Providing Optimal Maternity Care for Childbearing Women Who Identify as Indigenous Australian - Literature review Example

Name Institution Tutor Date Abstract This paper provides an introspective literature review on the issue of providing optimal maternity care for indigenous women of child baring age. Despite the many improvement in maternity health care services in Australia. Most of the studies reviewed acknowledge the fact that disparity does exist in the provision of optimum maternity care essential for indigenous women. The analysis found out several problems that create poor maternal health care service delivery to the women and infants in the remote areas, especially poor standards of parental support and child care. There is a lack of appropriate skills by the health service providers for providing health care to the infants and their mothers. Again there was lack of adequate leadership in the Aboriginal communities and poor coordination between the tertiary and remote services that are essential in improving the maternal health care and eliminate related risks that are introduced by the system. Cost efficient and sustainable improvements were proposed to the quality, acceptability and improved outcomes in the maternal health care. One of the key issues raised is the existence of remoteness which greatly affects the access of maternity care services. The studies therefore provide various crucial recommendations that should be adopted in order to transform the state of maternity care for indigenous women. Keywords: Aboriginal, Cultural safety, maternal, remote, sustainable health care, primary health car Introduction There should be several changes in the current culture and structure of the maternity services in Australia. The changes should reflect the needs of babies, women and families from different backgrounds. In Australia, several maternity care services are provided. In the recent years, there have been improvements in the provision of optimal maternity care for childbearing women in Australia. Despite these improvements, studies still indicate that there exist disparities in the provision of maternity care especially for indigenous women of child bearing age. This paper seeks to examine the issue of providing optimal maternity care for childbearing women who identity as Indigenous Australian. The scope of the study will be grounded on examining the scope various key issues which include; the condition of the maternal health and the maternity care for indigenous women, the practice of Midwifery and how to provide optimal maternity care for indigenous women. Background Australia is considered to be a healthy and well-developed nation. However, there exist several health disparities for the Aboriginal infants and mothers. The poor child health and the poor maternal care for the women may lead to the early start of chronic diseases. Due to this, it is essential that the Aboriginal infants and the mothers be provided with better health care services, specifically the preventive primary health maternity care, throughout all life stages to provide them with good health. There is no attention to how the services are usually used by the Aboriginal infants and mothers (Bar-Zee et al., 2013). Literature Search Strategy and Databases Searched In line with various methods outlined in the Cochrane systematic reviews, and different strategies that were used in the prior studies, the search strategy comprised of three different steps. The first step comprised of consultation with a skilled librarian who provided five electronic databases: Scopus, Cinahl, Informit, Pubmed, and ProQuest. Secondly, to maximize the coverage of the literature, the librarian searched eight websites related to Aboriginal women and infants and their maternal health care. Those included were the Lowitja Institute, health info net, health organization for the Aboriginal community, maternal and child health exemplar, Telethon Institute for research on child health, the office of Australian government of Aboriginal families, Institute of Australian family studies and national Aboriginal society control. The last date when the materials were last searched was on 17th.May, 2013. Thirdly, the reference list of the Aboriginal mothers and infants was hand searched and different wellbeing interventions were made by use of electronic databases. The initial search produced four thousand, seven hundred and sixty-five results (Crystal et al., 2014). Different studies were rejected for several reasons, first is when the studies were duplicate. Secondly the studies were rejected if they could not focus on the maternal and child health, or if the predictor or the outcomes variables could not relate to the maternal or child health. Thirdly is if the study did not address the indigenous individuals in Australia. Again, if the studies did not focus on primary health care services and programs and if the studies were not book chapters, reports or journal articles. The remaining studies were then examined to single out different studies that were considered as intervention research. Intervention research are studies that test quality of the maternal health of the Aboriginal families or the services that are designed to improve the maternal health among the Aboriginal families. The second group of studies was the program descriptions which are literature that describes different methods and procedures that are applied in the implementation of proper maternal health care to the women and infants (Crystal et al., 2014). Review process methodology The methodology of the study will involve an examination of various studies and publications that relate to the topic of providing optimal maternity care for childbearing women who identify as Indigenous Australian. The following sources will be