RISE SAFELY in rural Australia - Redesigning maternity services for Aboriginal mothers and babies who are accessing care at Waminda South Coast Women’s Health and Wellbeing Aboriginal Corporation in Nowra, New South Wales, using Birthing on Country principles and the RISE implementation Framework, to address preterm birth and health outcomes: A prospective, non-randomised, intervention trial.

A 'Birthing on Country' service will be established at Waminda South Coast Women’s Health and Wellbeing Aboriginal Corporation in Nowra, New South Wales, a rural demonstration site. The new model is going to be ongoing from 2024. We will partner with key stakeholders through our community-based Participatory Action Research (PAR) approach to redesign a rural maternity service and increase support for Aboriginal women in both the primary and tertiary setting. The intervention is commenced at the first visit to the Minga Gudjaga midwifery service. Co-design and planning for the new model, including the development of operational plans, transitional plans, risk assessment, workshops has been happening for several years (during the previous study Building on our Strengths). Key components of the intervention include: - Multi-agency Partnership Committee providing culturally responsive overarching governance and leadership of redesign of maternity services and research, community engagement in co-designing the new model of care. - Service redesign will be overseen by the Birthing on Country Executive Steering Committee with members from Waminda, My Midwives and ISLHD; a Cultural and Clinical Governance Committee with members from Waminda, My Midwives and ISLHD and an internal Waminda BOC Implementation Steering Group. - Antenatal care is provided by Waminda’s Minga Gudjaga Midwifery Group Practice within the Minga Gudjaga Gunyah clinic, the woman’s home or hospital environment, and in the future this will be located at the Gudjaga Gunyahlamai Birth Centre. - Aboriginal Health Practitioners will provide continuity of care, cultural and clinical support across the antenatal, intrpartum and postnatal engagement. - Antenatal care using Aboriginal knowledges will be co-designed to address modifiable preterm risk factors. - Midwives follow the National Midwifery Guidelines for Consultation and Referral. When women are Categorised as B (midwives consult with the obstetric staff at the hospital or GP at Waminda, depending on the condition). When women are Category C, midwives consult with the specialist at the hospital to plan a specialist antenatal appointment and ongoing care at Shoalhaven District Memorial Hospital (SDMH) however women will continue to receive continuity of care by their named midwife and receive specialist input as required (E.g. diabetes educator). Women have 24/7 phone access to a known Waminda midwife. - Minga Gudjaga Midwives will collaborate with a nominated O&G Consultant within the Minga Gudjaga Gunyah clinic and in the future the Gudjaga Gunyahlamai Birth Centre. - An Aboriginal Community Controlled Midwifery Group Practice that employs Endorsed Midwives will be established at Waminda. This will establish and embed a unique model of continuity of maternity care that sits within the service provision and model of care within Waminda. - After birth, when the women and baby return to the community, the primary midwife and Waminda support services provide postnatal care for up to 6-weeks after which time Waminda’s early childhood services continue care. - Waminda uses Communicare, which is a community-based system of formal clinical communication, which differs from the existing systems within SDMH. This places a communication burden on the midwives as they will be required to document in two communication systems. - Women are referred to Waminda support services in line with guidelines. Aim is to recruit and embed 1-2-student midwives into this service. - Aboriginal health practitioner embedded within the model will be the first point of contact within the maternity journey for all women. - Transport officer for women who require assistance. - Frontline staff are provided with clinical mentoring and reflective supervision with a focus on clinical and cultural safety, effective intercultural communication, and working together. - The Wiyana Yanaga (Cultural Framework) is the foundation of Waminda. Informing this is the Waminda Cultural Committee, made up of local Aboriginal women who represent many family bloodlines who guide and inform all practices and protocols at Waminda. - The Birthing on Country Manager providing cultural and operational leadership. - Non-Aboriginal staff attend monthly ‘Imperfect Allies’ groups to support continual self-reflection of their white privilege to ensure they are working safely with Koori staff and clients. - A community-based hub provides a culturally responsive and safe place for women, families, caregivers and Elders to undertake cultural activities that allow connection, sharing and learning from each other within a strength-based approach to birthing and parenting. Monthly drop in. - Aboriginal women and their babies are offered cultural ceremonies after the birth of their baby. - Support from Waminda programs, including family restoration and preservation services, diabetes educator, exercise physiologist, health and wellbeing services, healing programs, general case management.