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A selection of stories from our CRANApulse magazine written by remote health professionals or students during their clinical placement
Keeping Birthing on Country in the spotlight
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.”