used Author Topic Research Type Major Findings Kildea, S, Kruske, S., Barclay, L. & Tracy, S. (2010)., How maternity services can lead to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Journal of Rural and Remote Health Empirical study The study reveals that the reproductive health outcomes for Indigenous mothers in Australia are very poor when compared to other Australians Bar-Zee S, Lesley B, and Sue K. (2012). Use of health services by remote people. Aboriginal infants in northern Australia: Retrospective cohort study Remoteness affects infant health and therefore posing a challenge for child bearing mothers Gao Y, Gold L, Bar-Zeev S, Josif C, Steenkamp M, Barclay L, Zhao Y, Tracy S, Kildea S. (2014). A cost consequences analysis of a midwifery group practice for Aboriginal mothers and infants at the top end of the Northern Territory Retrospective and prospective cohort study Mothers travelling to town received better health care as opposed to the use of baseline maternity care Ireland S, Belton S, Wulili Narjic C, Kildea S.(2011). Exploring the experiences of Aboriginal women who give birth in their remote Naturalistic Study Giving birth in remote areas creates many challenges for child bearing mothers Olson, R. and Couchie, C. (2013). The politics of midwifery implementation on the First Nations Multisided ethnography National policy together with the existing jurisdiction within government are the main obstacle of the implementation of midwifery Crystal J, Janya M, Roxanne B and Komla T.( 2014). Aboriginal maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings Retrospective cohort study The maternal and child health care service programs for indigenous communities were in most cases weak Bar-Zee S, Lesley B, and Sue K. (2013). Use of Maternal Health Services by Remote Dwelling Aboriginal Women in Northern Australia and Their Disease Burden Retrospective cohort study Most women did attended antenatal care however are always late this resulted to Ba1irth complications NSW Ministry of Health.( 2013) Maternity: towards healthy birth in NSW Empirical study Most of the researchers and health departments have worked together to develop different policies and reforms that can promote maternal health care service to the Aboriginal women and infants. Australian Institute of Health and Welfare (AIHW). (2012). National maternity ser-vices plan Multisided ethnography . The study found out that among the Aboriginal women, childbearing happens at a very early age. The study further discovered that the Aboriginal mothers have large families Findings The studies examined provide an overall picture of maternity care for childbearing Indigenous Australian women. Some of the key issues identified include The Condition of the Maternal Health And The Maternity Care For Indigenous Women According to Bar-Zee et al. (2012), several Aboriginal mothers and infants live in remote communities. There exist poor social and economic standards for these infants and women. These problems are due to high level of poverty, the continuing colonization effects and low education in the region. The remote and rural people are disadvantaged by lack of primary health care and access to the health care services. This leads to low utilization of the health care services than those who live in the urban centers. Provision of maternal health care sustainability in the remote areas is very complicated since the distances are long the populations are small and dispersed in the society. The remote areas lack adequate road network and the human resource that can help in supporting different models of delivering health facilities to the residents. There should be a more elaborate way of provision of health services across all the sectors and areas in Australia (Ireland et al., 2011). A study conducted by Kildea et al. (2010), found out that there exists poor quality heatlhcare for the Torres Strait Islander and the Arboriginal mothers which is mainly worsened by the exsting remotenesss which creates a chalange for provising services. Other challenges include the lack of continued midwifery, inadequate coordination and poor practices by the clinicians that impacted the delivery of a natal care. There existed high degree of complications; twenty-three percent were admitted to having the antenatal complications while fifty percent of the mothers were found to be anemic, forty percent had abnormal test results in their urine while close to twenty-three percent had STIs. The study illustrates that ten percent of the infants’ birth occurred in the remote societies despite the recommendations that the women should be transferred to the urban areas for delivery (Kildea, 2010). Clinicians do not provide proper handover and communication at the regional hospitals to the remote health center staff. Interviews and information gathered indicated that the discharge summary was lacking, and several inaccuracies were identified. Inappropriate communication, documentation and coordination between the health center and the hospital staff and inappropriate clinical guidance led to inadequate health facilities in the remote areas. Again unqualified health nurses handled parents and infants this worsen the maternity health of the maternal mothers in Australia (Bar-Zeev, 2011). A study by (Gao et al, 2013) had the objective of comparing the costs effectiveness that exists between two service delivery models of the baseline cohort practice and the Midwifery Group Practice (MGP). The study disclosed that women who received MGP obtained better services such as more ultrasounds, better antenatal care and they were also more likely to get hospital admission. The use of the MGP approach reduced health risks for mothers. Additionally, saving on health costs was made when compared to the use of the baseline