world to the worst health in the world in just about every health indicator that you can measure and we know that this is because of the violence that occurred and there's a lot of evidence that we have around that how that can lead to intergenerational cycles of trauma and this included you know with the removal of over 100,000 children from their families with the stolen generations and a lot of this happened in our hospitals and maternity care services and impacted directly on families so that is something that impacts on our birthing practice today. We've had colonisation, medicalisation and the patriarchy as well which is really impacted on women's birthing practices. It's a triple hit. We're working to real estate women's places and birthing practices and recreate those safe and sacred places that women have been able to use for thousands of generations in Australia and that's one of the things with the re-planting the birthing trees project that we're really trying to focus on. Hey Kat, since you brought it up, do you want to just give us a little snapshot about replanting the birth trees because I'm a proud collaborator on this project. It's a fantastic piece of work really trying to ensure healthiest starting, keeping children with families and so forth. I'm a bit off script here but that's what we're here for. Do you want to just give us a snapshot on what replanting the birth trees is about? So birthing trees have been used by Aboriginal and Torres Strait Islander people for in not all Aboriginal and Torres Strait Islander communities but many of them. For thousands of generations and they represent a safe and sacred place and they're. What sort of tree are they? Well they can be any tree. Yeah, big trees usually. Where they're shade and where there's shelter as well and often plants around that are useful during birth and things to do with birth. And they're a sacred place that people go during this important time and they represent safety and so what we're thinking about, we drew on that analogy with the replanting the birthing trees which is aligned with the birthing on country movement about trying to recreate those safe and sacred places wherever it is that women are giving birth. How do we bring those census back? With a particular focus on transforming cycles of intergenerational trauma, inter cycles of nurturing and recovery or supporting families to do that transformation because we know that pregnancy in birth is a really critical time. We're babies bringing a lot of love into the world with them and it's love that is the healing of self, trauma and that's what we really need to be able to celebrate and foster here and do that in all those creative ways that you just talked about then with making birthing care a really safe nurturing place for all of you. Yeah, I see. So the birth tree that we should be trying to plant in all of our birthing places is just a place that is safe, that is protective, that we honor the sacredness of it, that we have the things around whether it's plants or people or whatever it is that make birthing safe and feel like it's accessible and that provides the protection and nurturing support to welcome this loving person into the world. Yeah, absolutely. And all the cultural elements as well so that it can be really rich for families. Yeah, you know, I think that people have had including myself, if I'd have to say, had this view that birthing on country was about being able to birth in a particular part of the soil of the northern territory or whatever it was and therefore it was only accessible for low risk models of care, you know, and while that might be birthing on country for some families, what we really need to do is bring the concepts of birthing on country into our health services and our community services and our general practitioners and our anti-natal clinics and our birthing suites so that those principles can ensure that we've got birth trees everywhere. Am I right about that? I think absolutely, I think you're right. I think the important thing is that women have choice and that we're respecting women's choices. Yeah. And that's where it can be, I mean, could some women, where they give birth is really important. Yeah. And I think there's three really important reasons why we need to respect women's choices around this and we used to talk about it quite a lot when I was working in maternity service in the Kimberleys as well because some of the places where women would choose to give birth were quite remote. But regardless of the three main reasons that we think we're important is first of all, even just having the discussion about where women want to give birth and what their choices are, we would like to know if women don't want to come and give birth at the health service, what are the issues? Is there things that we can make better about the health service and if those things were fixed, what would the woman's choice then be? Yeah. The second thing that would often come up is that women might be wanting to give birth closer to home because of the responsibilities that they have at home. Do they need help with that? And if we could provide help with some of those things like having children be now able to come and stay, where would they prefer to then give birth? Would it be in the hospital if they could have their children and their families with them, which is an option for a lot of women? And then once we've worked through that, then there are still some women who do want to give birth in a particular place because of the spiritual importance of that and that's really important that we respect that choice as well. And we need to know know, then be able to put the care and support that we can around people wherever they are choosing to make it as safe as possible. Because what we see happening then is people will sometimes not talk to the care provider about it and have that discussion and that's when things get really unpredictable. It can become a bit adversarial and you have the problem of abandoning care and women abandoning their health service, whereas as you say, the conversations that you have around those three principles, it's not just Indigenous women who have this struggle