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Providing good preconception and antenatal care in rural and remote

30 Aug 2021

Judy Burke has been working as the women’s and maternal health coordinator at Katherine West Health Board for the past two years.

My focus is on health pro­mo­tion in mater­nal health and the key mes­sage is for good pre- con­cep­tion and col­lab­o­ra­tive ante­na­tal care,” she said.

My belief is that every woman is enti­tled to mid­wifery-led ante­na­tal care but there’s often not the capac­i­ty in region­al, rur­al and remote to have that care due to nation­al mid­wife shortages.

It often falls to the clin­i­cians on the ground includ­ing RANs, GPs, and AHPs to take own­er­ship of the ante­na­tal care port­fo­lio with very few RANs with dual reg­is­tra­tion as nurse/​mid­wife,“ said Judy, recog­nis­ing that it’s not in the reg­is­tered nurse scope of prac­tice to pro­vide ante­na­tal care and it’s about capac­i­ty build­ing with the aim to sup­port RANs and GPs with edu­ca­tion and train­ing in women’s health.

Sit­u­at­ed on the Kather­ine Riv­er, 320km south­east of Dar­win, the Kather­ine West Health Board pro­vides health ser­vice deliv­ery across eight com­mu­ni­ty health cen­tres span­ning 160,000 square kilometres.

The four main cen­tres are in Kalka­rind­ji, Laja­manu, Tim­ber Creek and Yarralin. Small­er health cen­tres are in Bul­la, Nitjpurru (Pigeon Hole), Lin­gara and Mialu­ni (Kil­durk). Remote mobile teams ser­vice com­mu­ni­ties and pas­toral out­sta­tions fur­ther afield.

We have just employed two mid­wives so there are now three of us as a new­ly formed team to pro­vide a more holis­tic approach from pre­con­cep­tion, ante­na­tal and post­na­tal care with an aim to improve over­all health of our women in the Kather­ine West region, par­tic­u­lar­ly pre­con­cep­tion – in dia­betes man­age­ment, weight, and good nutri­tion to enable a good start to life,” said Judy.

Kather­ine West typ­i­cal­ly has 30 – 50 preg­nant women on their books.

Ini­tial­ly when I first start­ed as the only mid­wife in the region, I want­ed to vis­it each site at least once a month, but then there was COVID and I realised every two months was more realistic.

The ante­na­tal record is a tool that can guide GPs and RANs with what they need to do, and it helps with clin­i­cal han­dover,” said Judy. This is par­tic­u­lar­ly rel­e­vant for Kather­ine West which has a high per­cent­age of high-risk preg­nant women. A point of preva­lence inves­ti­ga­tion in August last year found of the 47 ante­na­tal women, 80% had a sig­nif­i­cant obstet­ric his­to­ry, pre-exist­ing co-mor­bidi­ties includ­ing Type 2 dia­betes, high BMIs and com­plex social issues, includ­ing vic­tims of fam­i­ly and domes­tic vio­lence and trauma.

We have a lot of dia­betes (30%) in preg­nan­cy, and for the major­i­ty of these women, this means they need to trav­el and stay in Kather­ine or Dar­win in the last four weeks, before they give birth. Com­plex­i­ty; it’s not a one size fits all. It takes an indi­vid­ual and a col­lab­o­ra­tive approach for holis­tic care of high-risk women, mak­ing sure clin­i­cians are on the same page. The mid­wives and RANs liaise reg­u­lar­ly by case con­fer­enc­ing with Dar­win Hos­pi­tal Mid­wifery Group Prac­tice, Kather­ine Hos­pi­tal O&G team, and oth­er vital health teams includ­ing endocrinology.

RANs liaise with the med­ical doc­tor on call refer­ral and work with Care Flight to organ­ise trans­fer if needed.”

Judy has been at the Kather­ine West Health Board since August 2019 but has been work­ing in the Kather­ine region since 1997.

I came up to the NT with no real expec­ta­tions and I’m still here. I worked as a mid­wife in the mater­ni­ty unit at Kather­ine Hos­pi­tal and I loved it. I was a naïve young nurse/​midwife keen to make a dif­fer­ence and help solve some of the prob­lems in Indige­nous health. In my first week, I asked my men­tor: How can I learn more about Indige­nous women and their cul­ture? What can I do?’ She said to me: Sit and spend time with women. Share your own sto­ries with them’.

Work­ing with women is what I love to do, there are lots of chal­lenges and rewards.”

Judy worked as a mid­wifery edu­ca­tor for many years. Her then hus­band was a Ranger in the remote nation­al parks around Tim­ber Creek.

She com­plet­ed a Mas­ters’ in Pub­lic Health and gained expe­ri­ence in sex­u­al health. How­ev­er, she returned to her pas­sion of midwifery.

I missed being a mid­wife. Some­times you must go away from some­thing to realise how much you miss it. It’s so hum­bling. I feel both hon­oured and reward­ed hav­ing had the oppor­tu­ni­ty to work with women.”

Judy is a strong advo­cate for ante­na­tal care and pre­con­cep­tion health.

We are behind the ball in the health of these women. Data shows new­born birth weights have improved. How­ev­er this could also be masked by a growth-restrict­ed macro­som­ic baby of moth­ers with dia­betes,” she said.

About 15 – 45% of babies born to moth­ers can have macro­so­mia, which can tip the scales of an under­weight baby to nor­mal due to uncon­trolled dia­betes in pregnancy.

Strong begin­nings through build­ing rela­tion­ships with women in the com­mu­ni­ty help improve health out­comes. Mod­els of care, such as the KWHB Strong Begin­nings for Strong Fam­i­lies pro­gram adapt­ed from the MEC­SH (Mater­nal Ear­ly Child­hood Sus­tained Home-vis­it­ing) pro­gram have been shown to strength­en the qual­i­ty of holis­tic care for women,” said Judy.

It helps build rap­port and rela­tion­ships. I’ve real­ly seen the ben­e­fit of this pro­gram, with nurs­es and women work­ing togeth­er. It makes a huge difference.

I use the advice giv­en to me – spend time with women.”

In Kather­ine I sug­gest nurs­es and mid­wives ven­ture out into the com­mu­ni­ty, go to the footy games and devel­op those relationships.”

It’s also about deliv­er­ing high qual­i­ty and cul­tur­al­ly secure pri­ma­ry health­care to all peo­ple in the Kather­ine West region, says Judy.

We have Indige­nous dri­vers and liai­son offi­cers who ensure cul­tur­al­ly safe care. If someone

has missed a scan, they can find out why in a cul­tur­al­ly appro­pri­ate way. They have shared knowl­edge with these women. I learn a lot more about the woman and where they sit in their com­mu­ni­ty; where they are in the family.”

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