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Midwifery Group Practice in the Torres Strait with CM Maxine Lenehan

12 Dec 2023

Maxine Lenehan CM works within the Midwifery Group Practice on Thursday Island. She explains how MGP works in the Torres Strait, the logistics of island-based healthcare, and the “beautiful influence” of local cultures on birth.

Mum Louisa and baby Angeli­na with Max­ine (left) and mid­wife Tomika.

Stand­ing on the bal­cony of Thurs­day Island Hos­pi­tal, Max­ine Lene­han can see across a few kilo­me­tres of ocean to Horn Island, Prince of Wales Island and Fri­day Island.

If she was to squint while gaz­ing out at the green moun­tain­ous head­lands, she might almost be in Syd­ney, where she used to live in the west­ern suburbs.

But when she steps inside again, it will be into a dif­fer­ent world: her new life as a mid­wife work­ing in the Mid­wifery Group Prac­tice (MGP) on Thurs­day Island.

The MGP based on the island ser­vices the pop­u­lat­ed out­er islands and five indige­nous com­mu­ni­ties on Cape York.

If deemed safe to give birth on TI, women trav­el to stay in local accom­mo­da­tion when they are 36 weeks preg­nant and then birth in the hospital’s mater­ni­ty suite.

All women receive MGP care,” Max­ine says, mean­ing they are engaged in their own health­care. We have a con­ti­nu­ity of care phi­los­o­phy, where the women get to know the team of mid­wives look­ing after them. 

Three mid­wives look after the Tor­res Strait islands, and three look after the com­mu­ni­ties on the Cape. On TI there is also a mid­wife 24/7 on shift in the hospital.

I care for women on the east­ern clus­ter of islands, includ­ing Mur­ray Island, Darn­ley Island, Stephens Island, Yorke Island and Yam Island.

We make day trips, often by heli­copter or fixed wing, to the islands we cater for, and have appoint­ments with women at the health clinics.

TI mater­ni­ty team: Ana Vranes, Louise Rich­es, Rosi­na Sailor, Natasha Bax­ter, Flo­rence Ketchell, Jade Yeung, Emi­ly Vink, Karyn Wil­son, Lin Hu, Paula Daw­son, Quyni­ra McK­eon and Max­ine Lenehan.

Hav­ing the pres­ence of a mid­wife who ser­vices com­mu­ni­ties, who comes to women rather than the women hav­ing to come to hos­pi­tal – that pres­ence and con­ti­nu­ity is great for build­ing trust and relationships.”

Before this role, Max­ine worked in West­mead Hos­pi­tal in Syd­ney for five years, begin­ning with a year of shift work before four years with­in the Mid­wifery Group Practice.

But it’s always been a goal of mine to move out of the city,” she says. 

I’ve been here 11 months now; I’ve stayed here and loved it. It was def­i­nite­ly a cul­ture shock – get­ting my head around the change in lifestyle. But it was the most wel­com­ing place and I’ve been real­ly well supported. 

I’m glad I got to start out as one of the shift work mid­wives, to under­stand the hos­pi­tal, the process­es, before mov­ing into MGP.

I have had a lot of edu­ca­tion­al oppor­tu­ni­ties here. For exam­ple, I did a Strength with Immer­sion (SwIM) pro­gram in Townsville Hos­pi­tal in the neona­tal inten­sive care unit. 

It was incred­i­ble to see the oth­er side of the sto­ry, to under­stand what hap­pens when the baby gets to Townsville [in the case of a medivac].”

The biggest change for Max­ine since she start­ed work­ing on TI has been the need to con­sid­er logis­tics, not just clin­i­cal care.

On the main­land, in urban and some rur­al loca­tions, when you need sup­plies or assis­tance, it is often just a mat­ter of a dri­ve away,” Max­ine says. 

Here, a woman may go into pre­ma­ture labour or her waters may break pre­ma­ture­ly, and if she is on the out­er islands, it usu­al­ly requires a heli­copter flight or task­ing the RFDS. And because of where we are, in the trop­ics, some­times the weath­er means the heli­copter can’t fly or land for a while.

When I was doing shift work as a mid­wife [on TI], some­times the staff on the out­er islands would have women present who may be in pre­ma­ture labour so we, along with a doc­tor, would sup­port the RANs in the clin­ic, who have mater­ni­ty train­ing but are not nec­es­sar­i­ly midwives.

We would talk to them over tele­health, and there was one instance where a woman from one of the out­er islands was in labour. She was tasked to come to TI, but in the mean­time, over tele­health, myself and the GP obste­tri­cian pro­vid­ed advice on how to care for her.

Pro­vid­ing mid­wifery care over the cam­era was daunt­ing, but it was a good out­come for all.’’

Max­ine reg­u­lar­ly pro­vides care in a cross-cul­tur­al con­text and she acknowl­edges the vital role played by Tor­res Strait Islander assis­tants in mid­wifery and nurs­ing, includ­ing Mar­garet and Flo, who have almost 60 years of expe­ri­ence between them.

Hav­ing that cul­tur­al con­nec­tion is high­ly impor­tant for health pro­mo­tion and for bridg­ing the gap between [non-Indige­nous] mid­wives and the local women, who have respect for [Tor­res Strait Islander] health work­ers and mid­wives,” Max­ine says.

They have cared for gen­er­a­tions of babies; they are part of the com­mu­ni­ty, and under­stand the cul­ture, and the cul­tur­al dif­fer­ences. Some­times they also sup­port women in labour, when these women do not have their escort or sup­port per­son with them for birth, because they are work­ing back home and can­not take a month off to be on Thurs­day Island.”

Being able to observe and learn from women while deliv­er­ing cross-cul­tur­al care has been one of the most reward­ing aspects of the job for Maxine.

Tides are some­thing that impacts your work, your life, whether you can get out on the water, and there is a cul­tur­al belief, strong­ly held by the com­mu­ni­ty, that tides also impact whether or not a woman is going to labour and when she will give birth,” Max­ine says.

Women will look at the change of tides, which are a lot less pre­dictable than on the east coast. One of the beliefs is that if the tide is com­ing in, their labour will be fast and strong, and they’ll give birth soon. If the tide is out, their labour will be slow and pro­longed, and things won’t progress until the tide turns.

I have noticed that if the women say, the tide is com­ing in around this time, this is when I’ll give birth’, then they are right every sin­gle time. That’s been pret­ty incredible.”