Pregnancy, Labour and Postnatal Outcomes for Women - Term Paper Example

Midwifery Student’s Name Grade Course Tutor’s Name Date: Introduction Women and infants of Aboriginal and Torres Strait Islander descent have for the most part of Australia’s history registered poor health outcomes (Murphy & Best, 2012). Some of the reasons often cited for such outcomes among Aboriginal and Torres Strait Islander mothers and children include their lack of access to health services, their poor nutritional habits, smoking habits, and even genetic predisposition to insulin intolerance (NSW Department of Health, 2009). This essay commences with comparing the health outcomes of the Aboriginal and Torres Strait Islander mothers and babies with similar outcomes in the rest of the New South Wales population as documented in a 2009 Ministry of Health report. The second part of the essay contains a strategy formulated for purposes of improving the health outcomes of mothers and infants as indicated in the NSW Ministry of Health report, while the third section recognises the psychosocial impact that relocating women at childbirth has on both mothers and their infants. Overall, the essay ends by noting that the poor health outcomes among mother and infants of Aboriginal and Torres Strait Islander communities can be improved through deliberate strategic actions. Outcomes for women and babies of Aboriginal and Torres Strait Islander descent and the rest of the birthing population in NSW Generally, the Mothers and Babies Report published by New South Wales Ministry of Health in 2011 portrays the Aboriginal and Torres Strait Islanders mothers and babies as having registered poorer outcomes when compared to the non-Indigenous population. Starting with the mothers, the report indicates that the Aboriginal and Torres Strait Islander mothers were more likely to delay their first antenatal visit. Between the 2005 and 2009 period for example, the report indicates that the proportion of Indigenous mothers who commenced antenatal clinics ‘at less than 14 weeks gestation’ was at 69.2 %, while those who commenced the same at 20 weeks gestation was at 83.4 %. Such statistics compare poorly with the non-Aboriginal or Torres Strait Islanders whose percentage of commencing antenatal visits was pegged at 79.2% and 89.2% for the 14 weeks and 20 weeks gestation periods respectively. According to the World Health Organization (WHO, 2007), antenatal care is important since it enables the mother’s health to be assessed by qualified medical personnel. As a result, the mother is advised and guided on self-care and nutrition during pregnancy and delivery, and is also treated for any conditions that may be detrimental to the pregnancy. Aboriginal and Torres Strait Islander women are especially encouraged to attend antenatal care because they are at an increased risk of urinary tract infections, diabetes, hypertension, anaemia and other lifestyle diseases – most of which are caused by poor nutrition and smoking (de Costa & Wenitong, 2009). The report further indicates that the Aboriginal or Torres Strait Islander Mothers are more likely to smoke during pregnancy (50.5%) compared to the non-Aboriginal or Torres Strait Islander mothers whose incidence of smoking during pregnancy was recorded at 10. 5%. The maternal ‘medical conditions and obstetric complications’ registered among the Aboriginal and non-Aboriginal mothers in NSW in 2009 however indicates that the incidence of gestational diabetes and pregnancy-induced hypertension was lower in indigenous communities (i.e. at 3.3% and 5.5% respectively) compared to the incidence of the same diseases in the non-Indigenous population which was at 5.5 % for gestational diabetes and 6.5% for pregnancy-induced hypertension. Other diseases such as diabetes mellitus and essential hypertension were more prevalent in the Indigenous mothers at 0.8% and 0.9% respectively, while the non-Indigenous mothers registered lower incidences of the same at 0.5% and 0.8% for the same diseases. The report however notes that the incidence of gestational diabetes and pregnancy-induced hypertension might have been lower among the Indigenous mothers ‘due to under-detection and/or under-reporting’ (NSW Ministry of Health, 2011, p. 78). Perhaps the poor health outcomes for the mothers and babies of Aboriginal or Torres Strait Islander communities are best illustrated by the report’s statistics on babies. For example, NSW Ministry of Health (2011) indicates that the incidence