While many Aboriginal and Torres Strait Islander women experience healthy pregnancies, for many poor health and social disadvantage contribute to poor prenatal outcomes than those experienced by non-Indigenous women.

Below is snapshot of perinatal health among Aboriginal & Torres Strait Islander women:

• Overall poorer perinatal outcomes than non-indigenous women
  • At least 4 times the rate of maternal mortality (Sullivan et al 2007)
  • Higher rates of preterm birth (13.3%vs 8.0%), low birth weight (12.3% vs. 5.9%) and perinatal deaths (17.3 vs. 9.7 per 1,000 births (Laws et al 2010)

• Risk factors for complications of pregnancy experience in some communities
  • High level of life stressors
  • Limited access to affordable nutritious food
  • High prevalence of urinary tract infections, sexually transmitted infections and anaemia
  • High prevalence of chronic illness-diabetes, kidney disease and rheumatic heart disease
  • High prevalence of smoking
  • Harmful levels of alcohol consumption in pregnancy
  • Lack of family or social support
  • Pregnancy in adolescence

• Access to health services
  • Limited availability of culturally appropriate services may affect attendance (eg. average no. of antenatal visits range from 5.5 in mainstream health care settings to 10.5 in community - controlled settings (Jan et al 2004; Rumbold & Cummingham 2008)
  • Financial issues may restrict access

While responses to this situation go beyond antenatal care and efforts are required to improve health and welfare in Aboriginal and Torres Strait islander communities more generally, heath services that are culturally equipped to provide services to Aboriginal and Torres Strait Islander peoples and that take a holistic approach to antenatal care can play an important part

Excerpt from Draft National Evidence-Based Antenatal Care Guidelines: May 2011

With these facts in mind, some general thoughts on issues that come up when caring for pregnant Aboriginal women.
1. A holistic approach is very important. Patients come along with the pregnancy, for antenatal care, but often have pre-existing issues related to housing, social stressors, drug and alcohol, and mental health, and often these may be of foremost concern. It is important to see patients at least twice before their initial hospital visit.
2. It is very important to look at the patient’s family including extended family and supports at the outset. Family is very important, and often extended family – mothers, aunts are very involved
3. You are not alone! Utilise existing services ie. Young Parents Clinic (RPA Clinic for pregnant women < 20 years run by a VMO (GP) and designated midwife), and services elsewhere in the community.
4. Opportunistic prevention. There is a high rate of smoking in the Aboriginal community and pregnancy is a good opportunity to encourage quitting. Always ask about cannabis, as well as other recreational drugs, and alcohol as well. It is a good time to do PAP smears, and also consider chlamydia screening in high risk groups with appropriate pre-test counselling.
Courtesy of Dr Cara Frame, ANSC GP: Aboriginal Medical Services , Redfern

Some reminders ... ANSC Record Card (Yellow) Whenever an antenatal care consultation is attended, please ensure that it is recorded on the woman’s ANSC Record Card. This ensures that hospital staff are aware whether routine check-ups and/or tests have been attended and eliminates the need for certain procedures to be repeated. Pregnancy Assessment: Auscultation It is highly recommended that a Fetal Doppler is used for fetal heart monitoring. Free: Parenting Education and Support Research Program for mothers who are isolated ‘Changing Life Trajectories’ Project – Nurse Home Visiting & Group Program for mothers with newborn babies is a research project being conducted by The Infants Home and UNSW. The program will include a series of 4 home visits and 6 group sessions by early childhood health nurses. They are looking for mothers with a baby born/due May - August, who:

• Has indicated that she feels isolated (her own terms)
• Has adequate English (if she is not born in Australia)
• Lives within 30 minutes drive of Ashfield
• Is available during the week for the group component of the program

The aim of the program is to: decrease social isolation and increase maternal responsiveness, knowledge of child development, parental confidence and social connectedness and usage of community services and mother & child wellbeing. If you have anyone who meets these criteria, please call Nicole Bechard – The Infants Home Child & Family Services on 9799 4844 or nbechard@theinfantshome.org.au