TANYA SITS AT the side of the couch, her head resting on her hand. She smiles when I say "hello", but her two-year old daughter has been sick with a cold and Tanya's caught it. A headache and a blocked nose add to the usual discomforts of pregnancy, but she's made an effort for the appointment: immaculately dressed in silver hip-hop pants, dark hair tied back, clear olive skin delicately made up. Carol Dorn, the midwife, guides her to the scales and then sits her down to take her blood pressure.
We all turn at the sound of small footsteps pounding down the hall. A toddler appears at the doorway, followed by a cry of, "Ryan! Wait for me!" then a tall woman pushing a pram who takes a seat on the couch next to Tanya. Joanne tries to restrain Ryan from pushing his pram into the computer desk while she listens to Carol. The midwife explains that it's time to test for gestational diabetes, and hands her a sugar drink which I know from experience tastes foul. Joanne swallows it but her focus isn't on the baby inside her, nor on Ryan, who is intensifying his efforts to crash test the pram.
She is talking about an older son. "He's getting into fights and bullying, and I've had all this trouble from the new doctor. He had me in tears when I saw him. He says he's not ADHD and taken him off his medication but now he's worse." Joanne cracks her knuckles distractedly, each etched with a letter: L O V E. Carol puts out a knee to block Ryan, and suggests that the most important thing when dealing with behaviour is consistency. Joanne continues: "Now the counsellor says she won't see him again until his medication's sorted out." Carol offers to arrange a meeting with her and the counsellor and the doctor. Joanne consents but isn't calmed. "The other day he said if another baby dies he's going to kill himself."
"You see, that's not normal for a kid to say that," Carol says quickly. She takes a breath. "You've got remember he's had a lot of difficult things happen, he's had a lot of grief in his life."
"Yeah," nods Joanne, turning towards Ryan now. "Like him. He asks, 'Where's Gracie?' And he looks at her ashes." Ryan gives up on the stroller, throws a crayon, and moves to an all-out grizzle. Joanne picks him up and says she'll take him outside for a run.
"Come back in an hour," Carol says, "and we'll do the diabetes."
I AM OLDER than both these women, but this is my first pregnancy. I had never planned on this age to start having children. It was simply that by the time I finished doing the things I wanted – the things that I took for granted as normal – travelling, studying, starting to build a career, and trying various relationships until discovering a partner I could be excited about parenting with – there I was: thirty-one, average age for a first-time white mother. It's an unnerving feeling to reflect the zeitgeist so perfectly. If, like Tanya and Joanne, I was Aboriginal then my "normal" would be very different. The chances are I would have started having kids earlier and would keep having them for longer. It is also likely that my pregnancy would have been complicated by the kind of maternal risk factors which are all significantly higher among Australia's Indigenous population.
In one New South Wales study, more than half the Aboriginal women reported smoking during pregnancy, compared with 14 per cent of other women, while foetal alcohol syndrome has been estimated to be a hundred times higher in Australia's Aboriginal population. The consequences for Aboriginal women and their children are clear. Nationally, Indigenous children are more than twice as likely to be born with low birth weight or prematurely. These babies suffer health and developmental disadvantages for the rest of their lives.
Rates of stillbirths and neonatal deaths for babies with an Indigenous mother in Queensland, Western Australia and the Northern Territory are about twice those for other babies, while in South Australia the rate is three times as high. The rates of infant mortality for Aboriginal and Torres Strait Islander children in Australia is more than double that for Native American or Maori children in the United States and New Zealand. Although it is now rare for any woman to die during labour in Australia, if you are black than you are three times more likely to die while giving birth to your baby.
SHE MOVES SO gracefully and quietly, I don't notice her come in. Tanya has seen the doctor and left, and sitting in her place is a very beautiful young woman, maybe sixteen or seventeen. Her smile is soft and open but she doesn't say a word and shakes her head when offered a cup of tea or a slice of cake.
