Better Care Gives Better Outcomes – Preterm Birth Prevention for First Nations Women

Better Care Gives Better Outcomes – Preterm Birth Prevention for First Nations Women 

There are often times when I lose sleep at night because I’m worrying about a baby and hoping that it continues to grow healthily inside its mother’s womb for another day, week or month, until it is strong enough to deal with the outside world.

There are nights when I’m obsessing over whether I have done the best I can in caring for my patients and their families. Sadly, too often tragedy strikes and yet another baby is born too early and must struggle to survive. 

I recall a couple from a remote Aboriginal community, who I met after they had already heartbreakingly lost two babies. For unexplained reasons, their babies arrived in the second trimester, well before they would have a chance at survival. Their pain was palpable but their hope to have a healthy baby never wavered. We met before they would try for another pregnancy.

Starting life on an even field remains a challenge for Australian First Nations babies.

The rate of stillborn and neonatal deaths for Australian First Nations babies is vastly disproportionate to that of non-First Nations babies. Not surprisingly, one of the leading causes of perinatal mortality for Australian First Nations babies is spontaneous preterm birth.

Nationally, approximately 14% of babies born to First Nations mothers are preterm, compared with 8% of babies of non-First Nations mothers. The odds of preterm birth are increased when First Nations mothers have limited antenatal care and pre-existing medical conditions such as hypertension or diabetes.

The key to improving outcomes is by providing the best possible pregnancy care and this should not begin following a positive pregnancy test. Providing good health care to women in the preconception period is a vital step in making a difference to better pregnancy outcomes. It offers an important opportunity to address a multitude of factors that can affect the health of generations.

Some important aspects for preconception care for First Nations families include (but are not limited to) screening for and adequately treating medical conditions, screening for infections, avoiding vaccine-preventable diseases, assessing nutritional status, providing supplements, tackling smoking, and delivering vigorous psychosocial support.

But for any health care to be effective it must be well constructed to meet the needs of First Nations populations in a culturally safe environment.

When First Nations women receive good quality and holistic care during pregnancy better outcomes ensue. Recent studies have proven that designing maternity services for First Nations with cultural sensitivity at their core results in dramatically improved outcomes such as lower preterm birth rates.

A workforce and health system that is capable of addressing social determinants of health, including education, social support, cultural pride, housing, transport and financial support leads to health improvements.

Meeting the couple in the preconception period was an excellent opportunity for us to prepare them emotionally. We made solid plans for pregnancy and identified key milestones for her care. We developed a team that were well informed to provide the best possible support.

My patient knew that her health care team respected her, supported her, and that we cared about her baby. Despite our best efforts her baby was born prematurely but survived and has remarkably made impressive gains in health and development. And my sleep improved, at least for a short time.

Dr Kiarna Brown
Obstetrician and Gynaecologist
Northern Territory Lead of the Australian Preterm Birth Prevention Alliance