Heavily pregnant women living in remote and regional areas across Australia are being forced to pack their bags and head to hospital to wait for the birth of their babies, far away from family, culture, community, and connection.
- In the NT, birthing services are only offered in four major hubs: Darwin, Alice Springs, Katherine, and Nhulunbuy
- Other large states, such as Queensland and WA, also require pregnant women to travel to birthing services if they live far away
- Experts are calling for more regional birthing hubs to fill the gap
Women’s health experts say this experience is traumatic for expectant parents and expensive for governments, but that the answer is simple: open more culturally safe birthing centres outside of big cities.
Charles Darwin University professor of midwifery Sue Kildea said Australia had “medicalised birth”.
“We thought we were making things safer for women by moving them into big city hospitals and closing down all our smaller hospitals, [but] we haven’t done that at all,” she said.
‘It’s hard, missing them’
Yolngu mother-of-three Leah Ngalirrwuy, who spoke to the ABC through a translator on Elcho Island, said the worst thing about leaving her home in East Arnhem Land to give birth to her daughter Judy, who is now six weeks old, was leaving her young sons behind.
“It’s hard, missing them,” Ms Ngalirrwuy said.
Ms Ngalirrwuy’s daughter was born in Darwin, roughly 550 kilometres south-west of the remote Aboriginal community of Galiwin’ku, where the family lives.
And her story is far from unique.
In the Northern Territory — a jurisdiction twice the geographical size of Texas — birthing services are only offered in four major hubs: Darwin, Alice Springs, Katherine and Nhulunbuy.
Women who live outside of these four areas need to travel to the nearest hospital at 38 weeks to wait for their baby to be born (although those with higher-risk pregnancies are sent to Darwin, which is equipped to manage complications).
For most of these women, English is not their first language, and some don’t speak English at all.
Most women travel alone and although they are offered a translator in hospital, one is not always available.
An ‘outrageous’ requirement to travel
Professor Kildea labelled Northern Territory Health’s remote birthing policy as “outrageous”.
“Why do they send women by themselves? We don’t even let them take their kids with them,” she said.
Royal Darwin Hospital’s co-director of women, children and youth, Theresa Clasquin, said conversations were already underway about how to return birthing services to remote and regional areas in the NT, but change would take time.
“How do we eventually get to that place where we have a birth centre in say, Galiwin’ku?” she said.
“The end goal is potentially five, 10 years away.”
Find out how pregnancy and birth is managed for families living in other regional and remote areas across Australia:
Australian Capital Territory
The ACT has four hospitals, including Canberra Hospital, which are equipped to manage high-risk births.
“Women residing in the ACT do not need to travel far to access birthing services,” a spokeswoman on behalf of the ACT Health Directorate said.
“The ACT has a very small geographical footprint.”
The Winnunga Nimmityjah Aboriginal Health Service offers publicly funded, culturally safe antenatal and postnatal care, as well as at-home support for First Nations families.
New South Wales
There are 16 hospitals across NSW that can manage complications, and a spokeswoman on behalf of the health department said all public hospitals in the state could look after low-risk pregnancies.
Women who live in remote communities still need to travel to hospital to give birth, although they may be able to access remote obstetric consultations in nearby facilities.
NSW Health budgets more than $26 million a year for its Isolated Patients Travel and Accommodation Assistance Scheme, which helps patients who need to travel long distances for medical care.
In Queensland, high-risk births are managed in Cairns Hospital, Townsville Hospital, Sunshine Coast University Hospital, Royal Brisbane and Women’s Hospital, Mater Hospital, Logan Hospital and Gold Coast University Hospital.
Across the state, there are 40 public maternity services that provide birthing, antenatal and postnatal services, 32 of which are in regional, remote, and very remote areas.
A spokeswoman on behalf of the health department said all Queensland public hospitals could manage low-risk births and about 96 per cent of women who gave birth between 2013 and 2017 lived within a one-hour drive of a public maternity service.
Of course, some women in remote areas still need to travel to access facilities, and those with higher risk pregnancies need to go to a hospital that is equipped to minimise potential risks.
