A study of factors which contribute to appropriate pregnancy care for Aboriginal women in far north Queensland

Humphrey, Michael D. (Michael David), 1946- (2001). A study of factors which contribute to appropriate pregnancy care for Aboriginal women in far north Queensland PhD Thesis, School of Medicine, The University of Queensland.

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Author Humphrey, Michael D. (Michael David), 1946-
Thesis Title A study of factors which contribute to appropriate pregnancy care for Aboriginal women in far north Queensland
School, Centre or Institute School of Medicine
Institution The University of Queensland
Publication date 2001
Thesis type PhD Thesis
Supervisor -
Total pages 300
Language eng
Subjects 111402 Obstetrics and Gynaecology
111401 Foetal Development and Medicine
111701 Aboriginal and Torres Strait Islander Health
Formatted abstract In 1990, pregnancy outcomes for Aboriginal women in Far North Queensland, particularly those living in remote communities, were significantly inferior to those of Caucasian women in the region, and the opportunities for remote indigenous women to access specialist obstetric and gynaecological care were minimal. The Cairns Base Hospital Department of Obstetrics and Gynaecology was improved by the development of a high quality training unit for junior medical staff, with clear and adequate supervision by specialist staff, by the development of clear protocols of care for the maternity unit, surrounding community hospitals and remote area health centres, and by the development of a comprehensive specialist outreach program (FROGS). Obstetric risk scoring was studied as a means of best allocating care resources, and an obstetric outcome score was developed and piloted to attempt to improve clinical audit of the entire childbirth process. The introduction of a computerised obstetric database at Cairns Base Hospital allowed a retrospective study of pregnancy and its outcomes in Aboriginal women. An appropriate perinatal mortality review processes, both at Cairns Base Hospital and throughout the region, was developed. These matters are detailed in Part 1 of this thesis.

The birthweight distribution in Aboriginal births was found to be clearly different to that in Caucasian births, with a significantly higher number of low birthweight babies being born to Aboriginal women. The gestational distribution in Aboriginal births also appeared different. However, in view of the high incidence of uncertainty regarding gestational age in Aboriginal pregnancies, these matters needed to be confirmed by a prospective study.

This prospective study (part 2 of this thesis) examined two null hypotheses:
1. That the average gestation at birth and the incidence of preterm birth in Aboriginal people is the same as that in Caucasians.
2. That the intrauterine fetal growth pattern of the Aboriginal fetus is the same as that in Caucasians.
Aboriginal women were recruited in four Cape York communities, and a Caucasian reference group was recruited from the public antenatal clinic of Cairns Base Hospital. These women had no apparent risk factors for preterm birth or for fetal growth abnormalities.

There were unavoidable epidemiological differences between the Aboriginal and Caucasian groups of women. The Aboriginal neonates were almost 450 g lighter than their Caucasian counterparts. Though the mean gestational ages of the two groups differed by 4 days, testing for equality of survival distributions confirms that the gestation-at-delivery distribution of the two groups is not significantly different.

It is clear from this study that prematurity is not the most significant cause of low birthweight birth in Aboriginal people. The Aboriginal fetus is particularly influenced by maternal BMI and alcohol use, whilst the Caucasian fetus is affected by maternal BMI, tobacco use and maternal age.

Minor differences in Aboriginal and Caucasian growth curves in biparietal diameter, abdominal circumference and femur length do not have any clinical significance. Therefore, there is no reason to use separate fetal "growth"" charts then examining Aboriginal fetal growth. Currently validated fetal "growth"" charts, such as the ASUM charts, are appropriate for use in Aboriginal pregnancies.

When the information from this study is examined in elation to possible interventions that may be put into place to attempt to actively lower the incidence of low birthweight birth in Aboriginal pregnancies it is clear that issues of improved pregnancy care of individual women are the important issues, rather than medical interventions aimed at reducing the likelihood of preterm labour which have been suggested in the past. Culturally appropriate pregnancy care and social support (particularly in relation to improved nutrition and harm minimisation programs) must target the effects of poor nutrition and excessive alcohol use if the excessive incidence of low birthweight birth in Aboriginal people is to be reduced.

These suggested changes are best brought about from within Aboriginal society, with support and training being provided by healthcare professionals with appropriate cross-cultural attitudes and training, rather than by externally based health services. Such programs are most appropriately centered on female Aboriginal healthworkers who have been selected by their community for this function. The funding of such programs must become a national priority if neonatal and subsequent childhood and adult morbidity and mortality patterns in Aboriginal people are to be significantly improved.
Keyword Women, Aboriginal Australian -- Health and hygiene -- Queensland, Northern
Prenatal care -- Queensland, Northern
Pregnant women -- Health and hygiene -- Queensland, Northern
Additional Notes The author has given permission for this thesis to be made open access.

 
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