In 2011 Gunawirra introduced programs to treat dangers during pregnancy: In 2012 Gunawirra has combined this program with the Inner Suburbs Project –  Leadership for Young Aboriginal Women.

Pregnancy — the best time to start harm prevention

The proof of this is in the latest internationally recognised research demonstrating that the trajectory to success in life begins in pregnancy and in the early years.

Data continues to confirm that highly stressed pregnant women pass on high cortisol levels to their unborn babies, which has an immediate detrimental impact. For the young Aboriginal women we work with, the stress is often related to domestic violence, poverty, mental health issues and drug and alcohol abuse. Our Miller and Marrickville projects are created specifically to intervene during pregnancy on all above issues in order to give these women and their babies the best possible foundations. Below is an example of how we might educate our program parents on positively managing their pregnancies:

Saying “No” is very hard

Gunawirra’s Professor Julie Quinlivan tells us what the main things you need to say “no” to, to help you make your baby well and strong.

Say “No” to:

  • Smoking
  • Drugs
  • Alcohol
  • Domestic Violence
  • Heavy emotional stress

Say “Yes” to:

  • Regular check ups. Visiting the clinic can ensure that anything wrong can be picked up early and that is the best way to avoid disaster during pregnancy. The serious affects of Diabetes blood pressure and indeed any mental problems can be dealt with if known and understood.
  • Getting help if you have problems with domestic violence. Did you know that one attack and its effects on you can affect your cortisol levels in the womb and so seriously affect your baby’s capacity to grow?
  • Help with drug taking.
  • Getting off alcohol.
  • Taking folic acid and iron, if prescribed. Did you know folic acid prevents damage to your baby’s spine?
  • Having a good diet.
  • Seeking out a safe environment even if it means moving back in to your mother and father and eating a little humble pie.
  • Antenatal classes. They are a fund of information on breast feeding and the birth and all sorts of things.
  • Having blood tests. These check baby’s health in so many ways.
  • Having an ultrasound scan. This checks for size and can help identify other problems.
  • Visiting your doctor. Go when you are 14 – 26 weeks every month. 27 – 36 weeks every 2 weeks. Over 36 weeks every week.
  • Going to hospital or seeing your doctor if you have vaginal bleeding, abdominal pains, less movement by your baby, marked swelling of your body, and/or change in your eyesight.

Hard evidence

Allan N Schore is the world authority on the importance of early attachment and its protection as an intervention against future harm to the psyche. He also demonstrates that future harm is preventable if one concentrates on attachment and regulation between mother and infant. His skill is in the use of many professional approaches, including neurobiology and psychoanalysis. He was invited to address the Australian Federal Government on his visit here in 2002.

Schore’s 2001 University of California study observes “adaptive infant mental health is positively correlated with the ongoing development of attachment experiences over the first year.” Moreover his work proves that “regular affective interactions with a familiar, predictable primary caregiver create not only a sense of safety, but also a positively charged curiosity that fuels the burgeoning self’s exploration of novel socio-emotional and physical environments.” (Schore, 1994; Grossman, Grossman & Zimmerman, 1999). “This ability is a marker of adaptive infant mental health.”

Schore and other international experts including Perry, Trevarthon, Main, Fonagy and Target all present a plethora of further research and material to give evidence to this. What happens during pregnancy and the first three years of life lays the foundation for either life as a productive, contributing member of society or alternately intergenerational cycles of abuse (physical, emotional and sexual), neglect, violence, dysfunction and mental illness. The good news is that many of these problems can be prevented if social-emotional development during infancy and early childhood is both understood and fostered — through programs and services that support children and their families.

This is where Gunawirra comes in.

Time and time again, research demonstrates that factors that put children at risk of mental illness include: violence, intense family conflict, maternal psychiatric disorder, poverty, abuse and neglect. These factors are endemic in Aboriginal communities. If these at-risk children can be identified early, intervention and support can lead to better outcomes in terms of the emotional wellbeing of the child. In other words, supporting parents and young children at the earliest possible stage offers the best outcomes, because this is when treatment is most effective. “Early intervention services have been shown to produce a sustained improvement in children’s health, education and welfare.” (McCain & Mustard – Early Years Study: Reversing the Real Brain Drain – report to Canadian Government, 1999).

