Introduction — labour and birth

In traditional Aboriginal culture birthing is strictly the concern of women and governed by Women’s Law (the 'Grandmother’s Law'). Many older women, known as traditional birth assistants, have this knowledge. Older women and traditional birth assistants talk about birthing on country, with babies connected by birth and ritual to that country.

Traditionally, women gave birth well away from the camps. Women birthed alone or were looked after by birth assistants or female relatives of the right skin. Rules about which relatives are 'right skin' vary by region. See Looking after women's health for where to find more information.

Traditional practices governed how the cord was managed, including cutting the cord after the placenta (traditionally known as the birth bag) was delivered, cutting the cord longer than what is now normal, crushing with a stone instead of cutting and tying the cord with hair or string. A long strand of cord may also be put around the baby’s neck.

Management of the placenta is also of cultural importance. Old women say the placenta is sacred, and should not be handled. Traditionally, the placenta was buried in a hole at the birth site, often dug by the mother, then a good hot fire lit on top. Women relied on a fire for warmth and healing.

After the birth, traditional practices focused on stopping bleeding​, healing, warming and making the mother and her baby spiritually strong. Traditional smoking ceremonies would be held for the baby and the mother. Women stayed isolated for up to a week after the birth. Appropriate relatives visited, bringing special food like kangaroo, sweet potato, and wild bananas or other bush foods depending on the season. The father usually didn't see the mother or the baby during this time.

Birthing places

Women from remote communities are strongly encouraged to birth in a regional hospital, in line with health service policies. Give enough information in the antenatal period to prepare the woman for going to a regional centre. Include advice about living and hospital arrangements, the birth experience, and having support people with her.

Birthing in hospital may be isolating and frightening due to unfamiliar staff (sometimes male), strange surroundings, and language barriers. Lack of knowledge about the birth experience can contribute to fear and feelings of isolation. Ongoing education is an important part of antenatal care. Good preparation can help reduce fear, and make the unknown less daunting. Strategies include a tour of labour ward and postnatal area, having an interpreter available and meeting maternity unit staff. It may be helpful to identify family or others in town who can support the woman while she waits.

Women may wish to follow some of their traditional practices after the birth. If in Alice Springs, she can go to Congress Alukura (women's health clinic) for traditional ceremonies or have them when she returns to her community.

Unexpected births 'out bush'

Births still occur unexpectedly in remote communities. Sometimes women don't agree with birthing in hospital for a variety of personal reasons and beliefs. Occasionally a baby is born in the bush with traditional birth assistants supporting the woman and practising Law and culture. Clinic staff may only find out when labour ​is well established or after the baby is born.

If a woman presents in labour​ and there is no time to send her to hospital — try to close the clinic and ensure birthing is private. Ask a female ATSIHP, ACW, or SWSBSC worker about the appropriate practice in this community. The woman can choose appropriate relatives and birth assistants to support her. Clinic staff should work with these women in an open, cooperative and culturally appropriate way. Traditional birth assistants have a wealth of knowledge and beliefs to help the woman through labour​. They are skilled at massage, easing pain ​by rubbing the woman’s back and encouraging the baby to be born by rubbing the woman’s belly.

After checking the placenta, ask the mother, ATSIHP, or birth assistants what to do with it. Check if it can be kept in the fridge or freezer. The mother may want to take it home and bury it on her traditional birth country. Old women are worried by stories that placentas are burned in the clinic rubbish bins or buried where dogs can get to them. They may not want the placenta stored in a freezer, saying that this causes sickness from the cold to enter the mother.

The mother and baby may still need to be sent to hospital for postnatal care. If not, the woman, female ATSIHPs and relevant family members will decide where the woman will stay and who is allowed to see her after the birth.

Cultural practices may take place in the community after a birth. Health staff need to be aware of these customs so they don't interfere with traditional practices or protocols. Staff are sometimes invited to attend and participate if culturally appropriate. An invitation is a sign of respect and should not be assumed.