Implications of Pregnancy Risk and Cultural Values on Maternal Health

This essay explores the implications of a case study on Shirley, a pregnant woman in a remote Aboriginal community. It discusses the high pregnancy risk for remote dwelling Aboriginal women and the decision to have the baby at home. The essay highlights the need for culturally competent care and the establishment of community-based maternal services.

Running head: NURSING
Nursing
Name of the student:
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Author’s note

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The case study is about Shirley, who is pregnant with her fifth child and lives in a
remote Aboriginal community in Western Australia. She has been told by her local health
services to fly to Perth to have her baby because of risk in pregnancy. However, because of
her strong cultural values and connection to her land, she is willing to have the baby in the
country and with her family. To ensure that she does not have to go to Perth to have her baby,
she has stopped visiting the health services for the rest of pregnancy and has planned to
deliver her baby at home. This decision of Shirley can have many negative implications on
her pregnancy outcomes as well as her baby’s health. The main purpose of this essay is to
explore the implication of the case study for health, the impact of such issue on professional
practice and use of health care services.
The case study of Shirley and the issues surrounding the pregnancy of Shirley
highlights the plight of remote-dwelling Australian aboriginal women. Research evidence
shows that Aboriginal pregnant women are more likely to have more complications of
pregnancy compared to non-aboriginal women (Griffiths et al., 2019). For example, many
aboriginal women deliver babies with low birth weight and the main factors associated with
low-birth weight includes being a teenage mother and high rate of health risk behaviours such
as smoking, drug use and medical complications (Ford et al., 2018). Because of the high rate
of pregnancy complications in aboriginal women, the Closing the Gap campaign has also
prioritized reducing incidence of pregnancy complications to reduce gap in life expectancy
between aboriginal and non-aboriginal Australians (). In addition, the main issue for
aboriginal women living in remote areas is that their intention to seek antenatal care during
pregnancy is shaped by various factors such socioeconomic status and traditional practices
and values related to pregnancy. They have strong connection with traditional fertility
practices and their decision not to visit health care clinic is shaped by traditional values too

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(Griffiths et al., 2019). This shows why Shirley decided to have her baby at home. She finds
the need to have the baby at Perth to be a culturally inappropriate act.
There are two critical issues linked to the case study. First issue is the high pregnancy
risk for remote dwelling aboriginal women and the second issue is the decision to have the
baby at home. Both these issues can lead to negative pregnancy outcome for Shirley.
However, to get more understanding regarding the issue, it is necessary to evaluate what
research explains about the factors leading to pregnancy risk for aboriginal women and the
factors associated with aboriginal women’s decision or choice to give birth at home. Shirley
is identified to be a high risk patient. There might be multiple reasons for high risk during
pregnancy for remote aboriginal women. Firstly, remoteness can be a factor behind this as it
delays early access to maternal services for indigenous women (Dossetor et al., 2017). In
addition, the case study also highlights the lack of quality maternal health services for
aboriginal women in remote areas. Bar‐Zeev et al. (2013) explains that high disparities exist
in pregnancy and birth outcome between aboriginal Australian women and their non-
aboriginal counterparts because of poor quality of care provided in existing services for the
population. Therefore, the evidence highlights impact of poor provisions of post natal care on
pregnancy complications and poor pregnancy outcome for remote dwelling aboriginal
Australian.
The analysis of Shirley’s decision to have baby in the country is also shaped by her
traditional and cultural values. Kildea et al. (2016) explains that aboriginal women avoid
giving birth in other place apart from their country because they have the perception that not
being born on land can threaten their claim to land rights. Their emotional values supports
them to avoid giving birth in other land as they view that by giving birth in another, they have
to spend long period of time away from their family and children. As the case study shows
that Shirley is pregnant with her first child, she might have planned to have the baby at home

