What I've learned as a male midwife in Arnhem Land

It was a dry Thursday afternoon in Arnhem Land, Northern Territory, when young mum Tanisha’s* waters broke at just 23 weeks of gestation. Approximately 417 kilometres from the nearest hospital, an aircraft and doctor chaperone were flown in to her remote Aboriginal community within a few hours of the call for medical evacuation.

But Tanisha felt anything but relief when her medical retrieval arrived. The doctor disembarking the aircraft was a man, and in her Aboriginal culture it is taboo for men — including medical practitioners — to interact with women about ‘women’s business’.

In an interesting plot twist, however, Tanisha requested for her male midwife Christian Wright to come with her and be present for the birth.

Aside from being one of just 448 men to be working in midwifery in Australia (1.6% of the total workforce) Christian is no ordinary practitioner.

Recognising the sensitivities around men and women’s interactions in Aboriginal culture, Christian has always thought outside the box about how he can make his patients feel comfortable.

His trust building with Tanisha began early in the antenatal process, when he learnt the local language and used cultural linguistic cues to convey empathy and earn trust.

“Speaking to people ‘in language’ is a great way to help them feel culturally safe. In some Aboriginal cultures though, there are other important linguistic considerations,” he said.

“For example, when discussing taboo subjects, like women’s health, men should use alternative, almost euphemistic, variations to formal language, to minimise embarrassment.

“‘Yothu Wanga’, which literally translates to ‘baby house’ is a culturally safe term an older Aboriginal woman taught me to use when describing women’s anatomy within some of the communities I work with.

“It is also important to use nuanced pauses and a hushed tone when discussing these subjects — and always with permission first.”

Above and beyond the call of duty

Culturally safe communication is only a foundation for Christian’s trust-building efforts with Aboriginal women.

Year after year, he has adjusted his everyday practice to meet patients’ needs, often going above and beyond his expected duties as a midwife.

Performing glucose tolerance tests in the afternoon is one key way Christian has earned respect from expectant mothers in a local community.

The community in question has a tendency to engage in late night ceremonial activities and wake in the afternoon. This makes morning tests — as are commonplace in medical practice — less practical.

Christian altered his clinic hours to boost test participation rates and make women feel more comfortable.

“Respecting community rhythms is key to achieving good clinical outcomes,” he said. “Since moving the tests to the afternoon, we’ve had greater patient compliance rates and much better health outcomes.

“Local women have also noticed my efforts to provide culturally safe care, which has built trust in my relationships with them.”

Building trust to relieve fear

It is Christian’s efforts to dispel fear among his patients, however, that have made the most meaningful impact.

Pregnancy and childbirth can be a daunting prospect for any woman — but for women in remote communities who have to fly alone to a ‘foreign’ land to give birth, it can be terrifying. At present, the Northern Territory has no mandatory provisions for a birthing partner to accompany these women to hospital, unless she has other children below the age of two that need to be supervised during the birth.

Christian has helped make this less intimidating by organising video introductions between hospital staff and expectant mothers, from early in the antenatal process.

“Women in remote communities typically do not attend the hospital for their antenatal appointments. This means they are only meeting the hospital staff for the first time when they give birth. Video introductions bring some familiarity to the people that will handle their care in hospital, which makes the whole process less scary,” he said.

Christian has also organised a program to take expectant mothers on mussel and oyster collecting excursions known as ‘hunting trips’ during their hospital stay. This important cultural tradition allows women to gather nutrient-rich food to support lactation and foetal growth in the lead-up to their birth.

A high-definition example

In life-threatening situations, like premature labour, Christian’s trust-building efforts have mattered the most.

Tanisha rang Christian when her waters broke and allowed him to make the assessments which led to her rapid evacuation. While in hospital, regular communication between Tanisha and her family with Christian back home, meant she agreed to stay with her baby in the neonatal intensive care unit.

Months later, Tanisha returned to community proudly showing off her ‘miracle baby’ to family and Christian.

For Christian, there is no sincerer form of feedback than having been requested as Tanisha’s midwife.

“As a midwife, listening to women and building continuity of care is paramount. Trust is everything.”

*name changed for privacy

Image credit: iStockphoto.com/Totajla