Health worker Trudy Allende examines Deeana Russell at the Malabar clinic. Photo: Sarah Rhodes
Aboriginal health worker Trudy Allende rests the monitor on Deeana Russell’s taut belly. There’s silence for a moment before the unmistakable galloping sound of a foetal heart beat fills the room. Smiles all round, especially from 22-year-old Russell, an Indigenous woman from La Perouse who is 28 weeks pregnant with her second child.
Russell is part way through her first visit to the Malabar Midwives (officially, the Malabar Community Midwifery Link Service). The service offers one-to-one midwifery care for women during pregnancy, labour, birth and the first six weeks after birth. Specifically, it cares for Aboriginal women and their families, women from culturally diverse backgrounds, young mothers and women with limited support.
Allende, herself a mother of four, is an important part of the service, offering an immediate “connection of familiarity and family”.
Consultant midwife Shea Caplice has been involved with the service since she helped to establish it in 2006. The service has grown from 30 births in its first year to 90 in the past financial year. Women give birth at the Royal Hospital for Women, Randwick, which provides the community midwifery service.
“We’ve engaged well with the community,” says Caplice, “and we’re getting returns [of women who’ve used the service before] and referrals … the women are ringing us or just turning up.”
She says “a unique way of working” that promotes flexible and culturally appropriate antenatal care underpins the service’s success among Aboriginal families in Sydney’s south-eastern suburbs. Indigenous women from other parts of NSW and Australia may also be cared for by Malabar because the Royal is a referral centre for difficult pregnancies.
Professor Caroline Homer, president of the Australian College of Midwives and director of the Centre for Midwifery, Child and Family Health at the University of Technology, Sydney (UTS), says the “profound differential … in maternal and child health” caused by disadvantage in Indigenous communities can be reduced by having more Aboriginal midwives and health workers. She is enthusiastic about the achievements of the Malabar service on that front.
“We know that one of the important things about midwifery is relationships – between woman and caregiver. There is a lot of research that shows that Aboriginal women like caregivers who understand their culture … who can help them navigate an unfamiliar, even unfriendly system,” says Professor Homer.
“The research we did early on [in the life of the Malabar service] gave us feedback from women who told us ‘I wasn’t just another number’; ‘they understood my mob’; ‘they understood my community’; and ‘they remembered me and my story’.
“Understanding is an important element. But trust is the critical thing, and not being judgmental. It’s easy for non-Aboriginal people to [be judgmental] because we don’t understand.”
Allende, a Wonnarua woman who grew up in La Perouse, says she knows her presence can help establish a connection with an Aboriginal woman. “I know that if I walk into a room, the first thing I look for is an Aboriginal person who I’ll gravitate towards … just for that comfort and knowing the familiarity,” she says.
This year, for the first time, UTS is targeting Aboriginal and Torres Strait Islander students with the launch of an undergraduate course in primary healthcare. The degree will put more workers such as Allende into the health service, but also, says Professor Homer, may lead more Indigenous women to work in the broader areas of maternal and child health.
Rebecca Moore, acting midwifery unit manager of birthing services at the Royal, says a key strength of the Malabar service is the way it treats each woman as part of a family unit. Having someone such as Allende, who has formed good links with the Indigenous community, has helped to develop the trust shown in a “flagship service whose good name is known far and wide”.
The Malabar service has four midwives on a rolling 24-hour roster – “so women have someone to ring, to talk to and to come into hospital with them when needed,” says Caplice. There is also a part-time social worker and a full-time child and family health nurse.
“The core business is midwifery dovetailed with child and family health,” says Caplice. “[But it’s also] a soft entry point to healthcare really … it’s building up the trust that is key and it seems to work. The women often come back to see us and ask about other health issues. We’ve referred them to dentists, gynaes, all sorts of things.”
From a midwifery perspective, she says, “we need to listen to what our Aboriginal health workers are saying, and learn from them. Stop, listen, never assume.
“As whitefellas, we’re very good at fixing and doing and sometimes, in trying to fix things, we are not culturally appropriate.”
Allende says there may be a bigger picture, to do with family or community, for example, that she will be aware of. She can also play the role of medical translator.
“I can put in plain terms what midwives and doctors are trying to say … I can be pretty harsh but let them know this is what’s best. They’ll probably take it from me … if someone else says it, they feel a bit picked on. I’m giving them the same message but it’s different coming from me.”