either. We've got a national oral commission on birth trauma at the moment. We all need to be listening more carefully to what things are significant and important for women around antinatal care and birthing and postpartum care and how can we be more responsive to what they are telling us. I'm straying into the voice again. Anyway, I think that's important and I think the worst outcome would be that somebody would feel that they had to go through something like labour and birth, frightening experience on their own with no care because they feel that they can't ask for the type of care and support that they want. So I do think respecting people's choices and having that discussion is absolutely number one. Yep, yep. And I'm just digressing a little bit here, but can I just ask in your experience at the Kimberley Working as a midwife, how can we use good language to initiate those conversations? Because I think we sometimes come to it with our own sort of unconscious bias and whatever else perspective about health services. And what were the ways that you used to successfully open up those conversations, I suppose, to ensure that people felt enabled and supported to say what was really important to them? So I think for me, the first thing is trying to have a good relationship and building up that trust first. And I always start off the discussion saying, whatever happens, I'm going to respect the choice that you make and that this is your choice as a leading, but that I need to go through what some of my concerns would be and what some of the issues are because this is an important choice to make. But make it really clear up front that this is a woman's choice and her family's choice and then talk through it. It's not rocket science. No, absolutely not. I can maybe, that's what we'd like to do in all of our consultations of our birth and caring for women. Okay, after I graced a bitch, I ask, just what sort of specific challenges do Indigenous communities face when accessing culturally sensitive health care during pregnancy and childbirth? How can we move the needle a bit to making it much more accessible, much more engaging, much more respectful and working in partnership, as you say, with women and their families? So there's so much that we can do and we're saying so much, I think we're going to talk about some of the successes after. But we have to acknowledge the historical context. I mean, this is a huge legacy for all of us working in maternity care that has been the removal of children from hospitals and that many Aboriginal and Torres Strait Islander women coming into health services experience that is unsafe and those, because the stories of children being taken from maternity care services are still alive and within living memory of many communities. And actually the reality is that more Aboriginal and Torres Strait Islander children have been taken in Victoria than they were during the Stollonge generations with one in ten Aboriginal and Torres Strait Islander children being removed from families now. So that is a really important issue and something that really impacts on the safety that is a really legitimate fear. You know, I feel sort of think it's one in ten and it feels a bit random to you. You can understand how that really undermines trust in the system. Absolutely. So I think having an awareness of the fear that people might be experiencing quite legitimately as you say so and then doing everything that we can to create this sense of safety and sacredness around that to improve care. Wonderful. That's great. That leads on to the next question where we might unpack a little bit any initiatives or programmes that are currently in place, specifically in Victoria, I guess, that aim to bridge the gap between Western healthcare and traditional indigenous birthing practices. So this is an exciting bit and it is absolutely amazing to see the success of some of the birthing on country initiatives that have been happening. So they're birthing in our community programme in Brisbane, the Bajari Yorgas programme in WA, the Women to Program in New South Wales. There's the birthing on a Pandana Smart. The Bagger Rook programme here in Victoria and we'll talk about the ones here at the Mercy as well. But the programmes where they're measuring the outcomes, we're seeing like a 30, 40% reduction in things like pre-term births. I mean, if we had a drug that did that, I know. We'd be putting it all in our water. Absolutely. We'd have pharmaceutical companies throwing themselves. We need to commercialise you can. What's not right is the people that are running and sitting up those programmes have just done such an amazing job and it's so exciting. And as you say, none of it is rocket science. It's around having that safety for families, having continuity of care of programmes so that somebody can have a trusting relationship with their caregiver, having a nice environment, working on the things, like proper support for families that might be at risk of losing their babies. I mean, that's the other thing with those programmes. The number of babies removed has dropped to zero in many cases. So incredibly successful here in Victoria. There's the Bagelbrook programme and also the Nung Babu Marab programme. Let me do a free programme which is, I don't think there's results of official yet, but you know, understand incredibly similar remarkable results which is great. And the amazing Marika Jakamos here who heads up. The Aboriginal team, you know, just her and Gina, the Royal Women's Hospital are doing just amazing work on helping women to feel safe and fathers as well to improve the safety that the people feel and get the cultural practices in, setting up the midwifery group practice with the team. It's really, really exciting. And it's really interesting that, as you mentioned before, through a lot of people, the concept of birthing on country, for some people believed that it was literally birthing in remote Australia somewhere, but we've been able to see results from culturally safe programmes implemented in large metropolitan hospitals in Melbourne that have shown how powerful, how great it is. Yeah, that's right, because the principles of the birthing tree, we