Trust, meaningful conversations key to improving First Nations preterm birth outcomes

Easily one of the proudest moments of my life was walking out of Hospital with my first born baby in my arms. I remember it so vividly. I’d had a smooth pregnancy and a great birth. My bouncing baby boy was three days old when we left the hospital. He was healthy and I genuinely left like the cat that got the cream as I walked the hospital corridors to my car.

There are few times in my life when I have felt that happy. Sadly, this is not the case for everyone. As an Obstetrician working in the Northern Territory, I see the devastating effects of babies born too early far too often.

Preterm birth is the definition given to babies born alive before 37 weeks of pregnancy are completed. It remains the single greatest cause of childhood death and disability in Australia.

Despite the broad improvements seen in reducing rates of early birth across the country through the Every Week Counts National Preterm Birth Prevention Program, these positive outcomes have not as yet extended to First Nations women.

First Nations women living in pockets of the Top End experience some of the highest rates of preterm birth in the world, on par with disadvantaged groups in low-income countries.

Preterm birth remains the leading cause of death in children up to 5 years of age. In 2021, there were almost twice as many preterm live babies born to First Nations mothers (14%) than to non-Aboriginal mothers (8%).

The complex interactions between maternal and perinatal health outcomes and the social determinants of health are key factors influencing the poorer health outcomes First Nations mothers and babies continue to experience.

We know that First Nations women have better birth outcomes when they have access to healthcare services and feel safe, respected, and have trusting relationships with their maternity care providers.
A recent study by the Menzies School of Health Research found the prevalence of many risk factors for preterm and early births were higher among First Nations women, compared to other expectant mothers.

Those risk factors included preterm membrane ruptures, diabetes in pregnancy, and blood pressure conditions. Importantly within a preterm birth context, First Nations women are also more likely to have shorter cervical lengths which is a key risk factor for early birth. This is a critical area that requires our focus and additional research.

Access to appropriate healthcare services remains our biggest challenge. We also need to find ways to engage and educate women — and I’m not saying we should tell women what to do — but actually getting their perspectives on how health services can do better.

The development of new programs should be shaped by yarning groups in remote communities, exploring the community’s awareness of preterm birth, hearing about their own experiences with maternity care and asking how health services can do better.

We must strive to work with the non-Indigenous workforce to ensure they are as culturally informed as possible, as Western medicine has long ignored how First Nations mothers had traditionally experienced pregnancy.

When women feel safe and respected, they’re going to engage with services more often and they’re going to have more meaningful relationships with their healthcare providers.

Then, and only then, will we be able to see meaningful and measurable improvements in Closing the Gap in preterm birth for our women, mothers, children and communities.

Dr Kiarna Brown
Obstetrician and Gynaecologist
University of Western Australia graduate
Top End Lead, Australian Preterm Birth Prevention Alliance