“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.”