Birthing business in the bush : it's time to listen

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The challenge of ameliorating or preventing the health problems of Indigenous Australians living in remote areas is compounded by the profound professional, cultural, social and personal isolation of the health professionals who work there. This isolation has direct effects on the recruitment and retention of health professionals to remote communities, and their ability to work effectively in this unfamiliar environment. The overarching goal of this research was to strengthen the capacity of these professionals to improve the quality of remote area maternity services in Australia and the experiences and outcomes for birthing women and their families. This was achieved by investigating a process of engagement with a wide range of stakeholders and utilising contemporary communication technology through the Internet. A case study approach was undertaken using participatory action research (PAR) with the elements off rapid assessment, response and evaluation methods (RARE). The research explored, described and analysed the development of resources aimed at decreasing isolation and increasing communication in the remote setting. Identifying the barriers, facilitators and utility of an information technology intervention was an integral part of the investigation process. The first case study saw the development and evaluation of the Maternity Care in the Bush Web Based Resource Library, designed to decrease the isolation of practitioners from the educational resources and professional expertise available in current literature, guidelines and reports. The second case study targeted isolation from peers, with the development and evaluation of the Remote Links Online Community. This was designed to build partnerships between isolated practitioners, for the purpose of interactive peer support, information exchange and mentoring. The third and fourth case studies were guided by Aboriginal researchers and resulted in the development of the Birthing Business in the Bush Website, designed to decrease practitioners' isolation from cultural knowledge. An integrated component of this Website is the Primary Health Care Guide to Planning Local Maternity Services, designed to decrease the isolation of the health care practitioner from the community in which they are working. Issues related to conducting research in the Australian Indigenous setting have been explored, analysed and detailed. Each case study contributed new knowledge and learning about the challenges and contemporary contexts of remote area maternity service provision in Australia. The use of PAR, and, most particularly, how this can be used in Indigenous research to produce goals that extended beyond the individual researcher's goals, has been described. The current difficulties associated with computer mediated communication, as experienced by remote practitioners, have been highlighted. The research has identified areas of need within the workforce that, if addressed, could contribute to improved health services. Importantly, the research has documented, acknowledged, honoured and disseminated the voices of Aboriginal women, through the far reaching communication technology that is the Internet. Furthermore, the voices, concerns and conditions of remote maternity services providers were also documented and acknowledged. This workforce, often invisible and poorly valued, was assisted and supported to provide evidenced based, culturally appropriate maternity care, through the resources that were developed. To further progress the lessons taken from the research, recommendations have been developed and are listed in the Conclusion.
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