Translating evidence into practice: Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia

Helen L McLachlan, Michelle Newton, Fiona E McLardie-Hore, Pamela McCalman, Marika Jackomos, Gina Bundle, Sue Kildea, Catherine Chamberlain, Jennifer Browne, Jenny Ryan, Jane Freemantle, Touran Shafiei, Susan E Jacobs, Jeremy Oats, Ngaree Blow, Karyn Ferguson, Lisa Gold, Jacqueline Watkins, Maree Dell, Kim Read, Rebecca Hyde, Robyn Matthews, Della A Forster, Helen L McLachlan, Michelle Newton, Fiona E McLardie-Hore, Pamela McCalman, Marika Jackomos, Gina Bundle, Sue Kildea, Catherine Chamberlain, Jennifer Browne, Jenny Ryan, Jane Freemantle, Touran Shafiei, Susan E Jacobs, Jeremy Oats, Ngaree Blow, Karyn Ferguson, Lisa Gold, Jacqueline Watkins, Maree Dell, Kim Read, Rebecca Hyde, Robyn Matthews, Della A Forster

Abstract

Background: Strategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service.

Methods: A prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020.

Findings: The model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model.

Interpretation: Key enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas.

Funding: Partnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.

Keywords: First nations; Implementation science; Midwifery.

Conflict of interest statement

We declare there are no competing interests.

© 2022 The Author(s).

Figures

Figure 1
Figure 1
Baggarrook Yurrongi project timeline. NB- Women's (Royal Women's Hospital), Mercy (Mercy Hospital for Women, Joan Kirner (Joan Kirner Women's and Children's Hospital. EFT-Equivalent fulltime.
Figure 2
Figure 2
Pregnancy care pathway for women having a First Nations baby. *Accepted, but had not had first appointment when data collection ceased: n = 12.*
Figure 3
Figure 3
Number of women having a First Nations baby who received caseload (before and after program implementation). Before program implementation – blue; after program implementation – green.

References

    1. Australian Government. National Aboriginal Torres Strait Islander Health Plan 2013–2023. Canberra: Commonwealth of Australia; 2013.
    1. Commonwealth of Australia. Closing the gap Prime Minister's Report. In: Department of the Prime Minister and Cabinet, editor. Canberra; 2020.
    1. Australian Institute of Health and Welfare. Australia's Mothers and Babies. Canberra; 2021.
    1. Jongen C., McCalman J., Bainbridge R., Tsey K. Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings. BMC Pregnancy Childbirth. 2014;14:251.
    1. Department of Health. Woman-centred care: strategic directions for Australian maternity services, In: COAG Health Council, editor. 2019.
    1. Department of Health. Koolin Balit, Victorian government strategic directions for aboriginal health 2012–2022. Melbourne: State of Victoria; 2012.
    1. Department of Health and Human Services. Korin Korin Balit-Djak Aboriginal Health, wellbeing and safety strategic plan 2017–2027. Melbourne, 2017.
    1. Barclay L., Kruske S., Bar-Zeev S., et al. Improving Aboriginal maternal and infant health services in the 'Top End' of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change. BMC Health Serv Res. 2014;14:241.
    1. Bertilone C., McEvoy S. Success in closing the gap: favourable neonatal outcomes in a metropolitan Aboriginal Maternity Group Practice Program. Med J Aust. 2015;203(6):262. e1-7.
    1. Kildea S., Gao Y., Hickey S., et al. Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial. Lancet Glob Health. 2021;9(5):e651–e6e9.
    1. Corcoran P.M., Catling C., Homer C.S. Models of midwifery care for Indigenous women and babies: a meta-synthesis. Women Birth. 2017;30(1):77–86.
    1. Hickey S., Roe Y., Gao Y., et al. The Indigenous Birthing in an Urban Setting study: the IBUS study: a 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, Australia. BMC Pregnancy Childbirth. 2018;18(1):431.
    1. Kildea S., Gao Y., Rolfe M., et al. Remote links: redesigning maternity care for Aboriginal women from remote communities in Northern Australia – a comparative cohort study. Midwifery. 2016;34:47–57.
    1. McLachlan H., Forster D., Davey M., et al. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG. 2012;119(12):1483–1492.
    1. Forster D.A., McLachlan H.L., Davey M.A., et al. Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth. 2016;16:28.
    1. Tracy S.K., Hartz D.L., Tracy M.B., et al. Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. Lancet. 2013;382(9906):1723–1732.
    1. Sandall J., Soltani H., Gates S., Shennan A., Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016;4
    1. Dawson K., McLachlan H., Newton M., Forster D. Implementing caseload midwifery: exploring the views of maternity managers in Australia - a national cross-sectional survey. Women Birth. 2016;29(3):214–222.
    1. Brown S.J., Weetra D., Glover K., et al. Improving Aboriginal women's experiences of antenatal care: findings from the Aboriginal families study in South Australia. Birth. 2015;42(1):27–37.
    1. Sivertsen N., Anikeeva O., Deverix J., Grant J. Aboriginal and Torres Strait Islander family access to continuity of health care services in the first 1000 days of life: a systematic review of the literature. BMC Health Serv Res. 2020;20(1):829.
    1. Middleton P., Bubner T., Glover K., et al. Partnerships are crucial': an evaluation of the Aboriginal Family Birthing Program in South Australia. Aust N Z J Public Health. 2017;41(1):21–26.
    1. Kildea S., Hickey S., Barclay L., et al. Implementing birthing on country services for aboriginal and Torres Strait Islander families: RISE framework. Women Birth. 2019;32(5):466–475.
    1. Kildea S., Tracy S., Sherwood J., Magick-Dennis F., Barclay L. Improving maternity services for Indigenous women in Australia: moving from policy to practice. Med J Aust. 2016;205(8):374–379.
    1. National Health and Medical Research Council . National Health and Medical Research Council; Canberra: 2018. Ethical Conduct in Research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for Researchers and Stakeholders.
    1. Martin K., Mullan Z., Horton R. Overcoming the research to policy gap. Lancet Glob Health. 2019;7(Suppl 1):S1–S2.
    1. World Health Organization. Nine steps for developing a scaling-up strategy, 2010.
    1. Barclay L., Kornelsen J. The closure of rural and remote maternity services: where are the midwives? Midwifery. 2016;38:9–11.
    1. Longman J., Kornelsen J., Pilcher J., et al. Maternity services for rural and remote Australia: barriers to operationalising national policy. Health Policy. 2017;121(11):1161–1168.
    1. Hickey S., Couchman K., Stapleton H., Roe Y., Kildea S. Experiences of health service providers establishing an Aboriginal-Mainstream partnership to improve maternity care for Aboriginal and Torres Strait Islander families in an urban setting. Eval Program Plan. 2019;77
    1. Council of Australian Governments Health Council. Woman-Centred Care: Strategic Directions for Australian Maternity Services. Canberra ACT: Department of Health.

Source: PubMed

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