Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia – A comparative cohort study

Kildea, Sue; Gao, Yu; Rolfe, Margaret; Josif, Cathryn; Bar-Zeev, Sarah; Steenkamp, Malinda; Kruske, Sue; Williams, Desley; Dunbar, Terry; Barclay, Lesley

doi:10.1016/j.midw.2016.01.009

Cited by 63 publications

(37 citation statements)

References 40 publications

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“…12,15 In 2007, the authors were awarded an Australian National Health and Medical Research Council (NHMRC) grant aiming to improve outcomes for Aboriginal women and infants living in two remote communities in Northern Territory (NT), Australia. Key results are reported elsewhere 16,17 however, we found that PTB and LBW rates were some of the highest in Australia, which urged us to investigate the risk factors for PTB, LBW and small for gestational age (SGA) births for women in our study. We have used the international literature to shape health service recommendations.…”

Section: Introductionmentioning

confidence: 69%

“…This alone would impact on the availability of ANC, with our study finding that at times, the single community midwife was absent for several weeks at a time with not backfill. 17 The high burden of disease evident in our data would see many women still being advised to birth in the higher level services. However, you would expect this proportion to reduce over time as the birthing on country model works as a complex, protective intervention,as it has been shown to do in the remote Inuit communities.…”

Section: Sv Kildea Et Al / Women and Birth XXX (2016) Xxx-xxxmentioning

confidence: 77%

“…17,[23][24][25][26][27][28] In brief, the study was conducted in two purposively selected remote Aboriginal communities both of approximately 500 km from the regional centre. Although only one hour flight time to the regional centre, a priority one evacuation can take more than four hours to transfer women to the regional centre.…”

Section: Methodsmentioning

confidence: 99%

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Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

et al. 2017

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Objective: To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. Methods: The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. Results: The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. Conclusions: Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.© 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved. Statement of significance Problem or IssueAustralian Aboriginal population has significantly higher rate of preterm birth, low birthweight and small for gestational age birth, especially in rural and remote areas. What is Already KnownRisk factors of preterm births, low birthweight and small for gestational age births include social and demographic factors and medical factors. What this Paper AddsCompared to non-Aboriginal women or Aboriginal women in urban areas, similar risk factors for these events were identified in the remote dwelling Aboriginal women.

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Section: Introductionmentioning

confidence: 69%

Section: Sv Kildea Et Al / Women and Birth XXX (2016) Xxx-xxxmentioning

confidence: 77%

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Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

et al. 2017

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“…14 15,24 In Canada and Australia, indigenous women are transferred to more urbanized areas to await birth in an MWH. 20,23 In the United States, pregnant women who are homeless or substance dependent may be admitted to an MWH. 15 In France, MWHs exist for single, high-risk pregnant women.…”

Section: Characteristic Descriptionmentioning

confidence: 99%

Maternity Waiting Homes as Part of an Integrated Program for Maternal and Neonatal Health Improvements: Women's Lives Are Worth Saving

Vermeiden¹,

Stekelenburg²

2017

J Midwife Womens Health

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“…Twenty‐four per cent of Indigenous women who give birth each year live in remote and very remote Australia (versus 2% of non‐Indigenous women), highlighting the importance of services in these areas. Although there has been some improvement in pregnancy care in some communities, 32 empirical studies continue to report the challenges of providing maternity services in these areas, a lack of regular access to midwifery care and suboptimal quality of care caused by the lack of a systematic approach, appropriate clinical governance and cultural competence among health care providers 18 , 33 , 34 . One approach to solving this in some of the larger remote and very remote communities is to establish Birthing on Country sites.…”

Section: Priority 3: Dedicated Programs For “Birthing On Country”mentioning

confidence: 99%

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Kildea

Tracy

Sherwood

et al. 2016

Medical Journal of Australia

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The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

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Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia – A comparative cohort study

Cited by 63 publications

References 40 publications

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

Maternity Waiting Homes as Part of an Integrated Program for Maternal and Neonatal Health Improvements: Women's Lives Are Worth Saving

Improving maternity services for Indigenous women in Australia: moving from policy to practice

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