of low birth weight (10.8%) was almost twice the same rates registered in non-Aboriginal or Torres Strait Islander mothers (5.8%) in 2009. Gestational age outcomes are also poorer among the Aboriginal or Torres Strait Islander babies with 10% of them being born before the 37-weeks gestation period compared to non- Aboriginal or Torres Strait Islander babies, whose rate of pre-37 gestation birth incidence was recorded to be at 7.2% in 2009. Another poorer outcome was that 3.1% of the babies born to Aboriginal or Torres Strait Islander mothers scored less than seven points on the Apgar score. Only 2.0% of non-Aboriginal or Torres Strait Islander babies had similar scores. According to the United States National Library of Medicine (NLM, 2012), a baby who scores less than seven points on the Apgar scores needs medical attention. Most such children may have been delivered through a difficult birth or a caesarean section, and may even have fluids in their airways. Aboriginal or Torres Strait Islander mothers are documented as being poorer in infant feeding (breastfeeding), with only 62.4 % of their babies being fully breastfed in 2009. This compares poorly to the non-Aboriginal or Torres Strait Islander babies whose rate of being fully breastfed was at 80.6% in 2009. The culmination of the poorer mother and babies outcomes among the Aboriginal or Torres Strait Islander is perhaps evident in the perinatal mortality which is evidently higher (“12.1 to 22.6 per 1,000 births”) compared to the non-Aboriginal or Torres Strait Islander perinatal mortality rate which is pegged at “8.5 per 1,000 births” (NSW Ministry of Health, 2011, p. 82). An antenatal strategy that could be implemented to improve maternal and/or foetal outcomes among Aboriginal or Torres Strait Islander mothers and babies Having identified the failure by Aboriginal or Torres Strait Islander mothers as the first main cause of poor maternal and/or foetal outcomes in the above section, a comprehensive strategy would factor in the need to educate the affected mothers about the need to attend antenatal care clinics. As Pokharel et al. (2007) note, “educating the community about the benefits of receiving regular antenatal care, at grassroots level may have a significant impact on improving pregnancy outcomes” (p. 176). Next on the list of activities in the antenatal strategy would be educating and sensitizing pregnant women and the women population at large about the dangers of smoking. Among approaches that can be used to make smoking cessation a reality among Aboriginal and Torres Strait Islander communities a reality include encouraging smoking mothers to give up their habits, giving them support in order to facilitate the smoking cessation habits, collaborating with tobacco cessation programs in specific areas to advance their programs therein, and educating communities not only of the dangers of active smoking, but of the risks that passive smoke poses to the unborn baby. Publicising anti-smoking messages in targeted media could also play a critical role in informing a wide-range of pregnant mothers about the need to quit smoking when pregnant. The diagram below is an illustration of one such publicised message. Most women who smoke when pregnant do not know the possible dangers that the habit poses to them and to their unborn children. For example, Williams (2010) observes that smoking while pregnant may lead to “bleeding from the placenta; premature labour; waters break early; more complicated births; [and] more miscarriages” (p. 12 [emphasis added]). Making such facts known to pregnant women may convince some to quit smoking. Figure 1: Publicising the anti-smoking message to pregnant women Source: Williams (2010). The inclusion of dietary advisory programs that would help the Aboriginal and Torres Strait Islander mothers to practice proper nutrition when pregnant would also be useful in the strategy, especially if the poor low birth outcomes are to be dealt with. According to Child Health Research Organisation (n.d.), Aboriginal or Torres Strait Islander people, just like other indigenous communities across the world are “prone to conditions known as Syndrome X, or insulin syndrome”, – a condition that predisposes them to health conditions such as obesity, renal disease, cardiovascular disease, and type II diabetes. However, an improved diet can give the communities some sort of protection from instance of disease, and can even be used to control the severity of the same diseases. In