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The Art of Pregnancy

Platypus in the Waterhole by Megan Porter

Platypus in the Waterhole by Megan Porter, who participates in the Gomeroi gaaynggal ArtsHealth program. She says that the platypus is an important environmental indicator species for the health and state of the environment. It is only present when the quality of the water is clean as they are very sensitive to toxins. The two platypuses represent two healthy kidneys that have reached a healthy state of equilibrium within their watery environment.

By Kirsty Pringle & Kym Rae

Low birth weight affects one in eight indigenous Australian babies. To counter this and the ongoing health issues it causes, an art program is attracting pregnant indigenous women into a research project that also educates them and monitors their health.

Preterm birth and the delivery of babies who are small at birth are common complications of human pregnancy. Not only are they life-threatening events for mothers and their babies, but they also increase the susceptibility of the baby to cardiovascular disease, kidney disease and type 2 diabetes in later life.

These pregnancy complications are at least twice as common in Indigenous Australian women. For example, rates of early onset end-stage kidney disease are up to ten times higher in Indigenous communities. As a result, the current gap in life expectancy is passed to future generations of Indigenous Australians.

Many of these diseases are “programmed” in the mother’s womb, when the mother’s health and her external environment influence the developing organs of the foetus. Low birth weight is associated with an increased risk of coronary heart disease, hypertension, stroke and type 2 diabetes mellitus in adult life. The basis for this association is not entirely clear but it is thought that babies who are small at birth are more vulnerable to chronic disease because they have reduced function in key organs such as the kidney.

Small Indigenous babies have smaller kidneys than non-Indigenous babies of similar size. Since kidney size is correlated with the number of nephrons available in the kidney for waste filtration, individuals with a lower nephron number compensate for this by hyperfiltration, which predisposes them in later life to kidney failure. Thus low birth weight Indigenous babies are at higher risk of renal failure and hypertension, both of which are significant health issues for Indigenous adults.

The prevalence of preterm and low birth weight babies is twice as high in Indigenous women compared with non-Indigenous women (13% vs 6%). This is not surprising, as young Indigenous women often show early signs of impaired kidney function, have higher rates of obesity and diabetes, and often have poor nutrition. Other risk factors for poor pregnancy outcomes include high rates of cigarette smoking, drug and alcohol use, and high rates of infection, all of which will adversely impact on a pregnancy outcome and the long-term health of the infant.

The Gomeroi gaaynggal programs were established by The University of Newcastle to understand the developmental origins of disease in Indigenous women and their infants, and to improve birth outcomes and reduce the burden of disease. Much of the success of the research study has occurred by building a trusting relationship between the local Indigenous people and the research team through a community ArtsHealth program run by the Gomeroi gaaynggal program at a purpose-built centre.

The ArtsHealth program was developed through community consultation with the Elders, who support pregnancy health research in conjunction with health education for the community’s pregnant Indigenous women. Prior to the ArtsHealth program, the only antenatal education classes had been held in a private hospital setting, and this was considered intimidating and culturally inappropriate for young Indigenous women.

The Indigenous artists leading the art program collaborate with health professionals from the health services, private health providers, researchers and health students. Health knowledge is imparted in an informal way while art is created by both the mothers and the health professionals, with cultural knowledge shared at the same time. The project effectively guides Indigenous families into improved health behaviours, and assists in the development of a culturally appropriate health workforce.

Health disciplines covered in the education program include dietetics, physiotherapy, mental health, sexual health, population health, obstetrics and gynaecology, women’s health and child/family health. Importantly, the ArtsHealth program is facilitated by Aunty Pearl Slater, an Elder and Indigenous artist who works on artworks with the mothers each week. During their informal weekly art sessions, representatives from a variety of health areas (such as a midwife, a dietician and oral health specialist) may all attend the centre.

As renal disease is a serious problem for the Indigenous community, it has been a primary focus for health research and education in the ArtsHealth program. The health research is the world’s largest longitudinal cohort of pregnant Indigenous women to date.

The women, who were recruited during their pregnancy by a team of Indigenous researchers, are seen a number of times during their pregnancy, soon after the baby is born, and regularly until the baby is 5 years old. At each visit the mother undergoes a number of health screens, but her renal health is of particular interest. Additionally, her pregnancy ultrasounds monitor growth of the foetal kidneys. Checking the mother’s renal function continues after her pregnancy, and the infant’s urine is also tested.

Becoming a part of the research study allows each mother to have many of the pregnancy-related appointments in the culturally-rich environment of the Gomeroi gaaynggal Centre, including ultrasounds and obstetric appointments. Obstetricians have reported that the Gomeroi gaaynggal program has significantly reduced the number of women who haven’t undergone any antenatal care, increased the number of antenatal care visits and increased the number of women who are undertaking their pregnancy ultrasounds.

At many of the health research visits, mother share their own personal and family experiences of chronic disease, particularly kidney disease, and this has created ongoing discussions with those in the ArtsHealth program. Indigenous artists have worked with the mothers to develop their creative skills while improving their health knowledge.

One of these areas is in the area of kidney health. The Gomeroi gaaynggal team has ensured that the Centre celebrates Kidney Health Week each year, with many posters promoting strategies for keeping the kidneys healthy. The mothers helped to create a poster for the front of their household fridge that includes a checklist of small changes in diet, including removing salt and soft drinks from the diet and increasing water intake.

From these small promotional activities, the Indigenous artists of the team helped the mothers to generate a range of artworks that all relate to kidney health. Many of the artworks generated through the ArtsHealth program are related to cultural stories, motherhood and pregnancy, and all create a discussion point around which community members can engage in a dialogue to promote health and well-being in the Indigenous community.

The motto of the Gomeroi gaaynggal program is “Healthy mothers grow healthy babies and healthy babies grow into healthy communities”. Through the lessons learnt from the Gomeroi gaaynggal programs we are helping mothers to recreate a positive nurturing environment for their children, rich in culture with high levels of physical and mental well-being. These women are building the health knowledge of their families, encouraging them to live long, productive lives and to contribute to the culture of their communities.

Kirsty Pringle is a Research Fellow in the Mothers and Babies Research Centre at The University of Newcastle and the Hunter Medical Research Institute. Kym Rae is a Research Academic in the Department of Rural Health at The University of Newcastle, and the program coordinator for both the scientific research and ArtsHealth Gomeroi gaaynggal program.