Greater diversity within the midwifery sector is necessary to address staff shortages as well as improve outcomes for Indigenous and culturally diverse mothers and babies, experts say.

Associate Professor Amanda Carter said studying midwifery through university was becoming increasingly expensive, and as a result, was further excluding Indigenous, Torres Strait Islander, and culturally diverse students from entering the profession.

“The increased cost of living and unpaid clinical placements make it difficult for all students, but even more so for culturally diverse students,” Assoc Prof Carter said.

She said providing culturally sensitive care to mothers was critical to address the current challenges faced by First Nations and culturally diverse mothers.

“We know Indigenous mothers and babies have worse outcomes than non-indigenous mothers and babies,” she said.

Programs run by Indigenous midwives, that recognise Birthing on Country, result in better outcomes for mothers and babies, she said.

According to the East Arnhem Region Mothers and Babies World Café Report, First Nations women, babies and families experience profound health inequities, disproportionately experiencing adverse outcomes in pregnancy and birth compared to non-First Nations Australians.

“For the past ten years, there has been little or no improvement in perinatal indicators. Maternal death for First Nations mothers remains 3.7 times higher than for other Australian women, and perinatal deaths, largely driven by complications of pregnancy, are twice as high,” the report said.

The report said there were five recognised barriers and opportunities to providing better care to First Nations families. Barriers include:

1) Lack of continuity of carer within services
2) Lack of continuity of information across services and systems
3) Under-representation of First Nations people in the health workforce
4) Limited accommodation options for families and escorts during sit-down
5) Limited cultural safety training for health workforce

Opportunities identified include:

1) Provide continuity of carer through an Midwifery Group Practice
2) Increase integration of care by developing a shared governance model with information sharing
3) Employ more Yolŋu staff, including djäkamirr
4) Build accommodation that feels safe and comfortable during sit-down
5) Invest in cultural safety training for the organisation

Birthing on Country recognises that when women give birth in Australia, in hospitals, birth centres, communities or at home, they are doing so on the sovereign lands of the First Peoples of Australia, who have never ceded ownership of their land, seas and sky.

“Women are frequently not able to, or do not choose to, birth on their traditional lands,” the report said.

The Birthing on Country movement is driving system-wide reform, aimed at transferring funding and control of maternity services for First Nations families from mainstream services into First Nations hands through community-controlled health services.

“Birthing on Country recognises the importance of a First Nations workforce to drive a strengths-based service that is clinically and culturally safe.”