Healthy Mums and Bubs - Birthing in Our Community (BiOC): Gold Standard Indigenous Maternal & Infant care

A successful Birthing in our Community program (BiOC) program has been established in one site and it is being scaled up to further 3 sites, with the health outcomes of mother-baby dyads being compared against the outcome of the original comparator site along with program acceptability. Therefore, the focus of the current study is to extend the reach of the BiOC program by expanding the service to three other sites (Logan, Bayside and Brisbane North) while continuing the original BiOC South comparator site/service, and follow cohorts of families to assess clinical outcomes and program acceptability up to three months postnatally. Background: Initially established in 2013 in the south of Brisbane (QLD, Australia) by the Institute for Urban Indigenous Health (IUIH), together with its partner organisation - the Mater Mothers Hospital, BiOC is an Aboriginal and Torres Strait Islander-designed and led maternity care and family support program, The BiOC program now provides services across Southeast Queensland at 3 additional sites (the intervention) for pregnant women with Aboriginal and Torres Strait Islander babies access to a midwife, family support worker and multidisciplinary team for the duration of their pregnancy and birth and post-partum. BiOC core elements include: - access to a birthing facility, specialist obstetric services, outreach (allied health) services, and social health services (social work, psychology, parenting support, support with child safety matters) – Intrapartum care is provided in partnering birthing facilities. - Community-based hubs facilitate access to antenatal and postnatal care in a culturally safe environment: Parenting and cultural support are integrated into all elements of the services with the Community Hub offering a ‘no wrong door’ and ‘one stop shop’ approach to service delivery. - Visiting and/or resident on-site services may include obstetric and gynaecological services, sexual and reproductive health, adult allied health including physiotherapy, exercise physiology, dietician, and diabetes educator; psychosocial services including social worker, perinatal psychologist, and counselling services; and paediatric medical, allied health and early childhood learning services. - Continuity of Aboriginal and Torres Strait Islander Family Support Workers (FSW): the FSW works alongside the woman’s primary midwifery carer to connect, engage and retain families in the program, gather psychosocial information, identify strengths and needs, assist families to access required services and supports, and advocate, as requested, on behalf of families. - Continuity of midwifery care including a known midwife during pregnancy (antenatal care), during birth and early parenting (postnatal care) for at least six weeks linked to the tertiary service with specialist support when needed. The midwives work between the community-based ACCHS-owned hub (for antenatal and postnatal care, education, and yarning groups), the hospital (for birthing and specialist care), and the woman’s home (for antenatal and post-natal follow-up care as determined by the woman and her care team). The LEWIS study has 3 separate components: 1) Quantitative Component: Quantitative comparisons of a prospective cohort of women and their families engaged in care across the four BiOC program sites. The data analysis under this component will cover the pregnancy, birthing, and postnatal periods and be focused on clinical and socio-emotional well-being outcomes. The exposure/intervention for this component will be the delivery of BiOC program and its elements. 2) Economic evaluation component: Routinely collected clinical outcomes and IUIH’s data on BiOC-related costs project expenditure data will be used for the cost-consequence analysis. The exposure/intervention for this component will be the economic cost involved in delivering the BiOC program and its elements. 3) Qualitative Component: Healing-informed, woman centred qualitative exploration of the acceptability and impact of the BiOC program among participating families and the feasibility of expanding BiOC for participating organisations including service staff. The exposure/intervention for this component will be the delivery of BiOC program and its elements. Duration and frequency of participant engagement with BiOC Elements: Frequency and engagement with BiOC services are determined on a needs-basis with consultation between client and service staff. Social health services are offered to BiOC families experiencing social complexities. Therefore, there are no universal frequency and duration benchmarks for these consultations. Antenatal appointment frequencies can vary depending on whether the pregnancy is considered complicated and can vary from 7-10 appointments. Clients also have the option to have their dedicated Family Support Practitioner join them in all their midwifery appointments. BiOC also offers home midwifery support up to 6 weeks post-birth, infant health checks, GP services, and dedicated family support. Overall duration of the intervention administration: BiOC started operating in 2013 and is being offered as an ongoing program (does not have a set end date for intervention administration). However, for the purpose of this study we will only be using the data spanning up to end of 2026 (with some variations between outcomes that are further detailed under the outcome variables section). Method of participant allocation: Participants self select by attending the study sites.