Male midwives are OK

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I would like to respond to the article in Women and Birth volume 19 issue 3 September 2006. ‘Cultural safety and maternity care for Aboriginal and Torres Strait Islander Australians’ Sue Kruske, Sue Kildea, Lesley Barclay.

This passionate plea to reform the care given to Indigenous Women is laudable and several reports including ‘Some Good Long talks 1992’² and Re-birthing 2005’¹ support reform and highlight poor outcomes for Indigenous women and their babies generally in Australia.

Kruse et al. (2006) state that “this paper considers the changes that can be made from the individual practitioner through to the design and implementation of maternity services” (p. 73). One of the changes proposed is that “Male practitioners need to take the initiative, recognising the cultural inappropriateness of caring for women in birth and step back from the ‘hands on’ care of Aboriginal and Torres Strait Islander women” (p. 76).

I am currently employed in the Maternity Unit at the Mareeba Public Hospital in Far North Queensland. 21% of the childbearing women in our jurisdiction are Indigenous. Statistically the outcomes for Indigenous and non-Indigenous women in the unit are similar; the antenatal attendance of all women is similar “Mareeba ATSI and NATSI Data 2005/2006”. The unit offers clinics with a named midwife and it is the childbearing woman who chooses which clinic she will attend. The unit, the mothers, and the midwives are supported by Mary, an Aboriginal Health worker, who has been a member of the Maternity team since 1996. Mary supports the childbearing women both in the unit and in a primary healthcare capacity; she also attends the outreach clinics with a midwife.

Dean, the male midwife on the team, is the midwife who has been chosen by the Indigenous women to attend their outreach clinic with Mary in the Aboriginal community. From June 2005 to June 2006 the unit had 158 births, In Dean's clinics he attended 44 women, of these 12 were Indigenous. Thus Dean's client base is 27% Indigenous.

It is not Dean's gender that is of concern to these women, what appears to be important is that he, treats all women with respect and dignity, he takes the time to know the women and their families, and he greets each woman and her children by name and understands her family relationships. The women continue to request that Dean cares for them during pregnancy ad immunisation. This is an outcome that is not achieved successfully throughout the state and an outcome that was highlighted in the Re-birthing Report 2005. Indeed it could be said that Dean is an exemplary exponent of the ‘Culturally safe’ practice Kruse et al. call for as part of ‘A Way Forward’. As a midwife Dean provides these Indigenous women with the support of their choice. It would seem counterproductive to exclude him from maternity care of Indigenous women based on his gender. Kruse et al. establish that cultural safety is essentially an individual matter and yet this generalised recommendation runs counter to that philosophy.

This paper states that most of the research relied upon was from New Zealand and there is a dearth of research in Australia. I agree that research is lacking in Australia and that more research in this area is essential. I also believe this research needs to be local, the women need to be asked who they want as their midwife and that this research is done prior to recommendation which implies all male midwives are inappropriate to care for Indigenous women.

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References 

1. Hirst C. Re-birthing, Report of the Review of Maternity Services in Queensland (p. 2), 2005.
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2. Myles H, Tarrago I. Some good long talks: Cross-cultural feminist practice. In:  Walters S,  Manicom L editor. Gender in population education methods for empowerment. London: CACE Publications; 1996;p. 181–201
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