Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial

Abstract

Background There is an urgency to redress unacceptable maternal and infant health outcomes for First Nations families in Australia. A multi-agency partnership between two Aboriginal Community-controlled health services and a tertiary hospital in urban Australia designed, implemented, and evaluated the new Birthing in Our Community (BiOC) service. In this study, we aimed to assess and report the clinical effectiveness of the BiOC service on key maternal and infant health outcomes compared with that of standard care. Methods Pregnant women attending the Mater Mothers Public Hospital (Brisbane, QLD, Australia) who were having a First Nations baby were invited to receive the BiOC service. In this prospective, non-randomised, interventional trial of the service, we specifically enrolled women who intended to birth at the study hospital, and had a referral from a family doctor or Aboriginal Medical Service. Participants were offered either standard care services or the BiOC service. Prespecified primary outcomes to test the effectiveness of the BiOC service versus standard care were the proportion of women attending five or more antenatal visits, smoking after 20 weeks of gestation, who had a preterm birth (<37 weeks), and who were exclusively breastfeeding at discharge from hospital. We used inverse probability of treatment weighting to balance confounders and calculate treatment effect. This trial is registered with the Australian New Zealand Clinical Trial Registry, ACTRN12618001365257.

He Tamariki Kokoti Tau: Families of Indigenous Infants Talk about Their Experiences of Preterm Birth and Neonatal Intensive Care

“…This is what quietens the ‘storm’ and returns whānau to a sense of calm, through the reclamation of their environment. This can be likened to the concept of Birthing on Country, a culturally safe model of maternity care in Australia, which shows great potential for enacting these principles to translate into health gains for Indigenous families, including reducing rates of preterm birth [ 36 , 38 ]. In this study, health practitioners who created space for Māori to be as Māori when experiencing preterm birth—by respecting whānau knowledge, involving, encouraging, and being welcoming—helped whānau conserve their energy for what was important to them, i.e., being there for their precious newborn gift.…”

“…Ultimately, culturally safe care is best evidence care [38,57,65,66]. Challenging the NICU to ensure this is a fundamental right and upskilling staff to ensure this occurs always, with all care, should be mandated, such as from the national Newborn Clinical Network (clinical leadership for newborn services).…”

“…While these issues are also reported in neonatal research without an Indigenous focus in Aotearoa [ 20 , 21 , 22 , 23 , 24 , 25 ] and internationally [ 26 , 27 , 28 , 29 , 30 , 31 ], Māori whānau also often describe maternal, neonatal, and paediatric care systems that are not culturally responsive [ 19 , 32 , 33 ]. Research with Indigenous women in other high-income settler-colonial nation states has identified similar birthing issues [ 34 , 35 , 36 , 37 , 38 ].…”

Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives

“…Maternity care partnership models – where Aboriginal health practitioners and (Indigenous and non-Indigenous) midwives work together with other health services to provide care during pregnancy and the early post-partum – have consistently demonstrated improved outcomes [ 43 44 64 65 ]. These models draw on Birthing on Country principles, described as ‘…a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families’ which provide an integrated, holistic and culturally appropriate model of care [ 66 ].…”

A better start to life: Risk factors for, and prevention of, preterm birth in Australian First Nations women – A narrative review

“…Multiple non‐randomized studies have reported reductions in PTB when models of care for pregnancy and birthing were specifically designed to meet the needs of First Nations families 67‐71 . Continuity of midwifery care, and care provision outside the hospital, were key factors guiding service redesign 68,72 .…”