Introduction — pregnancy

Antenatal care must respect the woman's cultural beliefs and social situation. It needs to be flexible, friendly, non-threatening and accessible to all women, including young women. Antenatal care aims to improve the health of the pregnant woman and her baby by monitoring progress, detecting and managing problems and providing education about pregnancy and birth. The earlier antenatal care starts, the better the outcome. Antenatal care in remote areas may also include supporting women who have additional life stressors.

Problems that can adversely affect pregnancy outcomes include

• Medical issues — UTI, STI, anaemia
• Chronic diseases — diabetes, kidney disease, RHD
• Social and emotional issues — history of depression, anxiety or other mental health concerns, limited family or social support, domestic/family violence
• Environmental issues — crowded housing, mobile lifestyle, poor nutrition, access to affordable nutritious food
• Substance use — smoking, alcohol, kava, other drugs
• Pregnancies in young women
• Late presentation to health services.

Remote area health services can have trouble accessing skilled women’s health providers. Providing antenatal information, education and care can be shared between a variety of providers including midwives, doctors, nurses, ATSIHPs, Aboriginal community workers (ACWs), and community-based workers such as Strong Women, Strong Babies, Strong Culture (SWSBSC) program workers.

Use an interpreter if needed, and if available, written materials in language.  To avoid shaming if woman has low literacy use material with illustrations and photos relevant to the community (eg foods that can be found in the community store).  

Traditionally, Aboriginal women acknowledged a pregnancy when the baby’s movements were felt at around 16–20 weeks pregnant. They believed that at this time a spirit child entered the woman. This spirit may have come from a deceased relative, from certain places in the country, or from eating certain food. Traditionally, women didn't talk much about pregnancy until it was obvious, although close family members often knew. Secrecy and privacy are still important to some women so they may give another reason for seeking medical care when they really want confirmation of a pregnancy. Practitioners need to be sensitive to non-verbal cues and offer a urine pregnancy test in these circumstances.

Women now tend to present for antenatal care earlier than in the past and many come in the first trimester. However, some women still don't present until they feel the baby moving. Young women may present late, as they may not understand what is happening or they may feel frightened, embarrassed or shamed about being pregnant.

A small number of women don't come for antenatal care at all. Reasons for not presenting may include feelings of shame or guilt due to social circumstances around the pregnancy (eg sexual assault, 'wrong way' marriage), because they believe things are going fine or due to previous bad experience with the health service. Other health staff may hear a woman is pregnant from an ATSIHP, ACW,  SWSBSC worker or from another culturally appropriate woman in the community. Respect the woman’s privacy and her reasons for not presenting. Talk with the ATSIHP or ACW about the best way to approach her to offer confirmation of the pregnancy and antenatal care.