All That Matters: Exclusive Extract

all that matters2
I had such a great review of my new short book: All That Matters: Women’s Rights in Childbirth on The New Statesman today that I’m celebrating with an exclusive extract below. This is the start of a section focusing on the struggles of Indigenous Australians to give birth ‘on country’. For the bigger picture and the references get your copy here, with 10% of the royalties going to Birthrights.

A Lonely Machine

Michaelis lives in the remote Indigenous Australian community of Saint Gerard, in the Northern Territory. When she had her first baby, like every woman across every single remote community in Australia, she had no birth options. Evacuated by air, weeks before her due date, she was sent 500km to Darwin to wait alone in a hostel for labour to begin. Fellow Saint Gerard resident Theodora described the hostel as full ‘of people humbugging you for money and drunks making you scared’. Other hostel residents have described a lack of food and threats of gang violence.

It is no secret that the Australia-wide practice of removing this particularly vulnerable group of women from their communities, often against their wishes, at a personally and culturally significant time isn’t working. Yet the only options open to Indigenous Australian women to avoid it are to opt out of care altogether, or go to a local clinic so late in labour that they cannot be transferred. Even then the routine practice is to stop a low-risk, full-term, well-progressing labour with drugs and airlift the mother to Darwin. A birth that has been interrupted by drugs and transfer may be difficult to restart without the use of significant intervention with potential for serious impact on mother and baby.

Australian policy documents from as early as the 1980s express the need for birth facilities for women in their local communities. The current five-year National Maternity Services Plan33 sets out a timetable for introducing birthing ‘on country’ programmes for Aboriginal and Torres Strait Islander women. Although research has taken place, and indigenous women from every state and every territory flocked to a recent national workshop, there is currently no government funding for services that the plan promised would be ready in 2015. Today, not a single scheme exists in Australia to provide ‘on country’ birthing in remote areas.

Michaelis was upset by what she experienced in the city, far away from her family. ‘When I had the baby, there were big mobs of people and male doctors watching. I was on the bed and told to open my legs up. I didn’t like being there, I didn’t like the men being there and I didn’t like being watched. It was such a shame job.’

Aboriginal and Torres Strait Islanders’ lives are based around a complex series of beliefs, rituals and rights, all deeply connected to the wider idea of the Dreaming. Men and women often have separate ceremonies, with different sacred objects. They are seen as guardians of distinct sections of folk law and community knowledge, sometimes referred to as the laws of women’s or men’s ‘business’. Birth, or ‘borning’, falls inevitably within the women’s business laws. The indigenous people of Australia are not a homogenous group and their rituals and practices around birth differ across communities. Nevertheless, pregnancy and birth are viewed across the board as a significant rite of passage; not only for the new spirit (who, it is often believed, will enter the foetus in the fifth month of pregnancy), but also for the woman herself and those around her.

Men are traditionally not part of the process and many women report shame at giving birth in their presence. Aunties and other female members of the community traditionally gather to give massage and practical support to a woman as she labours.

It is hard for those of us outside the Indigenous Australian community to begin to understand the importance for them that their infants are born in their home territory. Midwifery professor Hannah Dahlen explains that there are groups who believe a child’s spirit will weaken and it will die if it is not born on the land. Without the vocabulary to describe the relationship, we are grasping at comparisons that don’t really do it justice. Nala Mansell-McKenna, a youth worker, explains the difference as he sees it, between indigenous and non-indigenous approaches to land: ‘In white society, a person’s home is a structure made of bricks or timber, but to our people our home was the land that we hunted and gathered on and held ceremony.’35 More simply, Natasha Neidje describes her feelings for her country as ‘like the love for your mum and dad’.

Much is becoming known about the process of removing indigenous peoples from their country, the separation of their children, the part-destruction of their heritage and the catastrophic effect it has had on the generations that followed. That effect is shown to ripple out across health outcomes. Indigenous Australians live approximately 20 years less than the rest of the population. Maternal mortality is 3.5 times higher among Aboriginal and Torres Strait Islander people, and their babies are more than twice as likely to die after birth.

Francesca, mother to many children, was also evacuated from Saint Gerard to Darwin to have some of her babies. She missed the support of the community and felt exposed and alone. ‘It takes a long time [labour], always them watching, and they put you on to a lonely machine; no company, no one to rub you, just a green bowl and cold water to wash your face in.’

Extract from All That Matters: Women’s rights in childbirth, by Rebecca Schiller, published as an ebook by Guardian Shorts. See guardianshorts.com.

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