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Haora P, Roe Y, Hickey S, Gao Y, Nelson C, Allen J, Briggs M, Worner F, Kruske S, Watego K, Maidment SJ, Hartz D, Sherwood J, Barclay L, Tracy S, Tracy M, Wilkes L, West R, Grant N, Kildea S. Developing and evaluating Birthing on Country services for First Nations Australians: the Building On Our Strengths (BOOSt) prospective mixed methods birth cohort study protocol. BMC Pregnancy Childbirth 2023; 23:77. [PMID: 36709265 PMCID: PMC9883816 DOI: 10.1186/s12884-022-05277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3-5 times more likely than other mothers to experience maternal mortality; babies are 2-3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements. METHODS Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation. DISCUSSION Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up. TRIAL REGISTRATION Australia & New Zealand Clinical Trial Registry # ACTRN12620000874910 (2 September 2020).
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Affiliation(s)
- Penny Haora
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Yvette Roe
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Darwin, Australia
| | - Sophie Hickey
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Yu Gao
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Carmel Nelson
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia ,grid.1003.20000 0000 9320 7537Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD Australia
| | - Jyai Allen
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Melanie Briggs
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Faye Worner
- Waminda South Coast Women’s Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW 2541 Australia
| | - Sue Kruske
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
| | - Kristie Watego
- grid.492300.cInstitute for Urban Indigenous Health, Cox Road, Windsor, QLD 4030 Australia
| | - Sarah-Jade Maidment
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Donna Hartz
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Juanita Sherwood
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Lesley Barclay
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Sally Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Mark Tracy
- grid.1013.30000 0004 1936 834XThe University of Sydney, Camperdown, NSW 2006 Australia
| | - Liz Wilkes
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,My Midwives Brisbane, Windsor Road, Red Hill, QLD 4059 Australia
| | - Roianne West
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia ,Congress of Aboriginal & Torres Strait Islander Nurses and Midwives, Lytton Road, Murarrie, QLD 4172 Australia
| | - Nerida Grant
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD 4000 Australia
| | - Sue Kildea
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Grevillea Drive, Sadadeen, NT 0870 Australia
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Barclay L, Kornelsen J. The closure of rural and remote maternity services: Where are the midwives? Midwifery 2016; 38:9-11. [PMID: 27046265 DOI: 10.1016/j.midw.2016.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 03/01/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
Decisions to close small maternity units in rural and remote communities have often precipitated a community response as women and families rally to save local services. But where are the midwives? We argue here that professional bodies such as colleges of midwives have a responsibility to advocate more strongly at a political level for evidence-based decisionmaking regarding the allocation of rural services. We suggest that adopting a comprehensive definition of maternity services risk that considers both social and health services risks and their impact on clinical risk, could provide a solid basis for effective advocacy by professional bodies.
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Affiliation(s)
- Lesley Barclay
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia.
| | - Jude Kornelsen
- Centre for Rural Health Research, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3.
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McIntyre MJ. Safety of non-medically led primary maternity care models: a critical review of the international literature. AUST HEALTH REV 2012; 36:140-7. [PMID: 22624633 DOI: 10.1071/ah11039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 08/16/2011] [Indexed: 11/23/2022]
Abstract
The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no difference in outcomes associated with low risk women in midwifery-led, birth centre and home birth models compared with standard hospital or obstetric care. These findings are limited to services involving qualified midwives working within rigorous exclusion, assessment and referral guidelines, limiting the number of urgent intrapartum transfers that come with increased risk of perinatal mortality.
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Affiliation(s)
- Meredith J McIntyre
- School of Nursing and Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, VIC 3199, Australia.
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