The Murri clinic: a comparative retrospective study of an antenatal clinic developed for Aboriginal and Torres Strait Islander women

Abstract

BackgroundIndigenous Australians are a small, widely dispersed population. Regarding childbearing women and infants, inequities in service delivery and culturally unsafe services contribute to significantly poorer outcomes, with a lack of high-level research to guide service redesign. This paper reports on an Evaluation of a specialist (Murri) antenatal clinic for Australian Aboriginal and Torres Strait Islander women.MethodsA triangulated mixed method approach generated and analysed data from a range of sources: individual and focus group interviews; surveys; mother and infant audit data; and routinely collected data. A retrospective analysis compared clinical outcomes of women who attended the Murri clinic (n=367) with Indigenous women attending standard care (n=414) provided by the same hospital over the same period. Both services see women of all risk status.ResultsThe majority of women attending the Murri clinic reported high levels of satisfaction, specifically with continuity of carer antenatally. However, disappointment with the lack of continuity during labour/birth and postnatally left some women feeling abandoned and uncared for. Compared to Indigenous women attending standard care, those attending the Murri clinic were statistically less likely to be primiparous or partnered, to experience perineal trauma, to have an epidural and to have a baby admitted to the Neonatal Intensive Care Unit, and were more likely to have a non-instrumental vaginal birth. Multivariate analysis found higher normal birth (spontaneous onset of labour, no epidural, non-instrumental vaginal birth without episiotomy) rates amongst women attending the Murri clinic.ConclusionsSignificant benefits were associated with attending the Murri clinic. Recommendations for improvement included ongoing cultural competency training for all hospital staff, reducing duplication of services, improving co-ordination and communication between community and tertiary services, and working in partnership with community-based providers. Combining multi-agency resources to increase continuity of carer, culturally responsive care, and capacity building, including creating opportunities for Indigenous employment, education, and training is desirable, but challenging. Empirical evidence from our Evaluation provided the leverage for a multi-agency agreement to progress this goal within our catchment area.

‘Choice, culture and confidence’: key findings from the 2012 having a baby in Queensland Aboriginal and Torres Strait Islander survey

“…Aboriginal and/or Torres Strait Islander women’s satisfaction with maternity care has been measured in a number of previous studies [22,23,33-35]. …”

Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

“…All studies but two were conducted in high-income, OECD-member countries: Australia ( n  = 6) (Nel and Pashen 2003; Jan et al 2004; NSW Health 2005; Panaretto et al 2005, 2007; Kildea et al 2012), the United States of America (USA) ( n  = 4) (Julnes et al 1994; Thompson et al 1998; Jewell and Russell 2000; Marsiglia et al 2010), the United Kingdom (UK) ( n  = 2) (Mason 1990; Parsons and Day 1992) and Israel ( n  = 1) (Bilenko et al 2007). The two exceptions were conducted in Peru (McQuestion and Velasquez 2006; Gabrysch et al 2009).…”

“…All studies from Australia targeted Indigenous, Aboriginal and Torres Islander Strait women (Nel and Pashen 2003; Jan et al 2004; NSW Health 2005; Panaretto et al 2005, 2007; Kildea et al 2012). Indigenous women were also the focus in one of the studies from Peru (Gabrysch et al 2009), and the study in Israel targeted semi-nomadic Bedouin women (Bilenko et al 2007).…”

Applying Collective Impact to Wicked Problems in Aboriginal Health

“…Yet health care systems across Australia continue to offer usual health care to Aboriginal people (Bar-Zeev et al, 2012;Gao et al, 2014;Kildea et al, 2012;Steenkamp et al, 2012). There are few examples of tailored services, most notably is the Aboriginal Community Controlled Health Services sector, which as the name implies, are governed by, trusted and utilized widely by Aboriginal people.…”

“…There is a considerable body of evidence that the mainstream health system is ineffective for Aboriginal people (Bar-Zeev et al, 2014;Kildea et al, 2012;Steenkamp et al, 2012) and that health services intended for Aboriginal people must be tailored in order to achieve sustained and measurable health improvements. Yet health care systems across Australia continue to offer usual health care to Aboriginal people (Bar-Zeev et al, 2012;Gao et al, 2014;Kildea et al, 2012;Steenkamp et al, 2012).…”