Carol is busy on the phone and then Minna Huorata, a child and family nurse, walks in saying that Kerri-Lea hasn't turned up for her appointment and isn't answering her mobile. "I'll drop round," says Minna, "and see if she's there."
Carol turns to the new arrival, Lena. "How's it going, love?"
Lena answers so quietly that Carol leaves the desk to sit next to her on the couch. "I been getting drunk every night," Lena repeats.
"Have you?" Carol asks, taking Lena's hand. "How do you feel after?"
"Not good," Lena continues after a while. "I was at my sister's the other night and she says I pulled a knife on her boyfriend, but I can't remember."
They sit there quietly together. Finally Carol says, "You've got so much grief inside you, so much anger. Do you think you'd like someone to talk to? Yes? Because the drinking might help at first but then you'll just feel worse.
There's a nice new young counsellor in; she's young, she's really nice. Should we make a time to see her? Yes?"
Carol continues, "Because we've got to be careful with this new generation, got to make it strong – we can't have the same problems as the last. That's right, isn't it? You'll have to come in another day to see the counsellor but let's get you to see Wendy while you're here today, okay? And I'll give you something to read."
The door opens and a receptionist wants to know where Minna is because someone is waiting for her outside. Then the GP, Wendy Thornthwaite, appears, saying that the ear specialist is in her consulting room so where should she see the antenatal patients? Carol answers their questions while sorting through a filing cabinet. A few minutes later, I look over at Lena and she's leaning into the couch holding a blue booklet titledMiscarriage and You. Carol is back on the phone, another woman with a big belly walks in, and Lena says quietly to no one in particular, "Because it's the third baby I've lost."
THE "APPALLING STATE" of Aboriginal Torres Strait Islander health, as the Australian Medical Association describes it, is widely known, as are the prenatal origins of many adult illnesses. Healthy women having healthy babies is the lynchpin of improved Indigenous health. The equation is simple but it is something the mainstream medical system has failed to achieve. A high proportion of Aboriginal women still do not visit a doctor until late in their pregnancy, and then return only irregularly and infrequently. This makes it difficult to provide good antenatal care and education, and often results in the inadequate management of complicated pregnancies. The "appalling" statistics inevitably follow.
At the Nepean Hospital in Western Sydney, where Carol Dorn worked as a midwife in the 1980s, it was common for Aboriginal women to first present when they were already in labour, having received no antenatal care at all during their pregnancy. Women and their babies were often very ill; others died from conditions such as eclampsia and complications from diseases like diabetes. Carol became keenly aware of the health risks facing Aboriginal mothers, and just as conscious that these were bound up with a social reality that the hospital system was unable, or unwilling, to address. Building on the success of Redfern's pioneering Aboriginal Medical Service (AMS), the Daruk Aboriginal Controlled Medical Service was established in Western Sydney in 1987. Carol Dorn and Aboriginal Health Worker Elaine Gordon were given the task of setting up a community-based midwifery program in Mt Druitt. Sydneysiders know what this location means – poverty and race. (In his Griffith REVIEW essay, "Trying to find the sunny side of life", David Burchell refers to the sneering joke t-shirt "I climbed Mt Druitt".)
As a Brisbane girl, this was the first time I'd ever visited Mt Druitt, but even if I'd been raised in Sydney there would have been little reason for me to venture out to the suburb's little stretch of pawnbrokers, Asian bakeries, its tattoo parlour and the Ezi-Grow hydroponic store. For years Carol and Elaine operated out of what is now fruit shop on Mt Druitt's main drag, but since 2000 the clinic has occupied a sunny corner room in AMS Western Sydney's low brick building around the corner, an Aboriginal flag flying out the front, and the word "virgin" graffitied in black at the entrance.
