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Waminda Nesting Education Program

Women’s Health

Felicity Cheng and Lindsay Patch


Who is Waminda?
Waminda- the South Coast Women's Health and Welfare Aboriginal Corporation which provides
culturally secure health services to women in the Shoalhaven region.
Shoalhaven
-Area: 4,567 km²
-population: 99650 People (ABS,2016)
- 50.5% women (ABS, 2016)
- 49.5% men (ABS, 2016)
- In the greater Shoalhaven and Illawarra area 18.4% of the population in
2015 were females of reproductive age (Health stats NSW 2017)
- 5.5% identified as aboriginal or torres strait islander (ABS, 2016)
- Lies in the Yuin nation
- Comprised of the Guyangal and Kurial subtribes which incorporate the
Gurungatta -manji, Tadera -manji , Thauaira and Bugelli -manji tribes (A.W
howitt, 1904)
- Several dialects spoken including, but not limited to; Djiringanj, Thaua,
Walbanga and Dhurga
What’s the Issue?
The workers at Waminda observed adverse effects of stress and previous
trauma on both maternal and infant outcomes during pregnancy and labour.

The Waminda Nesting Education Program aims to provide psychological and


emotional support to women throughout their pregnancy. The program was
developed for both new mums and women who have previously experienced
trauma associated with pregnancy and birth.

Study on stressful events, social health issues and psychological


distress in Aboriginal women having a baby in SA by D. Weetra et. al:
➢ 344 women involved with a mean age of 25 years (range 15–43).
➢ 56.1 % experienced three or more social health issues during
pregnancy
➢ 27 % experienced 5–12 issues

Another study identified that Aboriginal women were more likely to have
three or more social issues during pregnancy (OR 2.69 [95% CI
1.2-5.9]).(Yelland. J et.al 2010).
The issue cont...
Possible determinants of maternal stress during pregnancy:
➢ Previous trauma associated with pregnancy, labour or miscarriages (C. L. Woods-Giscombé, 2010)
➢ Intergenerational trauma (J. Atkinson, J. Nelson and C. Atkinson, 2010)
➢ Less than grade 11 education (S. Marquis, E. Butler, 2001)
➢ Lack of connection to community and support (S. Elsenbruch et.al, 2006)
➢ Recent loss of a family member (Weetra et al. BMC Pregnancy and Childbirth, 2016)
➢ Young age (<25 years old) (C. Rubertsson, J. Hellstrom, M. Cross, G. Sydsjo, 2014)
➢ Indigenous (Yelland. J et.al 2010)

Protective factors:
➢ Social support network (S. Elsenbruch et.al, 2006)
➢ Ability to gain control of stressful situations (P. La Marca-Ghaemmaghami, U. Ehlert, 2014)
➢ Consistent prenatal care
➢ Adequate rest
➢ Healthy diet
➢ Avoidance of alcohol, smoking and other drugs
➢ Psychological resources such as higher dispositional optimism ,self-mastery, and self-esteem
➢ Relaxation interventions i.e yoga (A. Beddoe, K. Lee, 2008)
Low birth weight babies by Mothers indigenous status and remoteness 2011

WHat are its impacts?


- Emotional
- Risk of postnatal depression(Martini et al. 2010)
- Physical
- Fewer doctor’s visits mean less education on pregnancy
- Detrimental effects on both mother and child
- Low birth weight (Diego et al. (2006))
- Premature delivery (Diego et al. (2006))
- In 2015 45% of Aboriginal or Torres Strait Islander women
reported smoking in the initial 20 weeks of pregnancy, 5x
the rate of non-indigenous women. (Leeds et al. 2007;
Sayers and Boyle 2010)
- Social
- Passing on stress and behavioural issues to their children
(Martini et al. 2010)(O’Connor et al. 2002)
How does the program address this?
- Determinant Program

Previous trauma associated with meaningful conversations with women


pregnancy, labour or miscarriages and encouraging them to visualise
themselves positively as a woman

Less than grade 11 education Education

Lack of connection to community and discuss birth experiences from within


support their family and talk about their
traditional or cultural beliefs
related to birth and parenting.

Source: waminda.org.au
“We believe that in order to be physically well and
strong, you need to be in a mentally safe space and be
in a good state of mind” - Kate Stein, Waminda
Midwife
WHo helped?
- This corporation is made up of local indigenous women who
are self nominated and willing to share their cultural
knowledge, ensuring that it is a culturally appropriate
service.

Source: waminda.org.au
Has it worked?
- No data to see whether or not it has worked
What else can we do?
Waminda could implement a program running in conjunction with the Nesting
education program which involved Aboriginal health workers and midwives to
link women with culturally safe antenatal care.
This program could include:
- Antenatal checks
- Ultrasounds
- Antenatal classes
- Pap Smears
- GP clinic visits
- Sessions with Aboriginal health workers and midwives where they can ask
questions about breastfeeding, nutrition, available birthing pathways etc
Timeline
What Else can we do?
Exemplar program: Aboriginal Midwifery Access Program (ACT)

- Aims to provide access to antenatal care and improve pregnancy and birth outcomes for Aboriginal and Torres
Strait Islander women.

- Includes antenatal and postnatal care, community at home support, baby health checks, breastfeeding support,
immunisations and a range of women's health services.

