Mark Aitken: Hello! And welcome to the Nurse and Midwife Support podcast, your health matters! I’m Mark Aitken, your podcast host for today. I’m the stakeholder engagement manager with Nurse and Midwife Support and I’m a registered nurse. Nurse and Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free. You can call us anytime about any issue you need support in relation to: 1800 667 877. Or contact us via the website at nmsupport.org.au
My guests today are associate professor Catherine Chamberlain; Catherine is an NHMRC Career Development Fellow and principal researcher at the Healing the Past by Nurturing the Future project. Catherine has a PhD and is a registered midwife. My other guest is Tanisha Edwards; Tanisha is a registered midwife and sessional teacher at the Australian Catholic University (ACU) in the Indigenous Health and Culture subject, she currently works at the Royal Women’s Hospital in Melbourne. Hello, and welcome Cath and Tanisha!
Catherine Chamberlain and Tanisha Edwards: Hi!
MA: Great to have you both here today to yarn about all things Aboriginal health, particularly for midwives who are supporting Aboriginal and Torres Strait Islander communities.
CC: Thanks Mark, well it’s a real privilege to be here today, talking to you. I’d just like to start by acknowledging that we’re on the land of the Wurundjeri People where we meet today, here in Melbourne.
MA: Cath, would you tell us a bit about yourself and the great work you’re doing?
CC: Thank you Mark. I’m a registered midwife, as you said, and I’m currently a principal investigator at the Healing the Past by Nurturing the Future project. Most of my work is around how we can improve health during the perinatal period, so from pregnancy to the first two years after birth. It’s such an important time, for the baby and the parents. The things that we do during that time can have impacts on everyone, throughout the rest of their lives. One of the things that we’re learning, that’s really important at the moment, is complex trauma. So, intergenerational trauma is something that effects Aboriginal and Torres Strait Islander people particularly. But it’s a problem all over the world.
It occurs after there has been a severe threat in early childhood, from which the child cannot escape. It’s related to the fight or flight response, which is one of our survival mechanisms. It’s also related to attachment, to things that are really important during our childhood. They’re both conflicting; so, you get the child that is frightened but also really needing to be attached to the mother. We know now, how that can really cause a lot of problems for people throughout the rest of their lives. It leads to a lot of social, psychological and also a lot of real physical health problems. We’re doing some work now around what we can do during the perinatal period to identify and support Aboriginal parents that are experiencing complex trauma.
MA: Such important work Cath. How did you get into doing this area of research?
CC: Well I’ve been doing public health research for over 15 years now. I was originally looking at smoking, diabetes and obesity that is responsible for a lot of illness and death; in our communities, in particular. One of the things that we’re learning is that while a lot of things do help, a lot of the things that would work in other communities aren’t working quite as well as we would hope when we start to implement them for Aboriginal people. Some of the evidence coming out is showing that things that like smoking and obesity is quite closely linked with complex trauma and child maltreatment. Also, the interventions seem to be less effective in people that have had those experiences. So, it’s a part of the mosaic puzzle that we don’t quite understand all that well. In 2017, we submitted a grant application to the National Health and Medical Research Council and to the Lowitja Institute. We’ve started working with a really amazing team of psychologists, psychiatrists, other midwives, nurses and other Aboriginal health experts.
MA: I imagine in your long career as a midwife, you’ve cared for Aboriginal and Torres Strait Islander people who have suffered the effects of intergenerational trauma. You observe that through being a midwife, and probably found ways to support the community. Have you also identified things that need to happen, but won’t happen?
CC: As I said, this is something that all people working in Aboriginal communities have been grappling with for quite a while. There was a survey done by the Centre of Perinatal Excellence in 2015, and 98% of people working with Aboriginal and Torres Strait Islander mothers identified trauma, loss and grief as really important issues. This is something that people have known has been an issue for quite a while, and certainly a lot of Aboriginal organisations have identified this as a key priority. For instance, in 2016 it was the key theme of our National Lowitja Institute Conference. AMSANT: Aboriginal Medical Services Alliance Northern Territory have this as one of their key priorities and several other bodies are really trying to address this. It is something that we’ve all seen, it’s something that we’re struggling with and don’t really know exactly what to do at the moment. A lot of the research is about what we can actually do to try and support people better.