Carol Dorn isn't fettered by policy-speak or Pollyanna-ism. She sums up the early years as "one really hard slog". Indigenous families were simply not permitted to fall through the cracks the way they routinely did in the hospital system. If women missed an appointment or were reported in trouble, Carol and Elaine would turn up at their homes to find out what was happening. They would drive clients to and from antenatal checkups, ultrasound appointments and specialist referrals. They were persistent and they were resolutely non-judgemental. Over time, their approach won the trust of the community, and this remains the foundation of their work. Early on, Carol and Elaine were joined by GP Wendy Thornthwaite and obstetrician Kathy Niven, and Carol, Wendy and Kathy continue to make up the core of AMS Western Sydney's antenatal team.
Carol is aware that in the white world it is not good "professional practice" to have individuals so strongly identified with their positions, yet the reality is that this stability has allowed real relationships to be built with the community – something impossible with the high turnover of white staff usual in Aboriginal services. The members of the antenatal team are now seeing their second generation of Aboriginal mothers: girls whose mums had been reluctant early clients now insist their daughters "get down there and see Carol" as soon as they're pregnant.
I can see why pregnant women, regardless of background, would trust Carol. She's warm, frank and genuinely interested in women and babies. A five-foot blond dynamo, it's clear she gets things done, but without the matronly bossiness with which other midwives arm themselves. On the first morning we meet, she clip-clopped me across to her preferred local Vietnamese bakery, Than Loc, on Mt Druitt Road where her friendly but firm comments about some unusually salty hot cross buns she'd bought the week before led to bemused laughter from the baker, concern from his daughter translating the exchange, and a free donut. Walking back to Carol's office, I found myself easily confiding the horrors of pregnancy haemorrhoids and the surreal tininess of newborn singlets.
The western suburbs of Sydney have the highest urban Aboriginal population in Australia, and the AMS Child and Family Health Clinic oversees up to a hundred deliveries a year. Their clients tend to be the most disadvantaged members of the local community; the vast majority are having what is characterised as a "high-risk" pregnancy. And yet, compared with other Aboriginal mothers in the area, women attending this antenatal program are more likely to have healthy pregnancies and healthy babies: they report earlier for their first prenatal check-up, and have more prenatal visits; fewer obstetric complications, and an increase in rates of perinatal survival; ongoing care post-birth has resulted in good breastfeeding rates and increased monitoring of baby and child health, including immunisation and the problem area of hearing. As part of the AMS antenatal program, all women receive comprehensive health screening, including a Pap smear. This is a test Aboriginal women are otherwise less likely to have than other Australian women, although they suffer the country's highest incidence of cervical cancer.
Carol stresses, however, that it is "families" who are the antenatal clinic's clients, not just the individual women. This attention to "the world outside the womb" means the physical health of pregnant women is addressed as part of a wider context of social and emotional wellbeing, which may include housing needs, dealings with Centrelink, drug and alcohol addiction, and domestic violence. Partners are encouraged to become actively involved in their children's care through playgroups and weekly parenting programs; recently a single dad took his baby for a week's stay at a Tresillian Family Care Centre to learn about settling – a lone black father among a group of white mothers. In short, AMS's Child and Family Health Clinic has long been addressing the kinds of "social determinants" that Health Minister Tony Abbott is now acknowledging as crucial to improving Indigenous health.
MINNA HAS RETURNED witha Kerri-Lea and her partner Steven. Kerri-Lea says she'd forgotten about her appointment with the doctor and the phone company disconnected the phone, but then they saw Minna walking up the driveway so here they are. Steven and Kerri-Lea are a young couple, one black and one white, who already have an eighteen-month-old son. They banter between themselves, and when Kerri-Lea takes a draw on her asthma puffer, Steven chides her for smoking, reminding her that since he's given up his asthma has disappeared. She defends herself by saying it was easy for him to give up because he didn't have the stress of being hassled by him all the time.
Joanne, who has come back after taking Ryan for a walk, hoots. Carol has stopped what she was doing and focuses on Kerri-Lea. "I was a smoker too, and I know it is really hard to give up. But you can." Kerri-Lea raises her eyebrows in her pale, round face and takes another slice of cake from the coffee table. She says she doesn't want to know how much she weighs.
