Every year, thousands of migrant and refugee women give birth in Australia. They bring with them rich cultural traditions, unique health histories, and, in many cases, experiences of displacement and trauma. For midwives, this diversity is both a privilege and a challenge. Culturally safe care requires more than simply recognising differences — it means actively working to provide respectful, inclusive support that allows every woman to feel safe, heard, and empowered during pregnancy and birth.

The Need for Cultural Safety

Australia is one of the most multicultural nations in the world, with nearly one in three residents born overseas. Migrant and refugee women represent a significant proportion of the maternity population. Many face barriers such as limited English, unfamiliarity with the healthcare system, and, in refugee contexts, prior exposure to trauma or disrupted health care.

Research indicates that migrant and refugee women in Australia face higher risks of adverse maternal outcomes compared to Australian-born women. A Western Australian cohort study found increased odds of stillbirth among women from African, Indian, and other non-white backgrounds — particularly when interpreter services were not utilised; reassuringly, those who did use interpreters had lower odds. Qualitative research across NSW supports this, noting higher rates of complications such as preterm birth, congenital anomalies, and maternal mortality among refugee and migrant women, compounded by language and cultural access barriers. A recent BMC Pregnancy and Childbirth review further confirms that women from multicultural and refugee backgrounds in high-income countries — including Australia — consistently experience poorer perinatal outcomes, including elevated stillbirth risk.

Communication: The Foundation of Safe Care

One of the most immediate challenges is language. Without effective communication, women may not fully understand their options, consent processes, or even the purpose of routine procedures. Professional interpreters are therefore essential. Yet too often, family members are asked to translate, raising concerns about accuracy, confidentiality, and power dynamics.

Best practice involves offering accredited interpreters at every stage of care and ensuring adequate time for interpreted conversations. Digital interpreting platforms have improved access, but midwives must remain alert to whether the woman is truly understanding, and whether cultural nuances are being captured. Simple adjustments — like using plain language, checking comprehension, and avoiding jargon — also help reduce anxiety and empower women to participate in decision-making.

Respecting Beliefs and Practices

Pregnancy and birth are deeply cultural experiences. Beliefs around diet, modesty, pain, and the presence of men during labour vary widely. For example, some women may decline certain foods in hospital, prefer female-only care, or seek the involvement of extended family members in the birth room. Others may hold strong views on interventions such as caesarean section or induction.

Midwives play a crucial role in negotiating these expectations with sensitivity. Cultural safety does not mean agreeing to everything — clinical safety always comes first — but it does mean listening, explaining options clearly, and finding respectful compromises where possible. Involving cultural liaison officers or community workers can also bridge gaps and reduce misunderstandings.

Trauma-Informed Midwifery

Many refugee women have experienced significant trauma, including war, displacement, sexual violence, or loss. The maternity setting can sometimes trigger traumatic memories — for instance, invasive examinations, exposure to male staff, or the physical vulnerability of birth itself.

Trauma-informed practice emphasises safety, choice, collaboration, trust, and empowerment. For midwives, this may mean:

• Explaining each step of a procedure and seeking explicit consent.
• Offering choice wherever possible, such as positioning during labour or who is present.
• Being attentive to signs of distress and pausing when needed.
• Collaborating with mental health professionals for additional support.

By embedding trauma-informed principles, midwives can help reduce retraumatisation and foster a sense of control for women who may have had little control in the past.

Systemic Barriers

Despite individual commitment, systemic barriers remain. Many hospital forms and IT systems still use narrow categories such as “mother” and “father” without space for cultural or linguistic diversity. Interpreter budgets may be limited. Appointment times are often too short to accommodate complex conversations.

For women in temporary visa categories, access to Medicare-funded care may be restricted, further compounding disadvantage. Refugee and asylum-seeker health services play a vital role here, but access is patchy across Australia.

Policy change and organisational commitment are essential. Hospitals and health networks need to invest in interpreter services, cultural competency training, and flexible models of care that meet the needs of diverse communities.

Midwives as Advocates

Midwives are uniquely placed to advocate for migrant and refugee women. Beyond the birth room, they can influence how services are delivered by highlighting barriers and suggesting improvements. Some midwives engage directly with community organisations, attending cultural events or co-designing maternity resources with refugee groups.

Programs such as the Refugee Health Nurse Liaison at Dandenong Hospital in Victoria have shown how targeted roles can improve access, helping women navigate appointments, understand procedures, and connect with interpreter services. In New South Wales, qualitative research highlights that migrant and refugee women often report lower satisfaction with maternal care due to cultural and communication barriers, underscoring the importance of culturally responsive service models to improve trust and engagement. In Victoria, the Community Liaison Worker initiative has demonstrated how embedding trusted cultural connectors into health systems can enhance service accessibility and strengthen collaboration between families and providers.

Evidence shows that when women feel culturally safe, they are more likely to attend antenatal appointments, disclose sensitive health issues, and report positive birth experiences. For midwives, advocating for and participating in such programs can make a profound difference in bridging health inequities for migrant and refugee communities.

Looking Forward

Cultural safety in maternity care is not static — it evolves as Australia’s population changes. Ongoing training, reflective practice, and engagement with communities are all part of the solution. For many midwives, working with migrant and refugee women is a deeply rewarding aspect of practice, offering insights into resilience, family strength, and the universal desire for safe, respectful birth.

At its heart, cultural safety is about more than avoiding harm. It is about ensuring every woman — regardless of her background — feels that her dignity is upheld, her choices respected, and her family welcomed into the maternity space. In a country as diverse as Australia, this is not just good practice. It is essential practice.