Delivering a legacy of culturally safe maternity care

Professor Rhonda Marriott AM, a descendant of Nyikina people of the Kimberley, has devoted five decades to nursing and midwifery in clinical, academic and research roles.

This story is part of our 10 of the Best - fourteenth edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects. See more 10 of the Best.

She has also led a ground-breaking study based on four generations of Aboriginal women’s stories, experiences and expressions of giving birth in urban settings, which highlighted the fact that maternity care changes across time have failed to acknowledge and support Aboriginal women’s cultural needs. 

Birthing on Noongar Boodjar (‘Birthing on Noongar Country’) captured stories of First Nations Australian women from the south-west corner of Western Australia¹, including Whadjuk Boodjar (metropolitan Perth). Seventy-four women bravely shared their maternity experiences, documenting how they maintained cultural birth practices in the urban setting and interactions they had with health care providers, particularly midwives.

'The project gave us the opportunity to understand from Aboriginal women’s perspective, their experience of that intersection with the health system, the maternity system, at a time when they were giving birth', Professor Marriott says.

The researchers heard from 71 midwives too – about the limited knowledge of Aboriginal culture and the systematic culture bias in maternity care.

The research team developed recommendations for an efficient, effective, integrated and culturally secure maternity care system that can respond to Aboriginal women and their families during childbearing.

'The fact that we have births taking place in the hospital system does not mean to say that it needs to be so clinical that it becomes dispassionate', Professor Marriott says.

'It’s about being able to bring all of this together in a way that is culturally safe and clinically safe whilst meeting critical Close the Gap Targets.'

Birthing on Country refers to culturally safe birthing practices that respect the thousands of years of knowledge and practice of Aboriginal people. This philosophy is culturally significant for the future of the baby, providing ancestral and familial connection and belonging to their country.^2,3 This Way of Being is rarely understood by non-Aboriginal people, including health professionals involved in maternity care.⁴

'You are welcoming that baby into a culture that’s been there for 60,000 years and continuing, and this new infant is going to be part of that', says Professor Marriott. 

A scarcity of literature about women’s experiences when their Country is in an urban environment4 may have contributed to a misconception that Birthing on Country is only relevant to Aboriginal people living and birthing in a rural or remote setting.

An unexpected outcome of the project was the collation of 12 birthing stories from Elders and senior Aboriginal women who have birthed on Noongar Boodjar into a book titled Ngangk Waangening (‘Mothers’ Stories’).

The women shared their birthing stories as a legacy for their communities and as an educational tool.

'The elders, Aunty Doreen Nelson in particular, were saying, "We have to have this legacy, our stories can’t just stop here".

'It has to be there for our families and our kids … this has to be a teaching tool for midwives.'

Next steps

Professor Marriott continues to support maternity services on Noongar Boodjar to implement Birthing on Country principles.

She leads the Ngangk Yira Institute for Change, which focuses on research that benefits Aboriginal people and communities. Ngangk means both 'mother' and 'sun', and alongside Yira, the meaning expands to the rising sun or the presence of mothers across the journeys of our lives.

A second book is in the works, with 25 more stories to be accompanied by video and digital content. Its title, Because of her we will, refers to the instrumental role elder Doreen Nelson has played in the creation of this tangible legacy.

The project team acknowledges the Whadjuk people of the Noongar Nation, on whose land this research was conducted, and we pay our respects to Elders past, present and future, and to all the women, men and children who make up the Noongar Nation.

Team Members

• Professor Rhonda Marriott AM
• Associate Professor Roz Walker
• Mrs Tracy Martin   
• Mrs Terri-Lee Barrett       
• Associate Professor Tracy Reibel
• Professor Fiona Stanley AC       
• Professor Cheryl Kickett-Tucker
• Professor Julianne Coffin 
• Professor Yvonne Hauck 
• Alison Gibson