Health care, like much else, is usually a fiercely guarded private encounter. I would have been shocked had my own antenatal check-ups taken place anywhere other than in a consulting room with the door closed. But, over her years working with Aboriginal women, Carol has seen the benefit of addressing the experience of pregnancy in a group setting. So while sitting together waiting to see the GP or obstetrician pregnant women at this clinic have their weight and blood pressure checked, and Carol openly discusses their physical and social situation. The women can learn from and support each other. Carol and Elaine have also seen – for good and ill – how quickly information picked up here spreads to the rest of the community. Something similar happens with the transport service. Driving women to and from the clinic doesn't simply ensure they get to their appointments, it also allows for a "chat" – a noun which covers everything from antenatal education to relationship counselling. Carol is on call 24/7 if one of "her girls" needs help when in delivery, and her phone often used to ring in the small hours. From its inception, the AMS antenatal team has worked hard to make the local hospitals, Blacktown and Nepean, more Koori-friendly, and as a result such phone calls are now rare. But, although many hospitals are changing the way they approach Indigenous patients, Aboriginal-focused midwifery services believe institutional independence to be crucial to their success. Hospital bureaucracies preclude what Carol says is a necessary flexibility on "rules" and until very recently were part of a system that endangered Aboriginal families while claiming to protect them.
When Carol and Elaine first got the community elders together to find out their opinions on improving services for pregnant women, Carol showed them the standard props of antenatal education – a lifelike doll and plastic pelvis. The elders were horrified. "You can't show our girls that!"
The ignorance and fear surrounding pregnancy and childbirth were not the result of Aboriginal "culture" or "tradition", but the product of recent history. These elders were members of a generation who had not been mothered, whose cultural identity and knowledge had been assaulted in the missions and foster homes of the stolen generation. When it came to raising their kids, white doctors and nurses had directed them to bottle feed with formula, and had kept them uninformed about conception and birth. When they were told that arrowroot biscuits dipped in milk would "fatten up" their children, these women listened – if their children were fat enough, they wouldn't be taken away.
WHEN I DROVE out along the Western freeway to take a seat on the sofa in the antenatal program's waiting room, I had felt a little apprehensive and, along with my rounded belly, brought an orange poppy-seed cake from Than Loc as a passport. But my anxieties were unfounded. To the women and girls here, I'm just another waiting mum.
Sharon walks in, wearing a singlet and shorts, and lets out a cheer at the sight of the cake. She sits down next to me and laughs when I ask her if this is her first baby. "Number six mate," she says.
"A glutton for punishment," teases Carol.
"Nah, just stupid!" Sharon replies, rolling her eyes and finishing her first piece of cake. "I'm thirty-three, and when this one's born I'll have three kids under three – bloody stupid. But I can't stop getting pregnant." She leans forward. "So Carol, listen, I want to have me tubes tied after this one. The pill doesn't work for me, and I need something that's going to work straight away!"
She and Carol talk about the operation and what she should consider. "So talk to your partner about it," Carol ends.
"Bugger that, I'll tell him!"
Sharon takes another piece of cake and is keen to chat. This is the second baby she'll have through AMS Western Sydney. Before that, she'd gone to hospitals in Queensland and New South Wales, and she knows what she prefers. "It's so much better here. At the hospital they talk to you like you're stupid, and you have to wait forever. And they judge you, you know. Here you can have a good chat and a cuppa. With my last baby I had a lump here [she points to her neck]. I had to get it tested, 'cause they thought it might be cancer. But my husband had to stay home with the kids. These guys here, they picked me up, drove to me to the hospital, sat with me when I got the test then waited until the results. Other places would never do that – they'd drop you off but they wouldn't wait, they wouldn't hold your hand."
