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Introduction

Beyond clinical issues, social determinants of health play a significant role in the health and well-being of mothers, newborns, and families (Beck et al., 2020). This essay examines two crucial social variables and their significant effects on maternal, child, and family health through the case of Malabar Midwifery Service, ‘Birth on Country’. The essay also looks at typical obstetric procedures that can interfere with normal birthing and promotes methods to lessen their misuse. To encourage informed decision-making and improve maternal and newborn health outcomes, medical personnel such as midwives and child and family health nurses are essential in giving education, direction, and emotional support to women and their families. They play a crucial role in fostering comprehensive well-being by addressing the disparity between medical care and social determinants (Choi et al., 2020).

Social determinants of health

Access to healthcare services is one of the most essential socioeconomic determinants of health that significantly impacts maternal and newborn outcomes. Women who are Aboriginal and Torres Strait Islander and live in rural or remote areas of Australia are particularly affected by this problem. Numerous statistics and publications show that the difficulties people experience in receiving prenatal and postnatal care may result in serious repercussions (Sivertsen et al., 2020). Aboriginal and Torres Strait Islander women have higher rates of low-birth-weight kids, perinatal mortality and preterm birth than non-Indigenous women (Australian Institute of Health and Welfare [AIHW], 2021a). Access to healthcare services is restricted, which complicates these inequities. The AIHW also draws attention to the fact that Indigenous women are less likely to receive antenatal care in the initial phase of pregnancy, which is critical for monitoring and averting any issues (AIHW, 2021b). Initiatives rooted in the community, like the Malabar Midwifery Link program, have shown the potential to reduce these inequalities (Bradford et al., 2020).

McCalman et al. (2023) found that Indigenous women and babies fared better under community-led care models that included Indigenous midwives and medical specialists. These programs are effective because they strongly emphasise giving care that is considerate of cultural variances and provides services near home, removing the distance barrier. Aboriginal maternal and fetal outcomes are highly influenced by cultural and social determinants of health, such as psychosocial support, healthcare access, and quality. Geographic isolation and poor infrastructure make it difficult for many Aboriginal communities to access healthcare services, which delays prenatal treatment and raises the dangers associated with pregnancy (Coast et al., 2014). Additionally, the standard of healthcare services offered to Indigenous mothers frequently falls short due to problems, including prejudice, cultural insensitivity, and language obstacles, which discourage people from obtaining critical care (Pozo-Cano et al., 2014). Psychosocial support is also crucial since it guarantees expectant mothers access to mental healthcare facilities, adequate support and crucial prenatal care. Unfortunately, poorer mental health and lack of access to healthcare in Indigenous communities can harm a mother's health and fetal development (Allen et al., 2023). These discrepancies are highlighted by data from studies like the World Health Organisation, underscoring the critical need for culturally sensitive healthcare and all-encompassing psychosocial support to improve Aboriginal maternal mental health and fetal outcomes. Addressing these determinants is essential for achieving health equity within Aboriginal populations (Khan et al., 2023).

Obstetric Interventions

Several common obstetric interventions can potentially interfere with the normal process of labour and childbirth. While often necessary in certain medical situations, these interventions should be used judiciously to avoid unnecessary interference and support the natural course of labour (Beech, 1997). Induction of labour, for instance, can lead to more intense and frequent contractions, potentially increasing the pain and the risk of complications. Continuous Electronic Fetal Monitoring (EFM), though crucial in high-risk pregnancies, when used routinely in low-risk cases, may result in higher intervention rates (Roth, 2023). While offering effective pain relief, epidural analgesia can slow labour, often necessitating synthetic oxytocin to augment contractions and potentially leading to instrumental deliveries (Wray et al., 2023).

Though lifesaving in emergencies, Cesarean sections should be reserved for such situations, as their overuse can have severe implications for maternal and neonatal health (Moudi et al., 2019). Episiotomies, once routine, are now considered an intervention to be performed only when medically necessary (Falagario et al., 2023). Finally, vacuum extraction and forceps delivery, while useful in specific circumstances, carry the risk of injury to both the baby and the mother. Balancing medical intervention with natural childbirth support is crucial, particularly in low-risk pregnancies, to minimise undue interference and promote positive birth experiences (Bahl et al., 2023).

