Culturally safe and trauma-free maternity care requires more than cultural sensitivity—it demands compassionate, responsive care that actively listens and adapts to the needs of First Nations families. Yet, the Australian health system continues to fall short, leaving many families feeling marginalised and deeply distressed.

Nina Sivertsen, Associate Professor in Nursing at Flinders University and the Arctic University of Norway, focuses her research on the impacts of colonisation and assimilation on women’s health. Her work emphasises integration of cultural safety into mainstream healthcare, aligning with a recent project led by Flinders’ Caring Futures Institute in partnership with the Southern Adelaide Local Health Network (SALHN).

Following consumer feedback and SALHN’s commitment to improving First Nations maternity care, Sivertsen led a cross-cultural research team comprising Aboriginal and Torres Strait Islander researchers, a consumer advocate, and non-Indigenous colleagues, all with expertise in clinical nursing, midwifery, Indigenous health, and research. Their collaboration fostered trust, honoured Indigenous knowledge systems, and embedded community priorities throughout the project.

An initial scoping review explored Indigenous women’s dissatisfaction with birthing experiences in mainstream hospitals across Australia, Aotearoa, Canada, the US, Kalaallit Nunaat, and Sápmi. Drawing on insights from 1,437 women, 36 Elders, 14 fathers and family members, and 91 healthcare professionals, the review revealed widespread distress and unmet needs. These findings underscore the importance of culturally safe care that meets both physical and emotional needs, reduces postpartum mental health issues, and improves outcomes for mothers and babies. The research challenges the myth of health equity—systems cannot fix what they refuse to face.

The resulting Mums and Bubs project found alarming outcomes, with the results set to be published soon.

“Many First Nations women we spoke with described feeling unheard, disrespected, and powerless within a mainstream health system that often fails to recognise their cultural identity,” says Associate Professor Sivertsen.

“Racism, stereotyping, and discrimination were common themes. It’s not enough for nursing and midwifery staff to claim they treat all women the same—because that approach ignores what is culturally appropriate for First Nations women, wherever they are in the world.”

“First Nations women carry a heavy colonial load when navigating mainstream maternity care – an often-invisible burden that includes explaining cultural practices, facing systemic racism, and enduring power imbalances. Many spoke of being excluded from decisions about their own care, revealing deep mistrust and a strong desire for culturally safe, compassionate support. Their experiences highlight the urgent need for more Aboriginal Health Workers and Midwives, and for Indigenous leadership to drive meaningful change.”

Pan-Indigenous collaboration is vital to transforming healthcare systems. Sharing knowledge across First Nations cultures strengthens advocacy, builds solidarity, and drives meaningful change. As an Arctic Indigenous Sea-Sámi woman, Sivertsen brings a unique global perspective to First Nations health, bridging communities across continents to challenge colonial structures in maternity care.

Research involving Indigenous communities has traditionally been dominated by Western methodologies, often marginalising Indigenous perspectives. In response, the team explored existing First Nations data analysis methods and, in their absence, developed a novel Indigenous approach to ensure cultural continuity and culturally relevant findings. This method supported both Aboriginal and non-Aboriginal team members in building research capacity and deepening cultural understanding.

The four-step process included: (1) Collaborative Research Process, (2) Identifying Cultural Patterns, (3) Decolonising Interpretation, and (4) Knowledge Exchange Yarns – enabling consensus grounded in Indigenous ways of knowing.

Co-researching across academic and clinical research spaces presented practical challenges. Associate Professor Sivertsen emphasises the importance of creating environments grounded in two-way learning and truth-telling.

“Having early career researchers Tahlia Johnson and Tara Struck involved, plus clinical staff Shanamae Davies and consumer voice Larissa Taylor, helped build a team that invited trust and enabled open, honest conversations about problems and possible solutions,” she says.

The Mums and Bubs project exemplifies inclusive research capacity building, with both academic and clinical early career researchers contributing. Professor Annette Briley and Dr Susan Smith further strengthens the team by mentoring SALHN research midwife Jaclyn Davey.

The Mums and Bubs research also revealed that while many non-Indigenous nurses and midwives genuinely want to support First Nations women in culturally appropriate ways, they often lack the tools and understanding to do so. With over 98% of the nursing and midwifery workforce in Australia being non-Indigenous, it is critical that this majority take active responsibility for improving cultural safety in their practice.

What is required to improve care? “Cultural safety is not a simple recipe,” Associate Professor Sivertsen explains. “It’s about creating an environment where First Nations women are heard, respected, and supported—not just medically, but culturally and spiritually. Care is built through mutual trust. This alleviates trauma and leads to better health outcomes for mothers and babies.”

Despite ongoing professional development efforts, evidence shows that First Nations families are still not consistently receiving culturally safe care. Associate Professor Sivertsen says this highlights an urgent need for further research into why current cultural safety training is falling short.

“We must work collaboratively with the non-Indigenous workforce to reimagine the way cultural safety education is delivered—embedding a deeper understanding of the colonial load that First Nations women carry in maternity care, and ensuring all healthcare professionals are equipped to provide respectful, culturally responsive support.”

“We have to take these steps to ensure positive changes for all First Nations women that translate to more appropriate mainstream healthcare—in Australia and globally.”