News of the cake has spread. Elaine wanders in to get some and asks the room, "How's life treating you all?" Conversation turns to a story that Carol and a few others saw on TV last night about a new contraceptive vaginal ring. "I've got the rep coming in today," Carol announces. "I reckon it could be a real winner."
Sharon shudders: "I think it sounds, I dunno, yuk!"
Carol turns back to her computer and Sharon whispers to Elaine, "I'm ducking out front for a smoke." Elaine lets out a snort and Carol swivels round. Sharon looks at her and grins. "I'm just going out for some fresh air."
For all AMS Western Sydney's successes in improving antenatal care for local Aboriginal women, the major causes of low birth weight among their babies – and the related morbidity and mortality rates – remain: maternal smoking, alcohol abuse, sexually transmitted diseases and malnutrition. There is a new risk factor on the rise in this community. The number of pregnant women on methadone and active amphetamines attending the clinic has surged over the last three years. Carol and obstetrician Kathy Niven refer to the "Costello effect" – the increase in the number of babies being born to Aboriginal mothers, and especially to those who are drug-dependent. For a middle-class white woman, Peter Costello's $4,000 "baby bonus" might cover the cost of a new washing-machine or justify extra spending on yoga classes and massage, but it would never convince someone like me to take on the lifelong expenses of raising a child. Yet for women in chronic poverty, this is a huge amount of money and childbirth a unique opportunity to access it – all the more tempting if you, or your partner, might have a habit to feed.
Carol does safety assessments in the homes of these women in the lead-up to labour, clearly outlining the Department of Community Services' (DOCS) health requirements and explaining that if these go unmet the baby will be taken into care. The good intentions of the women she sees impress her over and over again. They enthuse about the cots and rockers they'll buy from Freedom with "all that cash". Then, when she visits six weeks after the birth, the money has gone – as has the excitement of a new baby. Each of these domestic collapses reverberates through the the community – elders end up taking the kids, already stressed families grow larger, and the need for Aboriginal foster families grows.
For Carol, the scenario is "heartbreaking". She is a mandatory reporter to DOCS and accepts that there are cases where Indigenous families aren't coping and children have to be removed – something she says the local Aboriginal community also understands. Carol has become convinced that the increase in the number of drug-dependent women demands changes in the way the clinic operates, and she is searching for new approaches. She wonders out loud whether she needs to be tougher on missed appointments and unheeded advice, saying that one of her current goals is to encourage self-sufficiency. Perhaps, now trust has been established, the intensity of support needs to be pulled back? With Aboriginal health, as with the ongoing failures in Indigenous education and the rates of community violence, the problems are clear. The question that's asked again and again is "What's the solution?" Carol doesn't know. She sighs and then laughs her open laugh. "You just keep trying."
DRUGS OR NO drugs? Elective caesarean or deep breathing? Private obstetrician or birth centre? The "mummy wars" – whose later battlefronts include schedule versus demand feeding, and institutional care versus stay-at-home parenting – start early. The question put to me directly and implicitly throughout my pregnancy by midwives, doctors, friends, other mums, newspaper columnists and pregnancy books has been "What kind of labour do you want?" The answer I've settled on is to aim for an active birth, as free of medical interventions as possible. During my pregnancy, I've relished having no obstetrician to report to, refused what I believed were unnecessary prenatal tests, basked in the support of the midwives running the birth centre I attended, and generally enjoyed exploring pregnancy as a natural, rather than medical, event.
But what I had assumed to be the natural focus of pregnancy – birth – wasn't so for the women coming and going in the AMS waiting room. Their focus was on the kids they already had, their troubles with the Department of Housing, their partners' whereabouts – basically everything going on, often so demandingly, outside of the womb. The baby, when it came, would be added to this list but they didn't prioritise the birth experience in the way I and other middle-class women have the luxury of doing. As Carol put it: "There are so many other things going on for them which are much more important than the baby they can't see at this moment."