order to improve maternal and foetal outcomes, the target pregnant women would need to be informed about healthy eating for purposes of enhancing their own health outcomes, and for purposes of enhancing the foetal development of their unborn child. The strategy will also include awareness creation among pregnant Aboriginal or Torres Strait Islander pregnant women regarding the need to seek medical assistance during childbirth (Kildea, 2006). Such a strategy will address the increased incidence of poor Apgar scores, and even when such scores are poor, the new born babies can be subjected to immediate medical attention hence increasing their chances of survival and lowering the probabilities of developing health complications. As Couchie and Sanderson (2007) noted in a Canadian study, women with high complication risks can be evacuated to well-equipped hospitals, while those with lower risks can benefit from mid-wife services or other assisted birth services available in their communities. Finally, in the strategy would be the resolve to educate Aboriginal or Torres Strait Islander mothers on the importance of breastfeeding. In line with the NSW Ministry of Health (2011) findings, it is apparent that Indigenous mothers register poorer breastfeeding habits, and this no doubt affects the health and wellbeing of their children. Binns and Scott (2002), Binns et al. (2004), Darling (n.d.) and Gilchrist et al. (2004) share similar sentiments about the poorer breastfeeding habits and techniques among Indigenous communities, but notes that awareness creation among mothers can change the tide to benefit the infants. Psychosocial impact on childbearing Aboriginal and Torres Strait Islander women as a consequence of the practice of removing women from country In a study conducted among Indigenous communities in Canada, Couchie and Sanderson (2004) recommend that as long as it is safe, indigenous women should be allowed to give birth among their communities. In other words, Couchie and Sanderson (2007) found information that was convincing enough for them to recommend against relocating women during childbirth, unless safety requirement demanded so. Similarly in Australia, such recommendations would be beneficial especially considering the cultural practices that Aboriginal or Torres Strait Islander communities attach to the birth experience. Kildea, Kruske, Barclay and Tracy (2010) for example observe that a significant number of pregnant women chose to hide their pregnancies, or move to remote locations in order to avoid relocation during childbirth. Consequently, they register poorer mother and infant outcomes when compared to non-Indigenous Australian mothers. The psychosocial effects of relocation during childbirth are closely linked to the integral links that Aboriginal or Torres Strait Islander communities have to their land and culture. Relocation is thus likened to moving a person from a familiar culture to an unfamiliar culture where she has to learn everything from the new language, new food, new ways of associating with others, and at a time when she needs the support of her family and community members most (Couchie & Sanderson, 2007). Kildea (2006) further notes that Aboriginal or Torres Strait Islander women view childbirth as a normal life experience, and oftentimes do not understand why they have to be relocated away from their communities, land and culture all in the name of safe child-bearing. The psychosocial implications of relocation at childbirth are perhaps better espoused by Wardaguga and Kildea (2004) and Roberts (2001), who observe that separating women from their culture, language, land, families and their children pose unacceptable risks that compromise their mental wellbeing during the entire time stay in hospital. Additionally, Wardaguga and Kildea (2004) observe that the detachment from birthing ceremonies is associated with a weak spirit in Indigenous babies, and could be a contributing factor to high infant mortality rates in such communities. For childbirth to attain its social significance among the Aboriginal or Torres Strait Islander communities, Rawlings (1998) observes that a woman needs to be surrounded by families, friends and relatives who care for her spiritual and cultural needs. Without such people around her, the woman cannot be at peace, and is therefore likely to be worried or stressed during the childbirth experience. A stressed mother cannot be good for her newborn, and this indicates the need for the