MA: And it really speaks to the importance of nurses and midwifes doing research, to really help to answer some of the big questions such as these. So, congratulations Cath. You’re doing really important research. I imagine one thing that prevents Aboriginal people from seeking support in mainstream health services is that sense of intergenerational trauma, particularly the stolen generation. Issues are really embedded, for many people that I speak to from those communities, and a suspicion about what will happen when they access mainstream health services.
CC: Yes, that an absolutely enormous issue for us that we’re trying to grapple with. This history is at the front and centre of our minds as we’re doing this research. It’s particularly important for us in maternity services. Children were taken away, literally from the hospitals, shortly after birth. That’s a legacy that we’re really trying to deal with at the moment. We have that history; those stories are still alive and real for people living today. It’s incredibly painful. The other issue that we have now, sadly, is that children are actually being taken away at a higher rate than what was endured during the stolen generations. This is because of this compounding intergenerational trauma effect that we’re seeing. So, it’s a real issue, this fear that we have in maternity services and dealing with complex trauma. We’ve really got to work out how we can deal with this, because it’s really important.
MA: As you say, the solution is complex and requires a sort of robust research. I imagine that’s where the importance of birthing on country comes into this? A lot of people don’t want to access mainstream services and want to birth on country, could you tell us a little bit about that?
CC: This isn’t just a problem for Aboriginal women, it’s a problem for all people worldwide. 25% – 50% of people worldwide experience child maltreatment. But it’s the intergenerational elements and compounding that has made it really concentrated, there are a lot more issues that we’re dealing with in Aboriginal communities. But, one of the things that we’re finding that is really clear from parents who have experienced maltreatment and for Aboriginal women as well is this sense of services not being safe.
For somebody who has experienced complex trauma and has grown up in a world that was unsafe, whether things are safe or not now, everything feels unsafe. That constant sense of feeling threat and danger around you is one of the diagnostic symptoms that people are proposing. Coming into a maternity service where the threat is real, and we have that history of it, it’s no wonder that people are afraid. A lot of the things that we do during perinatal and maternity care actually triggers people’s trauma responses. A lot of it is quite intimate and invasive, the procedures that we have, there is a lot of invasion of people’s personal space and body. That can be really, really triggering.
So, people actually feel as though they are back in the original trauma. A lot of parents, Aboriginal and non-Aboriginal, who have experienced this childhood trauma have described their maternity care experience as very similar to the original abuse that they experienced as a child. A part of trauma-informed care, and we’re still working our way around this, but the really important elements are feeling safe and having a trusting relationship with the person that’s caring for them. For a lot of people, that might be birthing on country in particular because going back to country be where people feel safe. I hope Tanisha will talk more about this, but country is one of the things that’s held us and kept us safe in the past. So that can be a really safer place for us to be. But also, in the birthing on country model of care, having that relationship with your care provider is a really important part of helping parents to feel safe during a time that can be really traumatic.
MA: Thank you so much for sharing that with us. Tanisha, you’ve had a really interesting career to-date as a midwife. We were talking about some of the great stuff that you’ve done on our way here today, could you please share your midwifery background with our listeners? And a bit about your teaching at the Australian Catholic University in the Indigenous Health and Culture subject please.
TE: Yes, sure. Thanks Mark. I was actually working as an Aboriginal health worker in Queensland, that’s where I’m from, and I worked in a midwifery group practice for Aboriginal and Torres Strait Islander women. I worked there for about a year, and then I decided that I wanted to be able to more for our women. Provide more care, and basically be more available for them. I decided to start studying midwifery and I did that through the Australian Catholic University’s Away From Base program in Brisbane. I was off-campus for most of my studies and came in four times a year for weekly blocks to do all of the practical stuff. I completed that and decided that I would move to Melbourne. I applied for a graduate position at the Royal Women’s Hospital, which I was successful to get into the Aboriginal graduate program. So that was really amazing support for me, coming from another state, I didn’t know anyone here. Didn’t have any family here. The support provided through that program was really amazing and I’ve made some really great friends, especially through the Aboriginal program, but also just with the other midwives that were in my block who were in the graduate program with me.