For Aboriginal women living in remote parts of Australia, there isn't even the illusion of choice in pregnancy and labour. Sue Kildea is Associate Professor of Midwifery and Homebirth Services Coordinator at Charles Darwin University in the Northern Territory, and she has worked extensively with pregnant Aboriginal women in remote Australia. Sue is passionate about what's going wrong for Aboriginal women's experience of birthing in the bush.
Hearing the description of current practice, it's easy to understand her indignation. If you're one of the 3.1 per cent of birthing women who live in remote Australia, you are given no choice but to fly into the closest town, which may be thousands of kilometres away, at around thirty-six weeks and wait for the birth of your baby. The kind of care and financial assistance you'll receive while there varies from state to state, but generally you'll stay in a hostel where you will be left to feed and entertain yourself, separated from your other children and the baby's father. Chances are you'll get lonely and bored, and spend what money you have on phone calls and shopping. This prospect is so unappealing that some Indigenous women living in remote communities avoid all antenatal care because they don't want to be forced to leave their homes to give birth.
Over the last two decades, there has been no shortage of official reports showing that women in rural and remote parts of Australia, especially Indigenous women, want to have their babies in their own communities. That these reports remain unacted upon reflects funding shortfalls, the unresolved issue of insurance for Australian midwives, and Medicare provisions designed to keep pregnancy care in the hands of doctors.
But Professor Kildea is adamant that the biggest factor is a lack of political will to make changes. She points to the success of schemes in other Indigenous societies, such as the Inuulitsivik Health Centre running in the Artic Quebec region of Canada, where the presence of locally trained midwives has allowed women to stay in their home communities to give birth. The result has been a significant improvement in health outcomes for mothers and babies, along with a profound restoration of cultural pride and autonomy. She argues that the success of such schemes could easily be replicated in Australia if politicians decided they were important enough to fund.
When I ask Carol Dorn whether the antenatal program at AMS Western Sydney receives enough money for what it would like to do, she looks at me incredulously. The team's salaries and cars are covered from various funding sources, but everything from the parenting group's morning tea to the textbooks needed for her research into foetal alcohol syndrome comes out of her own pocket. If she had the budget, her first "dream purchase" would be to hire a researcher to document conclusively the program's successes and the changes that might be needed. This kind of "number crunching" is something she has neither the time nor the skills to do properly. "But," she adds, "you can't wait for everything to be in place before you start. You can do a hell of a lot with nothing."
THERE'S A KNOCK on the waiting room door, and a cheery middle-aged man pokes his head around the corner. It's Rob, the medical rep who has come to spruik the new vaginally inserted contraceptive, NuvaRing, that had been on TV the night before. Carol invites him to take a seat but he's confused and a little put out by the number of women in the room. "This presentation is just for staff," he says, looking around.
"That's alright, love," answers Carol. "The others won't listen. So how's it work?"
We sit back expectantly. He is less confident than a moment ago, but starts his pitch. The questions and comments come from every direction: "Can you feel it?" "When do you change it?" "It costs too much!"
Carol asks if the ring comes in other colours, and Rob answers no, that their test groups showed people were put off by anything other than a clear ring. "Well they didn't test it around here then!" Sharon exclaims to woops of laughter.
Carol agrees, saying that glow-in-the-dark condoms are always the first to go in this clinic. She suggests they release a model with spikes.
Compared with the GPs Rob would usually see, this is more like a hens' party. But his nervousness has subsided as he sees how good-natured and genuinely interested – even enthusiastic – his audience is. He takes the plunge, discussing the mechanics of sex. He explains that if your partner falls into the small percentage of men who can feel the ring and don't like it, then it is possible for you to take it out for up to three hours while you have sex. Carol comments that if you're lucky enough to have sex for three hours you probably won't care if you get pregnant.
He ends with a caution about the small group of women to whom the contraceptive ring isn't suited – those who've had prolapses or who have unusually large vaginas. Kerri-Lea looks shocked and Sharon's face falls. "So if you've had six kids and your muscles are gone to buggery it won't work?"
