‘I’m dreading birthing in such a system’: what Indigenous women globally think of birth care and what they’d like to see instead

Pregnancy and having a baby can be a special time. And families want to feel safe and trust their maternity care.

But when we reviewed the evidence, we found many Indigenous families globally face unfair treatment during pregnancy and birth. This can include racism, neglecting cultural aspects of their care, or using health care poorly designed to accommodate their needs.

We found similar themes in research involving more than 1,400 Indigenous women, Elders, fathers, family members and health workers from locations including Australia, New Zealand, Canada, the United States, Greenland and Sápmi (parts of Norway, Sweden, Finland and Russia).

Many Indigenous families felt disrespected. They said hospital staff often didn’t understand their cultures or give them basic rights during their maternity care, such as being listened to, included in decision-making, or giving informed consent.

As a result, some families felt hesitant to seek care in mainstream hospitals. As one Indigenous woman told us during recent Australian research submitted for publication:

I’m dreading birthing in such a system.

But there are alternatives.

What can hospitals do?

There is a clear need to improve birthing services and cultural safety in mainstream hospitals with a focus on respecting the beliefs, practices and traditions of all families, including Indigenous ones.

For example, many Indigenous families view childbirth as a communal event with extended family support. But hospital policies that limit the number of support people often disregard these important cultural practices.

Indigenous families also need to get the type of health care they trust and feel comfortable with. Ideally this might involve staff with sound cultural knowledge and who can support families clinically in a culturally safe way.

Aboriginal patient liaison officers are sometimes available in hospitals or health services. But there are not often enough, they have to service entire facilities, and they provide cultural support not clinical patient care.

Indigenous families may also want to access a specific type of care. One example is “continuity of care”, where the same midwife or a small team of midwives, supports the family through the whole pregnancy. Ideally, these midwives should be Indigenous or, if not, be trained in supporting Indigenous families with respect and understanding.

What is ‘birthing on Country’?

For Indigenous women living in rural and remote areas, being sent away from home to give birth in a city hospital can be really hard.

Sometimes women and families are evacuated from their home communities and have to stay for weeks or months in temporary accommodation in the city, both before and after birth, or if their baby is born pre-term and needs extra care. This temporary accommodation can be far from the hospital.

All this takes place in unknown cities and towns, without family support, and sometimes away from their other children cared for by the community back home.

This makes it harder for mums who need extra support, and can get in the way of starting breastfeeding and bonding with their baby.

Again, there is an alternative. For many Indigenous families, giving birth is not just about having a baby. It’s also a spiritual and cultural event that strengthens their identity and connection to Country. A “birthing on Country” model of care, which respects Indigenous traditions and knowledge, reinforces that.

This is midwife-led care designed for and with Indigenous communities. It doesn’t mean you have to birth in rural and remote spaces, but it is a model of care that focuses on culture, and can also be implemented in the city.

Ideally, families would see the same midwife or team of midwives and use the “birthing on Country” model.

What else can we do?

Maternity services can be led by Indigenous people, which many women prefer. But Indigenous staff make up about 3.1% of the Australian health workforce.

So it is crucial to engage non-Indigenous staff in building relationships and to support Indigenous families in their right to receive culturally safe care.

This can start with better training for staff, not only to understand and respond to an Indigenous person’s individual needs, but to know when and how to speak up, call out or report racist or disrespectful behaviour.

This is everyone’s problem

A health system you can trust should be safe for everyone. If some people feel unsafe or face discrimination when getting care, this not only affects them, it affects everyone.

For instance, when Indigenous women avoid or delay going to the hospital because of past bad experiences or discrimination, it can lead to health problems that could have been prevented.

This not only harms the women, it puts more pressure on the public health system, which affects us all.

By talking about these issues, we hope all Australians begin to care about the safety of all women during pregnancy and birth.