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Keeping Birthing on Country in the spotlight

1 Dec 2020

Sue Kruske and Sue Kildea, midwives and leading university educators based in Alice Springs, are passionate about building knowledge of, and expanding services for Birthing on Country.

Get­ting it right from the start: sup­port­ing women to be strong, capa­ble moth­ers, leads to strong, capa­ble chil­dren,” they say.

The two Sues have been involved with CRANAplus since the mid 90s, were part of the orig­i­nal team to design the organisation’s MEC (Mater­ni­ty Emer­gency Care) and then the MIDUS (MID­wifery Up-Skilling) cours­es, and have been facil­i­ta­tors of both ever since.

Sue Kruske is Pro­fes­sor of Pri­ma­ry Health Care joint­ly appoint­ed between the Charles Dar­win Uni­ver­si­ty Col­lege of Nurs­ing and Mid­wifery and NT Health depart­ment, and Sue Kildea, is Pro­fes­sor and Co-Direc­tor at the university’s Mol­ly Wardagu­ga Research Cen­tre. The Mol­ly Wardagu­ga Research Cen­tre is ded­i­cat­ed to Mol­ly Wardagu­ga, Burar­ra Elder, Abo­rig­i­nal Mid­wife, Senior Abo­rig­i­nal Health Work­er and found­ing mem­ber of the Mal­abam (now Malal’a) Health Board in Man­ingri­da, Arn­hem Land, who was an impor­tant con­trib­u­tor to the Aus­tralian dis­course regard­ing the impor­tance of Birthing on Country. 

We are proud to be asso­ci­at­ed with the cours­es,” says Sue Kildea. The first MEC we did in Alice Springs was run out of two suit­cas­es and there was one foam mannequin.” 

Basi­cal­ly it remains the same pro­gramme, says Sue Kruske, reg­u­lar­ly updat­ed but the issues haven’t real­ly changed. Women have been hav­ing babies for for­ev­er and the same com­pli­ca­tions can occur. We deliv­er a very hands-on work­shop, with clin­i­cal sce­nar­ios – such as post­par­tum haem­or­rhage and unex­pect­ed breech birth– and we ask what are you going to do about it’.” 

A cen­tral mes­sage, they stress, is not to be so afraid of a nor­mal birth. Most women will birth per­fect­ly well by them­selves, they say, but, of course, you have to be pre­pared for a com­pli­ca­tion occur­ring. Being cul­tur­al­ly safe, under­stand­ing why women may not want to leave their com­mu­ni­ties and fam­i­lies for many weeks to await birth in a dif­fer­ent city and mak­ing sure you treat women with respect are core mes­sages of the course.

The MEC course was very suc­cess­ful from the start at meet­ing the needs of remote gen­er­al nurs­es, Abo­rig­i­nal Health Work­ers and para­medics, says Sue Kruske. MIDUS was intro­duced a cou­ple of years lat­er, specif­i­cal­ly to upskill mid­wives and GPs work­ing remote­ly. With two gen­er­a­tions of women now trav­el­ling to region­al cen­tres, trained mid­wives work­ing remote were not get­ting the expe­ri­ence,’ she says. They need­ed upskilling to feel they were not miss­ing out on the lat­est infor­ma­tion and knowledge.”

Nation­al pol­i­cy since the mid-late 80s is for preg­nant women to be tak­en to region­al cen­tres; in the NT at 38 weeks, and in Queens­land at 36. But we all know that the clo­sure of ser­vices has gone too far and we are now strug­gling to reopen them in many set­tings. It’s much safer to have a low risk birthing ser­vice in a com­mu­ni­ty than to have no ser­vices at all said Sue Kildea. Aus­tralia hasn’t got that right and it is fam­i­lies in rur­al and remote com­mu­ni­ties that suf­fer as a result. As a min­i­mum we should have mid­wives in com­mu­ni­ties across the coun­try – that would make it safer for women who choose to stay and birth on coun­try but also for women pre­sent­ing with oth­er com­pli­ca­tions such as pre­ma­ture births.

Sue Kruske explains that the pol­i­cy means that the women can be in a region­al cen­tre, away from their com­mu­ni­ty and per­haps with­out fam­i­ly sup­port, for up to 6 weeks and some decide to return home because of fam­i­ly mat­ters or a death in the com­mu­ni­ty, or avoid being flown out of their com­mu­ni­ties as they reach term. The team is work­ing with the Galiwin’ku com­mu­ni­ty of the Car­ing for Mum on Coun­try project which is devel­op­ing a course for Abo­rig­i­nal child­birth com­pan­ions (doulas), known as Djakamirrs, to help sup­port women in preg­nan­cy and childbirth.

Keep­ing the issues alive sur­round­ing Birthing on Coun­try is a focus for the whole team at the Mol­ly Wardagu­ga Research Cen­tre and when Sue facil­i­tates the cours­es. We feel there is a strong need to put a human face to the pol­i­cy that is remov­ing women from remote areas and trans­fer­ring them into the region­al facil­i­ty,” she says.

Of course the cours­es are deliv­ered over a huge range of amaz­ing coun­try and we always get great plea­sure to go where you’ve got a lot of coun­try around you and fab­u­lous peo­ple — it ensures you keep abreast of the issues.”

How to address iso­la­tion in the Bush has always been a focus for Sue Kildea, who spe­cialised on it dur­ing her doc­tor­al work. She sees the CRANAplus cours­es help­ing clin­i­cians to be safe and skilled.

We like to tweek our pre­sen­ta­tions,” she says, intro­duc­ing new infor­ma­tion and the lat­est guide­lines and evi­dence-based prac­tice each course.

We get great plea­sure if a health prac­ti­tion­er comes up to us at one of the con­fer­ences, for exam­ple, and out­lines a sit­u­a­tion they found them­selves in and com­ments and I remem­bered what you told me to do. Some­thing stuck in my mind’.

The bot­tom line, says Sue Kruske – keep calm, qui­et, respect­ful and don’t afraid.”