Rob considers such a client – one unlikely to have appeared in NuvaRing's trial groups. "No," he concludes.
"Well there goes me then," she shrugs.
An hour or so later, Kerri-Lea has returned from seeing the doctor and is sitting back on the couch with a cup of tea. She turns to Carol, "So love, what's all this about big vaginas?" Seeing it's a genuine question, Carol – without missing a beat – explains that women are differently shaped all over. Steven looks uncomfortable but Kerri-Lea and Carol are determined to sort this out. Once Kerri-Lea is satisfied with the anatomy briefing, she announces they'll go and wait outside for Minna to give them a lift home.
IT'S PAST MIDDAY and the number of women and children in the waiting room are starting to thin out. Jana arrives to show off her eight-day-old baby girl, Skye. Kathy has come in to see whether she's needed and exclaims how much mother and daughter look alike. Jana is concerned about the gunk in Skye's eye and Carol explains how to give her a salt-water wash. Folded into the corner of the opposite couch and watching the conversation is Amanda. She's a few days past her due date and I ask her whether she's ready. She turns her large eyes towards me and shakes her head.
"Are you scared?" asks Carol.
There are good reasons for Amanda to be frightened. She is sixteen and this is her first baby. She knows already that it is a boy and that he will be born with a cleft palate. Carol is running through what will happen after the birth, explaining that the baby will be taken straight to the hospital's Neonatal Intensive Care Unit. Amanda stays silent, occasionally drawing small circles on her belly with a finger, while staring at Carol.
Carol asks if Amanda would like to go with her to meet the staff at the hospital. She nods, and Carol makes a time for Monday. She repeats that all of Amanda's information is on the registration card at the hospital and it directs them to ring her as soon as Amanda arrives. "But if you start feeling pains over the weekend you ring me anytime and I'll come, okay?"
Amanda nods again. Jana is rocking her baby girl. "This one's birth was horrible," she says. "Even though it was my second and I thought I knew what was happening, I haemorrhaged."
Amanda's eyes widen.
"I'll come and show you my card from the hospital," Jana tells Carol. "I want you to go through it, so I know what happened."
Kathy calls Amanda in to her room, Jana takes Skye home, and Minna and the Aboriginal Health Worker, Veronica Henry, return from dropping off clients. The women discuss Amanda. "Her home's not good," Minna says. "It's really overcrowded."
"And her mum's volatile," adds Carol, "kicking her out and then letting her back." Cindy mentions a supported hostel she knows about in Parramatta which will let both Amanda and her boyfriend stay. Then Carol asks Minna how she keeps her AMS polo shirt so white. A lively discussion about laundry and the possibility of getting some new uniforms follows. Everyone agrees that the Health Education Team members have good shirts.
THE 2005 AMA Report Card on Indigneous Health focused on the rates of low birth weight among Aboriginal and Torres Strait Islander babies, arguing that "the solutions to premature and low birth weight babies are relatively straightforward". In practice, though, there is little that is "straightforward" about the social changes required to really improve maternal and child health among Indigenous Australians. Even in an antenatal program as grounded in the community as AMS Western Sydney, health outcomes still have a long way to go to approach the norms of white mothers. Yet this antenatal waiting room is providing benefits that go far beyond the physical. Whatever else these women have had to confront in their lives, in their families, schools, or with their partners, here they are listened to and encouraged. The "health outcome" of sharing a cup of tea, of having an open ear to listen, and a hug if you want are difficult to graph but they are life-changing nonetheless. And it sure beats leafing through old copies of New Idea.
Amanda returns from seeing the doctor and Carol talks to her about the possibility of the hostel, saying she and her boyfriend are going to need all the help they can get "when that little baby comes". Carol takes Amanda over to monitor her baby's heart, explaining to Minna how to operate the machine as she does so.
Suddenly the room fills with the rhythmic wet squelch of a foetal heartbeat. Carol turns around, smiling. "Isn't that a beautiful sound?"