Australian government to reconsider the relocation at birth policy for Indigenous pregnant mothers. Conclusion As evident from the three sections above, the Aboriginal and Torres Strait Islander communities in NSW (and elsewhere in Australia) register poor mother and infant outcomes when compared to the non-Aboriginal or Torres Strait Islander counterparts. However, such poor outcomes are not insurmountable, and as indicated in the strategy section above, deliberate actions to create awareness about healthy living (i.e. smoking cessation during pregnancy, proper diets, and breastfeeding the baby) are some of the strategic measures that can be used to improve the mother-infant outcomes among the Indigenous communities. Additionally, and as acknowledged in the latter section of the essay, the relocation of mothers during childbirth to ostensibly provide them with safe childbirth experiences has psychosocial effects, which may after all compromise the mother-infant outcomes. Such findings then mean that relocating mothers should only be done when the risk of giving birth within one’s community is too huge. References Binns, C., Gilchrist, D., Gracey, M., Zhang, M., Scott, J., & Lee, A. (2004). Factors associated with the initiation of breastfeeding by aboriginal mothers in Perth. Public Health Nutrition, 7(7): 857-861. Binns, C.W., & Scott J. (2002). Breastfeeding: reasons for starting, reasons for stopping and problems along the way. Breastfeeding Review, 10(2): 13–9. Couchie, C., & Sanderson, S. (2007). A report on best practices for returning birth to rural and remote Aboriginal communities. Journal of Obstetrics Gynaecology Canada, 29(3): 250-254. Darling, J (n.d.). Breastfeeding: The way our mothers taught us – Australian Aboriginal breastfeeding style. Retrieved October 24, 2012, from http://breastfeedingconference.asn.au/sites/breastfeedingconference.asn.au/files/Papers_Presentations/18_DARLING_J_Breastfeeding%20the%20way%20our%20mothers%20taught%20us%20full.pdf de Costa, CM & Wenitong, M. (2009). 'Could the BabyBonus be a bonus for babies', Medical Journal of Australia, 190(5): 242–3. Gilchrist, D., Woods, B., Binns, C W., Scott J. A., Gracey M., & Amith H. (2004). Aboriginal mothers, breastfeeding and smoking. Australian and New Zealand Journal of Public Health, 28(3), 225 -228. Kildea, S. (2006). Risky Business: contested Knowledge over safe birthing services for Aboriginal women. Health Sociology Review, 15, 387-396. Kildea, S., Kruske, S., Barclay, L., & Tracy, S. (2010). ‘Closing the gap’: How maternity service can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural and Remote Health, 10: 1-12. Murphy, E., & Best, E. (2012). The Aboriginal maternal and infant health services: A decade of achievement in health of women and babies in NSW. NSW Public Health Bulletin, 23(4): 68-72. National Library of Medicine (NLM) (2012). Apgar. MedlinePlus, retrieved October 24, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/003402.htm NSW Department of Health. (2009). Improving mental health outcomes for parents and infants – safe start guidelines. NSW Health- Families NSW Supporting Families Early package, retrieved October 25, 2012, from http://www.sfe.nswiop.nsw.edu.au/file.php/1/SafeStartGuidelines.pdf NSW Ministry of Health. (2011). Centre for Epidemiology and Research. New South Wales Mothers and Babies 2009.Sydney: NSW Ministry of Health. Pokharel, H.P., Lama, G. J., Banerjee, B., Paudel, L. S., & Pokharel, P. K. (2007). Maternal and perinatal outcome among the booked and unbooked pregnancies from catchments area of BP Koirala Institute of Health Sciences, Nepal. Kathmandu University Medical Journal, 5 (2): 173-176. Rawlings, L. (1998). Traditional Aboriginal Birthing Issues. Birth Gazette, 14: 6-13. Roberts, J. (2001). The Northern Territory Remote Area Birthing Project. 4th National Women's Health Conference Adelaide: Australian Women's Health Network. Wardaguga, M., & Kildea, S. (2004). Molly tells medical conference: It's time to listen. Aboriginal & Islander Health Worker Journal, 28 (6): 10-11. Williams, M. (2010). Maternal health tackling smoking project. Aboriginal Health Council of South Australia Inc., retrieved October 24, 2012, from http://www.ahcsa.org.au/media/docs/events/maternal_health_tackling_smoking_ahcsa.pdf World Health Organisation (2007). Health services coverage statistics: Antenatal care coverage, retrieved October 24, 2012, from http://www.who.int/healthinfo/statistics/indantenatal/en/index.html Read More