In South Australia, all women with high-risk births are transferred to Adelaide from between 34-37 weeks, depending on a pre-determined level of risk and pregnancy history.
Hospitals in Port Augusta and Mt Gambier offer maternity care to “moderate risk” patients and there are roughly 20 regional maternity units that offer “normal/low risk” care.
The Aboriginal Family Birthing Program has been operating in South Australia since 2004, and there are hubs based in Port Augusta, Ceduna, Whyalla, Gawler, and Murray Bridge hospitals.
Hospitals in Port Lincoln and Mt Gambier also have an Aboriginal-specific antenatal/postnatal support service within the local Aboriginal Health service.
The Tasmanian Health Department didn’t respond to questions.
However, as the state only accounts for about 0.9 per cent of Australia’s land mass, it doesn’t face the same complex geographical issues with service delivery as the Northern Territory (which accounts for 17.5 per cent).
The Royal Hobart Hospital has a birth centre available for women with low-risk pregnancies.
Other public hospitals thT offer maternity care in the state are Launceston General Hospital, North West Regional Hospital and North East Soldiers’ Memorial Hospital.
The state has its own Patient Travel Assistance Scheme to help with travel and accommodation costs for patients.
The Victorian Health Department also didn’t respond to questions.
The state comprises about 3 per cent of Australia’s land mass, making it about one-tenth the size of WA, which accounts for 32.9 per cent.
Across Victoria, 68 clinics offer public maternity and neonatal services (although not all of them provide services for pregnancy, labour and post-birth).
Victoria may also help cover the cost of transport if families have to drive a long distance to give birth.
The WA Country Health Service provides health services in rural and regional locations across the state.
In 2019-20, a spokeswoman on behalf of the service said it supported more than 4,200 families across 2.5 million square kilometres to birth on country and close to home.
Six hospitals managed by the WA Country Health Service can manage high-risk pregnancies.
In WA, expectant families who have to travel to give birth usually do so at about 37 weeks, depending on their risk factors.
Very high-risk patients may need to travel to a regional centre or metropolitan area.
The state also provides outreach antenatal and postnatal clinics to Aboriginal communities.
Birthing on country an international movement
Birthing on country is an international movement that aims to improve birth outcomes for Aboriginal and Torres Strait Islander mothers and babies.
But it’s not just about where a woman physically births a child — it also encompasses culturally safe care for First Nations families during pregnancy and after birth.
Vijay Roach, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, says any initiative that supports Indigenous women and helps them stay connected to community, culture and tradition will improve clinical outcomes.
“What is so frustrating when we talk about all of these issues is that we’ve said it before, the answer’s right there,” he said.
“It’s as simple as it sounds: women should be able to be looked after in pregnancy, or indeed in any other area of their lives, in a culturally safe way.”
Professor Kildea said Australia needed to open more birthing centres to manage low-risk births in regional and remote locations.
“The evidence says we can do this, and we can do this safely,” she said.
She said women with higher risk births would still need to travel to bigger centres, for the wellbeing of mum and baby.
“You don’t want to be having women out in remote communities who have got complex health histories and really do have risk factors and would be much safer with a team of medical professionals around them,” Professor Kildea said.
“Nobody’s talking about doing that.”
Government ‘supportive’ of birthing on country
Dr Roach said if Australia was going to offer services to assist women having babies in remote settings, it was vital these centres were adequately supported.
“And by supported I mean with the appropriate infrastructure and appropriate personnel, not just, ‘here’s a building and it has one midwife who is available occasionally’,” he said.
“It’s obviously a very desirable thing, but it’s also very resource intensive and it’s not always able to be provided across such a large country.
“It would need to be looked at on a case-by-case basis.”
Federal Health Minister Greg Hunt declined to be interviewed, and a spokesman directed questions to the Department of Health.
A spokeswoman on behalf of the department said the Australian Government was “supportive of the birthing on country approach”.
NT Health said the department was also supportive of a birthing on country model.