The Royal Women’s, that first year in my practice gave me a lot of confidence and provided me with a lot of support, and I guess really made me the midwife that I am today. I’m still working at the Royal Women’s Hospital and really love it there. At the start of last year, I did some sessional marking with ACU in the Indigenous Health and Culture subject. Then this semester I started doing some teaching in that subject as well. That’s the Indigenous Health and Culture subject at ACU.
MA: Sounds like a great subject, what sort of things do you teach? I imagine a large part of it is around cultural safety, and you teach it in a yarning circle which we are really interested in.
TE: Yes, that’s correct. So, all of our classes and all of the tutorials are taught in a yarning circle. We just set up our room with no tables, just chairs, and we all sit around with the students which I think is a really great way of teaching. I feel like the students feel quite comfortable. We’re all on the same level, we’re all equal and it’s about sharing our stories. We teach about what culture is, what it means for people and how these students can work it into their practice and how they can be culturally safe. We do a bit of education about why Aboriginal and Torres Strait Islander people might not want to be accessing mainstream healthcare service. Trying to instil in the up and coming health force how important it is for them to be culturally safe, not just for Aboriginal and Torres Strait Islander people, but for everyone. But specifically, why it is so important for Aboriginal and Torres Strait Islander people.
MA: That’s so interesting Tanisha, and when you were a student, which you know was not so long ago. It was a lot longer for Catherine and I. What sort of things supported you? What would you say to nurse and midwifery students that may be struggling with an issue and need support?
TE: For myself, because I already had a relationship when I was an Aboriginal health worker with some really great midwives at the hospital where I worked (I also did my placement there) so I had two really great midwives who I could go to for support. Any questions, any concerns, I could turn to them and ask for support. Also, the Aboriginal unit at ACU were a great support for me as well. If I had any problems, any questions or anything they were more than happy to provide support. I think finding someone, a nurse or a midwife to mentor and support you during your studies is really important.
MA: Yes, I agree. I think that notion of having a mentor or somebody that you can go to and say, I’m struggling with this, or, this doesn’t quite stack up, can I get your perspective on this? Is so valuable and important for nurses and midwives.
TE: And not being afraid to ask for help when you need it, because everyone goes through those periods where studying is quite tough. Not just doing the study, but your family life and everything around it as well. So, just not being afraid to ask for help when you need it is really important.
MA: That’s definitely a really important message, so I hope our listeners can act on that: don’t be afraid to ask for support. Nurse and Midwife Support is available 24/7 to provide that support. You can call us anytime at 1800 667 877, the service is anonymous, confidential and free. Catherine, Tanisha and I are here today because we’re making this podcast as a part of the NAIDOC week celebrations. They’re held across Australia each July to celebrate the history, culture and achievements of Aboriginal and Torres Strait Islander peoples. NAIDOC is celebrated not only in Indigenous communities, but by Australians from all walks of life. I think that’s really important, that Australians from all walks of life really connect with the importance of NAIDOC week. So, what does that mean for you Cath?
CC: The theme is Voice, Treaty and Truth and I think that those are really good ones. For me, as an Aboriginal midwife working in Aboriginal maternity care and research, having a voice is really, really important. It’s about Aboriginal parents feeling safe to talk about what is going on during this really exciting transition of becoming a parent. I think it’s really important for Aboriginal parents in particular, because we had the big women’s movement in the 70’s and 80’s, a lot of non-Indigenous women and women generally had an increase in voice.
There was the evolving birth plans and women becoming more involved in their care, but for a lot of those reasons that I’ve talked about earlier (including fear of losing their children and not feeling comfortable in maternity services) I don’t think we’ve seen that yet for Aboriginal women in maternity care services. I think a lot of Aboriginal women don’t yet feel safe to stand up and say what they want in terms of their birth plan and care. For me, I would really like to see that confidence. For Aboriginal women to feel as safe as other women do in saying what they would like in maternity care. That is, what I thought about under voice.
MA: I love that.
TE: It’s really true.
MA: How do you foster that, Cath?
