Australian Aboriginal kinship: a means to enhance maternal well-being.

BACKGROUND: The relocation of women from their rural communities to birth in a centralised hospital is becoming increasingly common as maternity units close in rural areas of Australia. The significance for Aboriginal women when they are denied the support of kin around the time of birth but have that support re-established postnatally is explored. METHODS: This paper gathered data from multiple sources including in-depth interviews with three Aboriginal mothers and one partner; observational field notes; and during debriefing, the knowledge and experience of an Aboriginal midwife. Thematic analysis was utilised to both explore and critique the collected data. FINDINGS AND DISCUSSION: Aboriginal women are particularly disadvantaged by maternity unit closures in rural areas of the south eastern Australian state of New South Wales (NSW). However, contrary to the expectation that this would result in postnatal mental health problems, the support the Aboriginal participants in this study received from kin may have had a mediating effect which enhanced their well-being and possibly prevented mental ill health. RECOMMENDATIONS: Recommendations relate to strategies and policies that have the potential to increase community governance and feelings of cultural safety for Aboriginal childbearing women living in rural areas. CONCLUSION: While the practice of forcing Aboriginal women to relocate around the time of birth has a negative impact on perinatal health outcomes, kinship support may be a mediating factor.

'Mind you, there's no anaesthetist on the road': women's experiences of labouring en route.

INTRODUCTION: The aim of this article was to learn from women in rural New South Wales (NSW) Australia, their experiences of labouring en route to birth in a centralised maternity unit. METHODS: This qualitative study was exploratory and descriptive. It was part of a larger project that explored women's experiences when they birthed away from their rural communities. Participants were recruited from communities all over rural NSW where a maternity unit had closed. Forty-two female participants and three of their male partners shared their stories of 73 labours and births. This article draws on data collected during in-depth interviews with 12 participants and one partner who shared their experiences of labouring en route to a centralised maternity service. Interviews were audiotaped and transcribed verbatim for the purpose of thematic analysis. Exemplars, using the participants' own words and highlighting story are identified as a tool used for data synthesis and presentation. RESULTS: Two themes were identified. These relate to the way the risk of dangerous road travel is ignored in obstetric risk discourse, and the deprivations experienced when women labour en route. An unexpected finding was the positive nature of one woman's experience of birthing by the side of the road. CONCLUSIONS: Many participants questioned why they needed to risk unsafe road travel when their preference was to labour and birth in their local communities with a midwife.

'You can drop dead': midwives bullying women.

BACKGROUND: This paper describes how women experienced what came to be labelled as 'bullying' by a small number of midwives when they were evacuated from their rural and remote areas of NSW, Australia to a maternity unit to birth. RESEARCH QUESTION: What is the experience of women who are required to travel away from their NSW rural/remote communities to birth? PARTICIPANTS AND METHODS: Forty-two participants together with a number of their partners/support people were interviewed in depth for this qualitative, exploratory study. Upon thematic analysis of the transcribed interviews, an unexpected finding was that four participants (plus one partner) described experiences which were interpreted as bullying, by a small number of midwives working with them. Women identifying as Aboriginal were especially likely to share stories of midwifery bullying. RESULTS, DISCUSSION AND CONCLUSION: Emotional and cultural safety of women must be a prime consideration of midwives. Strategies to reverse power differentials between midwives and women are urgently required to eradicate bullying by any midwife.