should be planting in all of our health services, you know, not just in maternity, but particularly in maternity, you know, about that sense of a safe space, a sacred space, a protected space, where you are surrounded by the people and the things that are good for loving this baby into the world, you know, and it's, we shouldn't need outcomes like 30% reduction in pre-term birth to think that it's a good idea. It obviously is, but how incredible that just such interventions can have such profound impacts on the things that we know disproportionately affect Aboriginal and Torres Strait Islander mothers and babies. So, yeah, big shout out to all of you out there who are involved in these programmes, we're so proud of the work that you're doing, but Kath, I don't think you should underestimate the huge power of your academic leadership in this area. So maybe just following on from some of that, for all of our listeners out there, Kath, can you maybe just provide us with some concrete examples of how healthcare providers and institutions can promote cultural safety for Indigenous birthing experiences. I mean, this is exciting, Beddard, it's things that are also good, I would say, for caregivers as well, our workforce to feel better, but having that trusting relationship with caregivers is the main number one thing. So having a model of care that people can see the same person, the same midwife or the same obstetrician, the same team, getting to know other people on the team as well, so any mental health support. We're treating social emotional wellbeing as importantly as we do with physical care. So that's one of the things I think we do really well at the moment in maternity care services is we can do all this really high-tech medical care and address physical needs, but we really need to focus on social emotional care and treat that as important because we know that impacts on outcomes massively as we've just talked about. So having that trusting relationship with the care team, having safe places and flexibility and understanding, so things like, you know, can we really challenging for people to get to appointments and especially with busy lives and things like that, so having that flexibility and understanding and trauma awareness, I guess, for communities, for people working in it, working on policies that can cause harm. So there are still unfortunately at least one hospital I'm aware of in Victoria that arbitrarily reports every Aboriginal mother to child protection services, so we need to really look at some of those dangerous policies and harmful policies. We need to look at how we can enable a sense of flexibility, empowerment and choice. So that's really important and having one thing Maria Music who's an international exporter on trauma awareness services talks about the importance of hope and how we can create these hope inspiring spaces that we know we know that hope is a really important emotion for people to be able to feel that they can take on these new challenges of having a baby and such an important time when a baby is coming into the world. world to really inspire that and support that. So I think they're the main ones, the trusting relationship, safe places, having the flexibility and choice, the hope inspiring places, and working on the policies that can cause. And having the practical support is really important for that as well. So one of the ways that we can build up those trusting relationships is providing really good professional care and practical support to help people with things like food, housing and all the things that you might need when a baby's coming along. Well, you've got us. We're hopeless, we're all. I love that. I love that. I love that we've touched today on the love that a baby brings into the world. This universal experience, you know, there is so much that unites us in the things that you've talked about today, the importance of really prioritising how your baby is born into the world, the love that surrounds it, the people that are there and providing protective, enabling, sheltering spaces for all women who birth, but being particularly sensitive to Aboriginal and Torres Strait Islander women who have not always felt safe, you know, in our health services. And it's a matter of us all meeting at the table, isn't it? And asking women, you know, respectfully and passing power to them and saying, "What is important to you and how can we enable that?" And as you say, not getting into that tricky dichotomy of abandoning care and abandoning health services, you know, we want to find the bridge between those two where we can provide, you know, culturally responsive sensitive care in a way that, as we've just heard, can dramatically improve outcomes, not just for mothers and babies and up to 28 days, which is often what we're reporting, but I know what you're talking about is the birth trees and the importance of what that means in the first 12 months of life and what it means for children to be able to safely stay with families and what it means for those children to grow up in a healthy, flourishing, thriving environment. And so, Kath, I just want to thank you so much for joining us today on the podcast. I've found it quite an emotional experience. I don't know, I'm going to be able to come back to now, but yeah, it's just been wonderful. I've learnt so much. I hope all of you have as well. Yeah. Thank you so much, Kath. I could talk about this topic for hours with you, but I think the main points that we've come away with really practical things that clinicians, healthcare providers or support people can do to really help Indigenous women and improve parinatal outcomes. So, thank you so much. Thank you so much to both of you. It's been a real honour to be proud of this spot and you've summed that up really beautifully. So, thank you. Everyone's pregnancy is unique. The information provided in this podcast is for educational and general purposes only. It is not intended to be a substitute for professional medical advice. It is important that you always seek the guidance of your doctor or other qualified health professionals with any questions you may have regarding your health, your pregnancy or any medical conditions.