CC: A lot of the training that Tanisha is doing around cultural safety. We actually, and at the moment, sadly have some policies that counter that. I’ve heard horror stories of people being referred to Child Protection Services if they don’t turn up to three antenatal appointments. We’re really going to have to start thinking seriously about these policies and how they affect people. Especially when they’ve experienced trauma and are coming into our maternity care system. This is a real area that just didn’t happen for Aboriginal women, like it did for other women. And that’s still not happening now, I mean, the birthing on country debate is a really important example of that.
Where people are just not feeling comfortable, to come in and talk about it. A lot of non-Indigenous women feel quite comfortable coming in and talking about what they want, taking home their placenta so they can plant a rose bush under it or whatever. There’s absolutely no reason why Aboriginal women should feel uncomfortable talking about the kinds of things that would help birth be a spiritually enriching experience as well as a safe one. But, we’re not there yet. Do you have any other suggestions Tanisha?
TE: Yes, I think it’s a really big question, but I think there needs to really be more education in regards to why people aren’t turning up to their appointments. It’s not that they don’t care, there are reasons why they’re not coming to the community health services. I think that until there is that education and people understand that, that’s why there are these policies where you just refer them straight to Child Protection Services. It’s just that vicious cycle again, where that child may be potentially taken away from that parent because they think that they don’t care about their appointments. But they do, it’s just the fear of coming and actually accessing those services. It’s a big question.
CC: I think you’ve hit the nail on the head there. Fear is the thing that we really have to address to help people feel safe in our maternity care systems.
MA: What advice would you have for midwives and nurses who really connect to this issue and want to try and help make a difference? What advice would you have about how we can go about making a difference? To dispel that fear that we really hear that people experience. Health services, especially hospitals, are very frightening places for many people. I used to work in intensive care and because I’d worked there for so many years, I started to normalize the equipment and all of the tubes and machines that were around the patient. Then I realised that that wasn’t the normal experience for families and relatives coming to visit. So, I’d spend some time, before I’d bring them in to see their loved one, explaining what they’re about to see or experience. And that, I think, really helped people. It didn’t fix their fear, but it really helped them understand what they were going to be confronted with. Have you got some advice in regards to what we can do, as nurses and midwives, to assist with this fear that people have?
CC: It is a really big question, it’s one that we’ve been thinking about a lot at the moment. I think, like you say, being aware of what is happening and understanding how fight, flight and freeze are playing out when people are having an intense fear response. If people are fleeing, and not turning up, if they’re getting angry, helping people to actually recognise that it’s normal. I think, listening is probably the most important thing. In Aboriginal culture, we talk about dadirri (deep listening) and really getting to know the person that you’re with and listening on a really deep level. Listening not just to what they’re saying, but how they’re saying it, looking at people’s body language. I think it’s really about building up that trust and relationships, that’s the absolute critical thing.
MA: Yes, I think those are really important points. I really like awareness. I like listening, and that going towards building trust. Tanisha, would you add to that?
CC: I think that those are really, really good points. I think, just understanding that you do have to spend time yarning. Just because you meet them and you’re there and you’re providing care it doesn’t necessarily mean that they’re going to feel safe straight away. You really need to build that relationship, spend the time yarning with them and building those connections. That’s the only way Aboriginal and Torres Strait Islander people will feel more comfortable accessing health services. If they can feel comfortable, and build good relationships. Education; educating yourself, educating other nurses and midwives that may not understand. If things are being said that you think, they might not be right, it’s always good (if you can) to step in and say no, this is how it should be done. I think education is really important.
MA: Something that I find a lot of nurses and midwives are really good at is feeling empathy for what somebody might be going through, so imagining stepping into their shoes and imagining how you would feel in that situation. Then showing that, and you said it in your presentation that you sent me Cath, compassionate care. Showing compassionate care; kindness, empathy and sensitivity. Include parents, to build trust and feel valued and cared for. I think that was a really important part of your research that I read.