cohort. A key challenge was also derived from the fact that several communities in Australia were not properly engaged with the Aboriginal society leaders, community services, and lack of leadership in Aboriginal on how various services were delivered, owned or designed by the local authorities. This has resulted to inadequate time frame for promoting health care for child bearing mothers (Josif et al., 2012). Journal of Obstetrics and Gynaecology Canada (2013), found out that postpartum conducted after six months indicated that forty five percent of the mothers had registered different morbidities in postnatal such as anaemia and different infections in the reproductive tract including eight percent caesarean section wounds and eight percent women who required admissions in the hospital. The Several mothers were able to visit the rural health facilities at least once in one week; however, very few of them recorded postnatal care. In order to effectively and efficiently address these disparities that resulted from the intervention of the Northern Territory Emergency, the group of midwife practice was introduced. The Practice of Midwifery There were significant improvements in the health care including statistical improvements in the record keeping of maternal cases, cessation advice on smoking and screening tests on the antenatal complications. There was a significant decrease in the distress of fetal during labor, and most of the women acquired advice on postnatal contraception. There existed a positive report on the experiences of midwives, mothers and others in the first year of formation of the practice of midwifery. Also, the engagement of many of the mothers with the healthcare services was well improved. Many of the midwives in the hospitals were able to receive messages on the weight of the reporting babies several weeks after their birth. Through this, there was improved care, and several appropriate clinical outcomes were achieved (AHMAC, 2011). The study conducted by AMOSS, (2012), found out that there should be an improvement in the clinical care. There was a significant increase in poor health conditions due to improvement in documentation. However with the introduction of the practice of midwifery, most of the factors have since been addressed. Continuity of care is provided by the qualified staff. Lack of proper leadership in Aboriginal leadership is improved by the good relationship between the clients and the midwives (Inuit midwifery network, 2012). Olson and Couchie, (2013) disclose that in many nations that have indigenous communities, the National policy together with the existing jurisdiction within government are the main obstacle of the implementation of midwifery. In most cases the existing policy does not address the needs of the Aboriginal communities. For instance the function played by midwives is very significant for the indigenous communities however many the existing policy in many nations does not integrate the midwives. This therefore makes the notion of maternity health care for indigenous communities to be a political issue. Ways of improving maternity care The study by AHMAC, (2011) found out that the needs of many of the Aboriginal mothers of child bearing age are not met accordingly. There exist evidence that indicate that the current provision of maternity care is not providing proper assistance to the mothers and the infants. The study found out that among the Aboriginal women, childbearing happens at a very early age. The study further discovered that the Aboriginal mothers have large families. The increased population in the Aboriginal families combined with the increased pregnancy risks creates a significant challenge for improvement of health care for the Aboriginal women. Increased number of pregnancy risks and inadequate reproductive health care in the Aboriginal parents is related to poverty, co-morbidities, social disruption, and alienation (AHMAC, 2011). According to Duckett and Wilcox (2011), improving the health outcomes for the Aboriginal mothers and infants can be done through the developing the cultural maternity services for the Aboriginal infants and mothers. This can be obtained through the provision of multidisciplinary and the collaborative approach to health care to the Aboriginal mothers and infants, medical specialist, health workers and the GPs. There should be instigated and support the culture of Aboriginal and creating awareness and training for the providers of maternal health care. Since the Aboriginal mothers and infants live in remote areas, there should be improved transportation network that can enable them access the maternity care services with ease. Again there should be the establishment of language centers and developed partnership with the medical services, Aboriginal society, and Aboriginal community control health organizations. This will ensure an adequate service provision to the Aboriginal mothers and infants. Dietsch et al. (2011), suggest that the maternity care can be improved by improving the well-being and health of the infants and their mothers. Childbirth and pregnancy are considered as physiological process. Proper preparation and planning for the pregnancy with adequate support from health care professionals can be of great benefit to the mothers. This can enable the parents and their families to make different choices that can meet their various needs. There should be the equitable provision of perinatal screening. Mothers should have more adequate, consistent and appropriate information on the perennial screening services, this can enable them to make informed choices. The continuous increase in obesity in women is a major concern in pregnancy. Obesity or overweight in women affects the ability of such women to conceive, it also creates series of health