The perils of remote living

In remote parts of Australia, the outcomes for women giving birth are not as good. The death rate for indigenous mothers is 2.5 times higher than for other Australians.

In remote parts of Australia, the outcomes for women giving birth are not as good. The death rate for indigenous mothers is 2.5 times higher than for other Australians.

Indigenous women are also less likely to receive adequate healthcare when they are pregnant - only 77.5 per cent receive at least five check-ups during their pregnancies, compared with 90 per cent for the rest of the population.

The World Health Organisation says pregnant women should receive at least four check-ups from doctors or other health workers.

Lesley Barclay, a professor with Sydney University's Centre for Rural Health, has been working with health services and Aboriginal communities for the past 14 years to improve the care women receive in remote areas of the Northern Territory.

She says Aboriginal women are more likely to be in poor health. They may have had undiagnosed rheumatic fever as a child, which can cause cardiac problems, and they are more likely to be anaemic, which means if they haemorrhage it is more likely to be catastrophic.

And a lot of the problems they face are also mental health-related.

"Mental health problems are greater in the indigenous population, which isn't surprising given the social distress and economic disadvantage that many of them experience."

Their remoteness also makes accessing health services a challenge.

She says research in the Northern Territory has indicated that one in 10 Aboriginal women have been avoiding the maternity system, in which they receive antenatal care in their communities, often from a community nurse or Aboriginal health worker, before being flown to Darwin to give birth.

"They found it distressing, being away from their other children, they were frightened of being evacuated to Darwin to give birth, where they didn't know anybody, they had no family, and sometimes were in a hostel waiting, where nobody even spoke their language."

She has been working with the territory Health Department to improve the system. There are now dedicated midwives working in larger remote communities, rather than nurse midwives trying to do two jobs, and women have more contact with their "own" health professionals in Darwin before they give birth, to ensure continuity of care.

"They will have met their midwife through a video call or on the phone before coming in, so the midwife knows the woman, and is expecting them.

"They are developing good friendships with their midwives - for example, they are texting them when they get home and the baby puts on weight."

The key to a successful system is to have all health professionals, doctors and midwives, working to provide the best medical and social care for a mother, an approach that she advocates for all remote and regional communities in Australia, not just indigenous ones.

The closure of maternity services in rural areas over time has meant women have to travel to larger towns for antenatal visits and to give birth. Sometimes they don't make it - in NSW last year, 74 babies were born on the side of country roads.

One solution she advocates for regional Australia is re-establishing obstetric training as part of general practitioner training.

This would ensure more country GPs are qualified to undertake a normal birth or support midwives providing the service.

She also calls for a more flexible system, where midwives can work on call with local GPs to provide services locally for women in country areas, providing them with continuity of care, without adding to the workload of hospital nursing staff.

"We need to redesign the system, to maximise different skills, and keep services open and providing contemporary care."

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