OUR PREGNANCY PROGRAM – Inner Suburbs of Sydney

 Beginning in April 2011, this program was working with 4 pregnant  Aboriginal women  in an intensive, on-going program. Many of our young teenage mothers to be have little knowledge of parenting or how to physically care for an infant. In 2012 we thought the right women to help our young pregnant mums was new mums themselves.

We still used the same techniques –  a psychodynamic approach in keeping with the latest parent-infant work in both the USA and UK, including the Tavistock Clinic’s Infant Observation method. Here our young mothers will have access to parenting programs, facilities of the RPA Aboriginal Maternity Unit, cooking classes, group and individual therapy, art groups and massage. We also coordinate with services for alcohol and drug abuse. Each mother receives weekly psychotherapy by one of Gunawirra’s highly trained professionals — each experienced in the local community, who are themselves supervised by a more senior professional.

Our experience has shown that pregnancy — for both the Aboriginal mother and father to be — brings up many traumatic emotions from their own childhoods, usually expressed in uncontrolled anger or anxiety, which they frequently try to erase or manage through drugs and/or alcohol — all of which increase cortisol levels in unborn babies.

If these feelings are merely felt, without being spoken about and understood with professionals specialising in this area, they pose great risks to the mother and unborn child, even without the abuse of substances. However our work demonstrates that when parents are given the opportunity to acknowledge, understand and work through those traumatic feelings and memories, it will allow them as a family to really embrace a new, healthy beginning, preventing harm to the unborn child and giving them a better start in life after birth,

By becoming aware of their own behaviours parents to be can recognise both the damage such parental behaviour did to them as children and the damage it is and will do to their own child. They then become ready to begin the step-by-step work to stop this cycle. No parent wants to harm their child. Gunawirra gives these mothers (and fathers, if present) the tools to start to become the parents they often wished they had and certainly would like to be. We provide all the practical and psychological assistance they need to take themselves out of harms way, in every sense.

Fetal Alcohol Spectrum Disorder

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term used to describe a range of disabilities and a continuum of effects that may arise from prenatal alcohol exposure and it is widely recognized as the most common preventable cause of birth defects and brain damage in children. FASD is not a clinical diagnosis in itself but represents a range of diagnoses that fall under the spectrum. These diagnoses are Fetal Alcohol Syndrome (FAS), partial Fetal Alcohol Syndrome (pFAS), Alcohol Related Neurodevelopmental Disorders (ARND) and Alcohol Related Birth Defects (ARBD). If doctors have not been specially trained to diagnose FASD, they may misdiagnose affected children with ADD/ADHD or Aspberger Disorder.

How much alcohol is safe during pregnancy?

Alcohol is a teratogen and a neurotoxin i.e. an agent that is known to adversely affect fetal development and cause birth defects and brain damage.  Alcohol crosses the placenta freely and produces equivalent concentrations in fetal circulation to that in the mother.

Researchers do not know how much alcohol, if any, is safe to drink during pregnancy and there is also no safe time for consuming alcohol.  What they do know is the risk of damage increases the more you drink and that binge drinking is especially harmful.

So less alcohol is better but even small amounts may cause changes to the developing brain so no alcohol is the safest choice for a healthy pregnancy.

Please don’t be alarmed if you are already pregnant and have been drinking small amounts of alcohol – the risk to your baby is low and stopping drinking at any time increase your chances of a healthy pregnancy.  If you don’t think you can stop drinking it is important to ask for help and discuss your alcohol intake with your doctor or midwife.  It is also important to get good antenatal care, take folic acid and have a healthy diet.

Diagnosis and Prognosis

FASD is a lifetime disability. It is not curable, however early diagnosis and appropriate interventions can make an enormous difference to the life of the person with the disability.