None listed
Conditions
Brief summary
With persisting maternal and infant health disparities, new models of maternity care are needed to meet the needs of Aboriginal and Torres Strait Islander people in Australia. To date, there is limited evidence of successful and sustainable programs. Birthing on Country is an emerging evidence-based and community-led model of maternity care; the principles underpin a newly established service model: Birthing in Our Community. The Indigenous Birthing in an Urban Setting study is a mixed-methods prospective birth cohort study comparing different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland. It includes women’s surveys (booking-in to model at~20 weeks gestation, 36 weeks gestation, two and six months postnatal) and infant assessments (two and six months postnatal), clinical outcomes and cost comparison, and qualitative interviews with women and staff. This study aims to evaluate the feasibility, acceptability, sustainability, effectiveness and efficiency of a Birthing on Country model of care for Aboriginal and Torres Strait Islander families in an urban setting. If successful, findings will inform implementation of the model with similar communities.
Interventions
Birthing in Our Community is a complex intervention designed to improve maternal and infant health outcomes for Indigenous families in an urban setting. Launched in 2013, Birthing in Our Community was developed in partnership between the Mater Mothers Hospital, and two local Aboriginal community-controlled health organisations: the Institute for Urban Indigenous Health and the Aboriginal and Torres Strait Islander Community Health Service Brisbane Ltd.
Key components of the intervention includ
Birthing in Our Community is a complex intervention designed to improve maternal and infant health outcomes for Indigenous families in an urban setting. Launched in 2013, Birthing in Our Community was developed in partnership between the Mater Mothers Hospital, and two local Aboriginal community-controlled health organisations: the Institute for Urban Indigenous Health and the Aboriginal and Torres Strait Islander Community Health Service Brisbane Ltd. Key components of the intervention include: • Indigenous governance (operating through a Steering Committee) functioning in accordance with Terms of Reference and underpinned by a MOU • A community-based Midwifery Group Practice (MGP), which provides continuity of carer to enrolled women throughout pregnancy, birth and up to six weeks postnatally. Care is provided according to hospital guidelines and protocols in the home, at community venues where regular cultural and education days are held, or in the hospital • 24/7 access to caseload midwife who works in MGP on annualised salary with each woman allocated a primary midwife. Midwife support during birthing is likely to be by a known midwife • Location for birth is the Birth Suite (no homebirth or Birth Centre services provided) • Indigenous Maternal Infant Health/ Family Support Workers and Indigenous student midwives work with the caseload midwives to provide culturally tailored care • Referral to Indigenous community support agencies as required; All women are offered a formal handover to child health services with other referrals as required (e.g. paediatric, allied health) • Clinical / cultural supervision for staff • Indigenous Liaison Officers are based in the hospital to strengthen culturally responsive care and support • Access to medical staff, allied health professionals, social workers, child safety officers and other professionals as required (e.g. Diabetic educator) • Discharge letter to referral doctor and referrals to community support agencies as required Referred to as Group 1, data collected Jul 2013 to Dec 2019
Sponsors
Prof Sue Kildea
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Healthy volunteers
Yes
Inclusion criteria
Women’s surveys, Tell My Story and Infant Assessments: Women are eligible to participate if they: • Identify as Aboriginal and/or Torres Strait Islander, or identify their baby as Aboriginal and/or Torres Strait Islander person; • Receive their maternity care through the Birthing in Our Community Program and are planning to birth at the MMH (Group 1); receive their maternity care through the Ngarrama Indigenous Maternity Service and are planning to birth at the RBWH (Group 4); receive standard maternity care and birth at the MMH or RBWH (Groups 2 & 5) and • Consent to participate. Infants are eligible if: • They are Aboriginal and Torres Strait Islander babies and their mothers received care through either of these programs and were recruited to the study. Staff are eligible to participate in the staff surveys, interviews and focus groups if they have been involved in the planning and/or provision of maternity care services for Aboriginal and Torres Strait Islander families in South East Queensland during the study period; and consent to participate.
Exclusion criteria
Women are not eligible to participate if they: • Have been transferred into the RBWH or the MMH from out of area for high-level specialist services or received no antenatal care.
Outcome results
None listed