problems to the mothers and the infants. Close to nine percent of the women develops diabetes with the high degree found in the obese women. All providers of health services should be aware of the advantages of promoting good weight before pregnancy, the importance of exercise and healthy diet throughout the period of pregnancy. They should also be mindful of the importance of early detection of different complications and adequate referral services when needed (Dietsch et al., 2010a). The women awareness on child birth should be improved, different care models that are capable of providing continuity of GP and midwifery care during pregnancy period, labor period and during postpartum and that which incorporates primary health care and providing optimum care in the community are likely to improve the level of satisfaction and provide better health care to the women and the infants. The GPs and the midwives should be able to give consistent information to the women on child bearing. This can help the mothers to have confidence and be well informed on what they are likely to expect when go to the hospitals to deliver (Amanda and Hetherington, 2012). Discussion This paper explores the maternity health care and reports different results obtained from the collaboration of the health service program that is aimed at improving the maternal health care. Most of the researchers and health departments have worked together to develop different policies and reforms that can promote maternal health care service to the Aboriginal women and infants. This collaboration has enabled improvement in the health care services and delivery to those in remote areas. Some of the reforms were successful deployed and created changes in the provision of health care. However, there need to be more improvements in the infant care (SOGC, 2014). The paper has singled out several problems with the delivery of infant services that need to be addressed. Different practices like following the set guidelines, meeting the right enumeration of infant birth in the remote areas and well-organized staffing should be implemented. The study found out that close to a third of the infants from the remote societies were admitted to the nurseries for special care. Again the Aboriginal infants possess a birth weight of one hundred and eighty-six grams less than that of the Australian infants, more precisely if the mother of the infant smokes. Nurses working with the Aboriginal mothers and infants need to have an appropriate qualification and be prepared to work in their area of specialization. Again there should be more improvement to the delivery and organization of child and infant health care together with continuous and supportive relationship with the parents ( Veitch et al., 2011). There should be a remedy in recognizing and supporting the child bearing mothers in ingenious communities. This can be ascertained by ensuring that the staffs are more effective and efficient in promoting maternal health care and creating resilience with the infants and mothers. Different reforms of services like extending the continuous model of care that is employed by the midwives in the health of children can enable the staff to work together with the mothers and their families. Also, adequate and informed relationship with the society leaders, working together and increased consultations would adequately address the adverse outcomes in the Aboriginal women and infants. The research identifies several ways of improving the maternity care in the Aboriginal women and infants. There should be enhanced health care for the women and children through the provision of various reforms and approaches. There should be improvements in the cultural maternity services to the Aboriginal women and infants. There should be the proper preparation for pregnancy (Steenkamp et al., 2012). Conclusion The research program has identified several problems with the maternal health care sustainability for the Aboriginal women who live in remote areas in Australia. More improvements have been suggested. These developments occurred due to the support of different stakeholders such as clinicians, Aboriginal women, managers and the policy makers who actively took part in the program and are continuously working in order to improve the maternal health care. Several transformation is still happening, the implementation of the practice of the midwifery group has led to quality and efficient care for the women and the infants. This idea is more sustainable and more women can access health services more freely. For the poor maternal health care for the Aboriginal women and infants to be addressed more efficiently, there should be more work in the health services specifically redesigning of various systems and improving the already existing skills. This needs more commitments to address the problems through the provision of relevant skills that are necessary for the staff to perform their task efficiently. To achieve sustainable maternal health care, the Aboriginal leaders should be adequately be engaged in the oriented care model of wellbeing. References Amanda J. and Hetherington R.(2012). A decade of research in Inuit children, youth, and maternal health in Canada: areas of concentrations and scarcities. Int J Circumpolar Health.Vol 71. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3417531/ Australasian Maternity Outcomes Surveillance System (AMOSS).(2012). AMOSS Newsletter. Sydney: University of NSW. Available at http://www.amoss.com.au Australian Health Ministers Advisory Council. (2012). National maternity ser-vices capability framework. Canberra: Commonwealth of Australia. Australian Institute of Health and Welfare (AIHW). (2012).Public hospital establishments NMDS 2010–2011. 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