Improving birthing outcomes for First Nations families in Brisbane

The challenge in society the research addresses

Perinatal health inequities persist for First Nations people in Australia. Maternity care can be clinically and culturally unsafe for First Nations women and families. There is limited evidence available or successful and sustainable programs to rectify this, particularly in an urban setting.

In partnership with local Aboriginal community controlled health organisations and a large maternity hospital, the research team re-designed and evaluated a new model of maternity care that was trialed and poved successful in Canada and applied it to Aboriginal and Torres Strait Islander families in Brisbane, called Birthing On Country. Birthing on Country Services are services designed to meet the needs of First Nations families and communities to improve healthcare outcomes.

How the research is addressing the challenge

The IBUS study research team worked closely with industry partners who re-designed a new model of care for First Nations families in Brisbane South naming it the Birthing in Our Community'' service. The research team documented what worked well and what needed improving in a timely way so that partners could refine the service throughout the study period.

Key components of the Birthing in Our Community service include Indigenous governance, caseload midwifery, increased Indigenous workforce focused on family wellbeing and strength-based approaches to birthing and parenting, and improved cultural capability of the non-Indigenous workforce. This service has resulted in greater integration of care and support for families.

The real world benefit/change the research is creating

The team analysed routinely collected clinical data to track impact on health outcomes. We also analysed costing data to see whether the new service was cost-effective. We conducted longitudinal surveys with women accessing the new service and another service with over 600 families. We also conducted qualitative interviews with families and healthcare staff.

This new service saw a 50% reduction in preterm birth, less use of neonatal nursery, fewer planned cesareans and epidurals, increase in antenatal care attendence and more breastfeeding

Beneficiaries (and how they are benefiting)

The primary direct beneficiaries of the study are the service users: First Nations families using the Birthing in Our Community Service in South East Queensland. The results of the research also directly benefited the health industry partners who were able to engage in timely informed decision-making to improve the service. Indirect beneficiaries from the study include other health services and First Nations families in other communities who learn from our study findings and wish to implement similar services. Health service funders can also benefit from the study findings to inform decisions about funding clinically and cost-effective services for First Nations families.

Associated research that supports the research and change/benefits

The results from this study provide much needed evidence of the clinical effectiveness of a service designed to implement national Birthing on Country policy for the best start in life for First Nations babies in an urban setting. In five years, the IBUS study found that the new service resulted in an almost 40% reduction in preterm birth, an increase in the First Nations workforce and control over the funding and services. Women were less likely to have an elective caesarean section, epidural in labour, or have their babies admitted to the neonatal unit. Women attended earlier and more often for antenatal care, and breastfeeding rates increased. At this stage, it is difficult to say which elements of this complex intervention are essential and which could be done without. Synergistically, this combination of elements are driving improved outcomes, most likely by increasing cultural safety and driving early and frequent health engagement. Our team have developed the RISE framework to guide implementation that allows for customisation of the service to the local community context through a participatory action process: Re-design the health service, Invest in the Workforce, Strengthen families capacities, Embed First Nations leadership and control in all aspects of the service. This Framework has been widely popular across Australia, has been translated into Yolgnu Matha and is informing community-led health service changes for First Nations communities across the Top End NT and regional NSW. The IBUS study has been cited in policy documents including Qld Health’s (2019) Growing Deadly Families Aboriginal and Torres Strait Islander Maternity Services Strategy 2019-2025, a report to the Close the Gap Steering Committee (2019), and the Indigenous Evaluation Strategy by the Productivity Commission (2019). Media attention for this program of work has included SBS News, ABC local and national news, ABC Radio Health Report; NITV, local First Nations community radio services.

Additional information about the research

A community-based participatory action research approach facilitated the implementation of the new co-designed service. This meant we were able to work closely with industry partners to make changes to the Birthing in Our Community service in response to the needs of First Nations families throughout the study period. This was achieved by regularly presenting interim study findings to the Birthing in Our Community Steering Committee generated from our mixed-method design (longitudinal surveys with over 600 women, analysis of clinical data and qualitative interviews with women, families and staff).

Impact date	31 Jan 2001 → 31 Mar 2018
Category of impact	Cultural impacts, Other impacts
Impact Status	Benefit