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to stay close with her other children and partner throughout the pregnancy. Therefore,
considering Shirley’s cultural and emotional preferences, giving birth in Perth can increase
distress for her. Koelewijn, Sluijs and Vrijkotte (2017) supports that pregnant women are
most susceptible to anxiety and depression when they are away from other children while
awaiting the birth of new baby. Remoteness is identified to play an integral in Shirley’s
decision too because if she might have been living in a city, she would not have to go to far
off place for delivery. Giving birth on another country can increase risk of ill health as it can
break her link with her strong culture and land.
The discussion of the risk or issues in the case study gives implications for
professional practice in Australia. For example, as it has been identified that aboriginal
women have strong connection with their land and culture and cultural disconnection is the
main reason for them to stop going far off places for giving birth (Kildea et al., 2016). Hence,
to minimize risk in such situation, it is critical that health care professionals particularly
working in antenatal and maternity service engage in culturally competent care. The
significance of utilizing this approach is that this will help them to understand cultural values
linked to aboriginal women’s perception and decision related to pregnancy. This knowledge
can help them to take the best decision for the mother in accordance with her cultural and
emotional preferences too (Felton-Busch & Larkins, 2019). For example, the risk of adverse
pregnancy outcome for Shirley can be resolved by ensuring that she give birth at Perth,
however she get the opportunity to take her family there too. As part of risk management
strategy, arrangement can be done to give assurance to Shirley that her children will be safe
or ensure that they can travel with her too.
Research evidence suggest that as there are many challenged in providing maternal
service in remote area, one strategy that can address the issue of suboptimal care and the need
to move to new region for giving birth includes establishing birthing on country sites (Kildea

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et al., 2016). Health service agencies in Australia must focus on increasing utilization of
maternal service in Australia by establishing centre which is community based and that
incorporate traditional practice and values both indigenous and non-indigenous way of risk
assessment. Such services can resolve maternal health challenged and emotional risk related
challenged for patients like Shirley (Homer, 2016). Taking the decision to support Shirley to
give birth in her own country will address any legal and ethical considerations too as it will
reduce risk perception related to disconnection from land and disparities in care.
From the case study analysis of Shirley, it can be concluded that risk of disparities in
relation to pregnancy outcome is high in remote aboriginal women compared to non-
aboriginal women because of remoteness, poor access to maternal services in remote areas,
delay in early antenatal access and increase in behaviour risk. The essay explained that
remote aboriginal women have poor intention to leave their land and give birth in other
regions because of fear of losing connection with the land and family. The issue gives the
implication to health care professionals to engage in culturally competent care to ensure that
cultural and traditional values of aboriginal women is maintained throughout the pregnancy
and they get the opportunity to access high quality maternal services within their land too.

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References:
Bar‐Zeev, S., Barclay, L., Kruske, S., Bar‐Zeev, N., Gao, Y., & Kildea, S. (2013). Use of
maternal health services by remote dwelling Aboriginal women in northern Australia
and their disease burden. Birth, 40(3), 172-181.
Dossetor, P. J., Martiniuk, A. L., Fitzpatrick, J. P., Oscar, J., Carter, M., Watkins, R., ... &
Harley, D. (2017). Pediatric hospital admissions in Indigenous children: a population-
based study in remote Australia. BMC pediatrics, 17(1), 195.
Felton-Busch, C., & Larkins, S. (2019). Remote dwelling Aboriginal Australian women and
birthing: A critical review of literature. Women and Birth, 32(1), 6-15.
Ford, E. J., Cade, T. J., Doyle, L. W., & Umstad, M. P. (2018). Pregnancy risk factors
associated with birthweight of infants born to Australian Aboriginal women in an
urban setting-a retrospective cohort study. BMC pregnancy and childbirth, 18(1), 382.
Griffiths, E., Atkinson, D., Friello, D., & Marley, J. V. (2019). Pregnancy intentions in a
group of remote-dwelling Australian Aboriginal women: a qualitative exploration of
formation, expression and implications for clinical practice. BMC public
health, 19(1), 568.
Homer, C. S. (2016). Models of maternity care: evidence for midwifery continuity of
care. Medical Journal of Australia, 205(8), 370-374.
Kildea, S., Tracy, S., Sherwood, J., Magick‐Dennis, F., & Barclay, L. (2016). Improving
maternity services for Indigenous women in Australia: moving from policy to
practice. Medical Journal of Australia, 205(8), 374-379.

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Koelewijn, J. M., Sluijs, A. M., & Vrijkotte, T. G. (2017). Possible relationship between
general and pregnancy-related anxiety during the first half of pregnancy and the birth
process: a prospective cohort study. BMJ open, 7(5), e013413.