Approaches to Minimise Obstetric Interventions

Minimising obstetric interventions is crucial for ensuring safe and satisfying childbirth experiences. One highly effective approach is the continuous support doulas provide (World Health Organisation, 2018). A study by Sobczak et al. (2023) found that the presence of a doula during labour related to a substantial decrease in the likelihood of cesarean sections and the use of any analgesia or anesthesia. Doulas offer emotional and physical support, helping women manage pain and anxiety, which can reduce the perceived need for interventions (Lunda et al., 2018). The reduction of unneeded interventions is further aided by educated decision-making and birthing education (Kingdon et al., 2018). According to research by Abd El Aliem et al. (2020), knowledgeable pregnant parents are more likely to make decisions that are in line with their birth preferences, which reduces the need for interventions. In low-risk pregnancies, models of care such as midwifery-led care and birth centres have shown positive outcomes with lower intervention rates (Yu et al., 2020).

A study by Poškienė et al. (2021) found that midwifery-led care was related to a substantially decreased risk of episiotomy and instrumental vaginal birth compared to obstetrician-led care. Additionally, the promotion of physiological birth is essential. Research by Melo et al. (2020) demonstrates that providing an environment conducive to physiological labour, such as encouraging freedom of movement, hydrotherapy, and non-pharmacological pain management techniques, can help labour progress without needing medical interventions. Intermittent monitoring, as opposed to continuous electronic fetal monitoring, has been advocated by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) for low-risk pregnancies as it allows for greater mobility and reduces unnecessary interventions (RANZCOG, 2019).

Role of health professionals

Health professionals, particularly midwives and child and family health nurses, wield a multifaceted and indispensable role in educating women and their families across the spectrum of pregnancy, childbirth, and the postpartum period. Early in pregnancy, they play an educational function by giving pregnant mothers and their families a thorough awareness of the physical and psychological changes that come with pregnancy (Gray et al., 2014). This prenatal education covers various subjects, including prenatal care, nutrition, exercise, and delivery preparation. Families are given the tools to make wise decisions regarding their care, delivery choices, and early parenting techniques (Zinsser et al., 2020). These healthcare professionals' labour and delivery responsibilities go beyond standard clinical tasks. They develop into persistent mentors who provide unyielding emotional support, helpful advice on pain management approaches, and attentive labour progression monitoring (Feltham et al., 2016).

This ongoing presence guarantees that expectant mothers and their loved ones feel comfortable, informed, and heard, reducing anxiety and lowering the possibility of unneeded medical procedures. A more pleasant and natural childbirth experience can be fostered by this support (Salomonsson, 2018). Healthcare experts continue to be a dependable source of information and support when the journey enters the postpartum period. They provide advice on newborn care, such as feeding, sleep schedules, and infant hygiene, giving families the tools and information, they need to deal with the difficulties of new parenthood (Lindsay, 2020). Their knowledge of breastfeeding support is essential for encouraging effective nursing partnerships, which have numerous advantages for both the mother and the child. Their role requires them to be sensitive and culturally competent (Blixt et al., 2019). Lastly, to meet cultural preferences and habits, they modify their instructional materials and methodologies, fostering an inclusive healthcare atmosphere where every family feels respected and understood (Srivastava, 2022)

Conclusion

This essay's conclusion highlights the complex interrelationships between obstetric interventions, socioeconomic determinants of health, and the critical role that health professionals play in influencing the well-being of mothers, babies, and families. It highlights the pressing issue of healthcare access, particularly among marginalised populations like Indigenous communities in remote areas, and its significant impact on maternal and infant outcomes. By acknowledging cultural and social determinants of health and implementing community-based, culturally sensitive care models, we can work towards narrowing healthcare disparities and ensuring that every woman receives the care she deserves. Furthermore, the essay advocates for a balanced approach to obstetric interventions, emphasising the importance of minimising unnecessary medical interventions in low-risk pregnancies. The judicious use of interventions, the promotion of physiological birth, and informed decision-making can lead to more positive and satisfying childbirth experiences while prioritising safety. Finally, health professionals, particularly midwives and child and family health nurses, emerge as essential players in this holistic approach. Their multifaceted roles encompass education, emotional support, and cultural sensitivity, ensuring that expectant mothers and their families are well-prepared and supported throughout pregnancy, childbirth, and postpartum.

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