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Cassandra Nest. Photo: Rana Rankin Photography.

Midwife takes students under wing to help close the gap

It was hearing birthing stories from her grandmother and aunties that sparked midwife and urbanised Ngunnawal woman Cassandra Nest’s passion for maternity care.

Now, she plans to share her knowledge of the industry and of the importance of culturally safe maternity care with the next generation of health professionals by mentoring First Peoples midwifery students from Griffith University.

Nest, who currently works in the Midwifery Group Practice at the Gold Coast University Hospital (GCUH), says mentorship is the best way to support students and support more First Peoples midwives who understand the complex dynamics of the Aboriginal and Torres Strait Islander cultures into the system.

Nursing Review speaks with Nest about the work she will be doing with Griffith students and the ties between birthing and pregnancy and Aboriginal culture.

NR: Where did your passion for midwifery and education come from?

CN: I learned about birthing and women's business from my grandmother and my aunties and all their birthing stories, plus my own birthing experience, so that's where my passion for midwifery began. My grandma used to tell these amazing stories about her and her friend, who was a registered nurse. They would just go around the community and support women through labour and birth, and they would see them antenatally. So, basically, they had their own little form of midwifery-led care, but they weren't actually midwives, just birth attendants. Her stories about natural home births were just absolutely mesmerising. Footing breach births in the toilet, breach births in the shower, normal births with no intervention.

During my studies, I was honoured to receive an Aboriginal midwifery cadetship and also the Australian Rotary Health Indigenous Scholarship, which supported me through my degree as a single mum. I also received numerous awards for academic excellence and was honoured to then be accepted into the Golden Key Honour Society, which was a pretty awesome feat considering that neither of my parents even went to university, and none of my siblings have gone to university either.

My passion for education comes from the disparities that my people face. Education is the key to supporting close maternal, infant, family and community relationships. The driving force behind pursuing further academic and clinical qualifications is to address the lack of choice and control that Aboriginal women currently have over their birthing experience, and to assist, enable, encourage and inspire Bachelor of Midwifery students to enter the healthcare workforce.

Why did you decide to specifically begin mentoring Aboriginal midwifery students from Griffith University?

At the moment, I'm actually the only Aboriginal midwife working at the Gold Coast University Hospital, and I have a role in the midwifery group practice where we provide continuity of midwifery care to women during the antenatal period, through labour and birth and in the postnatal period. This model of care is basically the bee’s knees of maternity care and is exactly what First Peoples women and families need, as it statistically improves birthing and perinatal outcomes. There are only two Indigenous midwives that I know of in the Gold Coast area, and I feel like it is my role within my community to support our undergraduate midwifery students into the workforce.

Griffith University and GCUH are focusing on closing the gap between Indigenous and non-Indigenous disparities in maternity care through education and providing additional support to First Peoples midwives, and I am so excited to be a part of that.

I began mentoring students in my third year of studying at Griffith and it continued through my working career. You just take them under your wing because they're part of your mob. So while working at the Tweed Hospital, I mentored the Aboriginal midwifery cadet there, and I'm in the process of organising a roster to mentor numerous First Peoples students from Griffith University at the moment.

Everyone learns differently, and I know that there is a bit of research surrounding the best teaching methods for First Peoples, and I think we're intrinsically hands-on and visual learners. That's how we have learnt: through stories, song and dance. I think the best way for us to learn is on the job and with a mentor that understands cultural safety and the different aspects of that.

What are some of the things that you will work through with midwifery students? What do you hope they come away with?

I hope that through assisting, enabling, encouraging and inspiring Bachelor of Midwifery students to enter the midwifery workforce that together we can contribute to closing the gap in First Peoples’ health outcomes through the employment of more First Peoples midwives and provision of culturally safe maternity care that encompasses our holistic view of health and focuses on supporting women, families and communities through the childbirth journey and assisting them with their transition into parenthood.

What are some of the ties between birthing and pregnancy and Aboriginal culture?

This is a really complex question that is difficult to explain. In Aboriginal culture, a person's relationship to their land, their totems, skin name, kin group are all attained through birthing and pregnancy, and are integral to the Dreamtime, law and our holistic view of health. First Peoples’ health not only refers the individual’s physical wellbeing, but encompasses the social, emotional and cultural wellbeing of the whole community.

Current Indigenous maternity services in rural and remote Australia involve the removal and transferral of pregnant women from their community to a tertiary institution between 36 and 37 weeks’ gestation to give birth. Aboriginal women are routinely removed from their land, family, culture and community to await the arrival of their new baby with little or no emotional, psychological and financial support.

Although the initial idea surrounding these policies was to improve the immediate disparities between non-Indigenous and Indigenous birth outcomes, I believe that failure to adhere to traditional birthing practices creates a birthing environment which can weaken culture, contributes further to the poor perinatal outcomes experienced by First Peoples women and their babies, and cannot act as a true rite of passage for the newborn.

Indigenous women have approximately twice the incidence of perinatal stillbirth and neonatal death rates compared to non-Indigenous women, and they're more likely to suffer from pregnancy-related conditions and are less likely to initiate breastfeeding, all of which can be attributed to transgenerational trauma and previous removal policies.

We are currently a part of a very exciting time when it comes to birthing on country, with the recent announcement of the Birthing on Country maternity services program reforms.

[As stated in the Birthing on Country position statement released by the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the Australian College of Midwives and CRANAplus last year]:

The Birthing on Country model provides integrated, holistic and culturally appropriate care to provide the best start in life for Aboriginal and Torres Strait Islander families and communities.

Why is it important that we have more Aboriginal midwives working within continuity of care models, and that women have access to these midwives, in the Gold Coast area and across Australia?

I think it's important for First Peoples women to have access to First Peoples midwives to ensure cultural safety is maintained and achieved. It can break the circle of distrust surrounding hospitals and healthcare and encourages women to link in with maternity services.

If we break this cycle now we are making a positive impact on how the younger generation of First Peoples view mainstream hospital services, and they in turn will be more likely to then link in with services when they need to. Our mob’s grapevine is quicker than the speed of light! If one person has a good experience, it has a positive impact on the whole community.

An example of how Aboriginal and Torres Strait Islander women are misunderstood based on culture relates to attending appointments. It is common for Aboriginal and Torres Strait Islander women to have lower rates of access to maternity services. It's likely due to the intricate social aspects of First Peoples’ culture and this needs to be understood, instead of shunned as a failure to attend appointments or non-compliance, which is what a lot of these women are getting [marked] on their antenatal cards.

In Aboriginal culture, your family is your number one, especially when it comes to your elders. So a routine antenatal appointment for you is not a priority if you have got to drive your auntie to the doctor.

First Peoples midwives are integral to implementing culturally safe maternity care for First Peoples women and families, as they intrinsically understand our holistic view of health and the complex family and community dynamics of Aboriginal and Torres Strait Islander culture.

We know concepts such as shame and women’s business and have lived firsthand the impact that transgenerational trauma has on our health outcomes and community. Aboriginal and Torres Strait Islander midwives value and understand our cultures’ ways of knowing and learning and place significant importance on meeting our cultures’ spiritual, emotional, social, community and physical needs.

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