- Of 187 women in the program 50.3% presented in the first trimester and 94.7% attended five or more antenatal
visits
- Compared with the ACT Maternal and Perinatal Collection, Aboriginal and Torres Strait Islander AMAP clients
had a lower caesarean delivery rate (20.0 vs 27.6%), a slightly lower proportion of preterm babies (18.8 vs 21.6%), a
slightly lower proportion of low-birthweight babies (18.8 vs 21.0%) but a higher smoking rate (63.8 vs 49.0%).
What Else Can We do?
Necessary professionals:
❖ Midwives
❖ General Practitioners
❖ Psychiatrists specialising in prenatal and postnatal issues
❖ Epidemiologists and public health professionals in the local area
❖ Aboriginal elders and other members of the Aboriginal community
❖ Aboriginal health care workers
❖ Mothers
WHat else can we do?
Community capacity building

- Aboriginal elders
- Partnership with UOW?

Measuring the effectiveness

- “Yarning” (Walker et al,2014)

Reporting the findings back to the community

- Research paper
- Community meetings
References
1. Beddoe A, Lee K. Mind-Body Interventions During Pregnancy. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2008;37(2):165-175.
2. Australian mothers and babies [Internet]. Aihw.gov.au. 2015 [cited 2 May 2018]. Available from:
https://www.aihw.gov.au/getmedia/728e7dc2-ced6-47b7-addd-befc9d95af2d/aihw-per-91-inbrief.pdf.aspx?inline=true
3. The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, Oct 2010 [Internet]. Abs.gov.au. 2016 [cited 30 April
2018]. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter610Oct+2010
4. 4. 2016 Census QuickStats: Shoalhaven (C) [Internet]. Censusdata.abs.gov.au. 2016 [cited 1 May 2018]. Available from:
http://www.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/LGA16950
5. Waminda: Mums and Bubs Program. Aboriginal And Islander Health Worker Journal [Internet]. 2012 [cited 28 April 2018];(36):17-19.
Available from: https://www.researchgate.net/publication/281212554_Waminda_Mums_and_Bubs_program
6. HealthStats NSW Population by Local Health District and year [Internet]. Healthstats.nsw.gov.au. 2017 [cited 1 May 2018]. Available from:
http://www.healthstats.nsw.gov.au/indicator/dem_pop_lhnmap
7. Howitt A. The native tribes of south-east Australia. London: Macmillan Co.; 1904.
8. Ferguson-Hill S, Atkinson J, Nelson J. Working together. 2nd ed. Barton, ACT: Telethon Institute for Child Health Research/Kulunga
Research Network; 2014.
9. AIHW, NPESU. 1.01 Low birthweight | Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report [Internet].
Pmc.gov.au. 2014 [cited 1 May 2018]. Available from:
https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-1-health-status-and-outcomes/
101-low-birthweight.html
References
10. Prandl K, Rooney R, Bishop B. Mental health of Australian Aboriginal women during pregnancy: identifying the gaps. Archives of Women's
Mental Health [Internet]. 2012 [cited 1 May 2018];15(3):149-154. Available from:
https://link.springer.com/article/10.1007%2Fs00737-012-0276-0
11. WONG R, HERCEG A, PATTERSON C, FREEBAIRN L, BAKER A, SHARP P et al. Positive impact of a long-running urban Aboriginal
medical service midwifery program. Australian and New Zealand Journal of Obstetrics and Gynaecology [Internet]. 2011 [cited 29 April
2018];51(6):518-522. Available from: https://obgyn-onlinelibrary-wiley-com.ezproxy.newcastle.edu.au/doi/10.1111/j.1479-828X.2011.01326.x
12. Woods-Giscombé C, Lobel M, Crandell J. The impact of miscarriage and parity on patterns of maternal distress in pregnancy. Research in
Nursing & Health [Internet]. 2010 [cited 3 May 2018];33(4):316-328. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070408/
13. Marquis S, Butler E. Practice Guidelines for Prenatal and Postnatal Outreach in British Columbia. BC Ministry for Children and Families.
2001;.
14. Rubertsson C, Hellström J, Cross M, Sydsjö G. Anxiety in early pregnancy: prevalence and contributing factors. Archives of Women's Mental
Health. 2014;17(3):221-228.
15. Elsenbruch S, Benson S, Rücke M, Rose M, Dudenhausen J, Pincus-Knackstedt M et al. Social support during pregnancy: effects on
maternal depressive symptoms, smoking and pregnancy outcome. Human Reproduction [Internet]. 2006 [cited 8 May 2018];22(3):869-877.
Available from: https://doi.org/10.1093/humrep/del432
16. La Marca-Ghaemmaghami P, Ehlert U. Stress During Pregnancy. European Psychologist [Internet]. 2015 [cited 4 May 2018];20(2):102-119.
Available from: http://Stress During Pregnancy Experienced Stress, Stress Hormones, and Protective Factors
17. Kildea S, Stapleton H, Murphy R, Low N, Gibbons K. The Murri clinic: a comparative retrospective study of an antenatal clinic developed for
Aboriginal and Torres Strait Islander women. BMC Pregnancy and Childbirth. 2012;12(1).
18. Walker M, Fredericks B, Mills K, Anderson D. “Yarning” as a Method for Community-Based Health Research With Indigenous Women: The
Indigenous Women's Wellness Research Program. Health Care for Women International. 2013;35(10):1216-1226