Risky business: contested knowledge over safe birthing services for Aboriginal women.

ABSTRACT

Maternity services in Australia are becoming rationalised with contemporary, authoritative knowledge driving the provision of services under the premise that birth in larger regional and tertiary settings is the safest option. There is increasing evidence that families who live in rural and remote areas are not satisfied with having to travel long distances and be absent from their homes for weeks at a time for childbirth. This is particularly problematic for remote dwelling Aboriginal women, with evidence suggesting current maternity services and relocation for birth are culturally, socially and emotionally unsatisfactory and unsafe. The Indigenous knowledge around birthing that still exists in remote communities today, is not being acknowledged or incorporated into health service provision with the current 'risk equation' excluding the social, emotional and cultural risks that have been identified by the women themselves. Unlike the Inuit situation in Canada, which could provide leadership and advice for Australia, there has not been sufficient dialogue in Australia around the construction of risk and its importance in the birthing environment, particularly for Aboriginal women.

KEY WORDS

Sociology, birth, Aboriginal, risk, safety, Indigenous authoritative knowledge, Inuit

Risk in childbirth is an emotive issue, with personal experiences, professional experience, different cultural values and vested interests all influencing the debate. Maternity services in Australia, as with many other countries, are progressively becoming rationalised. Many smaller units, particularly those without caesarean section facilities, are closing requiring women to travel increasing distances from their home for birth (Rural Doctors Assocation Australia 2005). Considerable evidence suggests that current maternity services in Australia, which require relocation for birth, are socially, culturally and emotionally unsatisfactory and, as a consequence, potentially unsafe (Biluru Butji Binnilutlum Medical Service 1998, Fitzpatrick 1995, Hirst 2005, Kildea 1999, NSW Health 1998). For many, childbirth is a normal life event, and should not require relocation from home and family. Though this paper reports mainly on Aboriginal women and their experiences, many issues are similar for non-Aboriginal women who live in remote, and increasing numbers of rural, areas.

This paper discusses remote area birthing services, cultural safety and current health issues facing remote-dwelling Aboriginal women in Australia. It argues that the authoritative knowledge driving the provision of birthing services needs to be contested, and should incorporate Indigenous knowledge around birthing. The current 'risk equation', measuring risk and safety in birth, does not include the social, emotional and cultural risks that have been identified by the women themselves. To date there has there been insufficient open dialogue in Australia around risk construction and its importance in the birthing environment, particularly for Aboriginal women. Until this occurs it is unlikely that the maternity services will meet the needs of these Australians.

Authoritative knowledge