CC: Yes, that’s true. That’s a really important point, the other one that I should have mentioned from another paper that we’ve put out there is around the power of choice and control. Rather than telling people what to do, offering a couple of choices. For people who, because of those effects of trauma, having some form of control is really critical. Some of the things that we do during pregnancy and birth are really quite invasive. There’s really strong stories from people talking about how, it’s not what you do, but how you do it. So, taking time to explain to people what you’re going to do. It’s not the same for every person, that’s what makes it a little bit tricky and why you need to spend a little bit of time getting to know people. Some people, for instance, would prefer not being told everything that midwives are going to do because that might be what their abuser told them.
But, for some people that is really important. But definitely giving people the choice to opt in and out of the types of care and to be conscious of how people are reacting to what’s happening in care, so you can stop and give choices.
- Care and compassion
- Having a voice
The other thing that people talk about is even though people may have had a lot of difficulty with it in the past, having a baby is such an important chance for new hope and new beginnings. It’s a time when people talk about hope affirming practices, we talk about strength based practices a lot in Aboriginal health, but around birth it’s slightly more nuanced with hope affirming practices. It’s about finding out what peoples hopes are, and what we can do to really support people in that. It is a time when people can piece back together. Another nice analogy I heard was around re-weaving our future. Sort of, pulling parts, we have this history of intergenerational trauma but now with this new baby coming into the world, babies are sacred. We know that. So, talking about how we can help people to reweave that future back together for themselves and their new baby. Everybody wants that, it’s just how we can do that. Trying to be positive and reassuring parents that they can do this, and putting what supports we can in place.
MA: Really important points Cath thank you, Tanisha, you’re nodding. Have you got anything that you want to add to that?
TE: No, just really great work. It’s amazing, I feel privileged to be here and hearing about all of these things. I think support is probably the number one, the biggest and most important thing that we can provide is supporting our families. Putting things in place so that they can achieve the things that they want to achieve and be the family that they want to be. So yes, it’s really great.
MA: Thank you, Cath, you’re going to talk a bit about the other things in this NAIDOC weeks key messages.
CC: Great, thanks Mark. So, yes. I just think that they’re fantastic themes. Treaty, under the theme of treaty, one of the things that I think is really important for me is that all Australians can start to really appreciate and celebrate that we’re living in a country with the oldest living culture in the world. There is just so much wisdom, and particularly around this area of pregnancy, parenting, birth and complex trauma. One of the most exciting things about the research project is that most of the research team are Aboriginal and we’re drawing from diverse Aboriginal wisdom and knowledge with Western research methods.
There is so much knowledge in our community around birthing, and parenting in particular. Around relational development of children, a lot of that not been understood as much outside of Aboriginal culture. But it’s very rich, and we ought to all celebrate that. Finally, under truth, I think the main thing that I wanted to say under that was that there’s nothing to be afraid of in regards to truth. I have a mixed background, from both sides, and I think we all just need to be honest and deal with it and it isn’t anything to be afraid of. We do have that history, but moving forward, I would really like to see us celebrate so that our children can be happy. That’s one thing that our ancestors would all want, to work towards a future where our children are all happy.
MA: Thank you very much Cath. I can’t believe we’ve come to the end of the podcast! Time flies when you’re talking to such great guests like yourselves. My hope is that we can all work together as nurses and midwives to provide support for Aboriginal and Torres Strait Islander people. We can do that in a collaborative, person-centred way.
We hope, today, you’ve got some key messages that will enable you to do that. We’ll have more information up on our website, that you’ll be able to access once you’ve listened to this podcast at nmsupport.org.au
CC: And, I’d really like to thank you for the invitation to come along today. It’s a real privilege to come and talk to you and your listeners, thanks so much for the initiation.
MA: Thanks Cath, we really appreciate it and it’s our privilege to have you both speak on the Nurse and Midwife Support podcast, so thanks again!
TE: Thank you, I’d also like to say thank you and that it’s been a privilege coming on the podcast.
MA: You’ve been great guests, and I know our listeners will really benefit from your words of wisdom.
CC: Thanks, and it’s great to have people like Tanisha coming in and taking on the baton.
MA: Indeed! If you found this podcast useful, please share it with other nurses, midwives and students. And if you need support, NM Support is available 24/7 1800 667 877 or contact us via the website nmsupport.org.au
Thank you to AusMed for making the editing of this podcast possible.