Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial

Sue Kildea, Yu Gao, Sophie Hickey, Carmel Nelson, Sue Kruske, Adrian Carson, Jody Currie, Maree Reynolds, Kay Wilson, Kristie Watego, Jo Costello, Yvette Roe

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Abstract

Background 
There is an urgency to redress unacceptable maternal and infant health outcomes for First Nationsfamilies in Australia. A multi-agency partnership between two Aboriginal Community-controlled health services anda tertiary hospital in urban Australia designed, implemented, and evaluated the new Birthing in Our Community(BiOC) service. In this study, we aimed to assess and report the clinical effectiveness of the BiOC service on keymaternal and infant health outcomes compared with that of standard care. 
Methods 
Pregnant women attending the Mater Mothers Public Hospital (Brisbane, QLD, Australia) who were havinga First Nations baby were invited to receive the BiOC service. In this prospective, non-randomised, interventional trialof the service, we specifically enrolled women who intended to birth at the study hospital, and had a referral from afamily doctor or Aboriginal Medical Service. Participants were offered either standard care services or the BiOCservice. Prespecified primary outcomes to test the effectiveness of the BiOC service versus standard care were theproportion of women attending five or more antenatal visits, smoking after 20 weeks of gestation, who had a pretermbirth (<37 weeks), and who were exclusively breastfeeding at discharge from hospital. We used inverse probability oftreatment weighting to balance confounders and calculate treatment effect. This trial is registered with the AustralianNew Zealand Clinical Trial Registry, ACTRN12618001365257. 
Findings 
Between Jan 1, 2013, and June 30, 2019, 1867 First Nations babies were born at the Mater Mothers PublicHospital. After exclusions, 1422 women received either standard care (656 participants) or the BiOC service(766 participants) and were included in the analyses. Women receiving the BiOC service were more likely to attendfive or more antenatal visits (adjusted odds ratio 1·54, 95% CI 1·13–2·09; p=0·0064), less likely to have an infantborn preterm (0·62, 0·42–0·93; p=0·019), and more likely to exclusively breastfeed on discharge from hospital(1·34, 1·06–1·70; p=0·014). No difference was found between the two groups for smoking after 20 weeks of gestation,with both showing a reduction compared with smoking levels reported at their hospital booking visit.
Interpretation
This study has shown the clinical effectiveness of the BiOC service, which was co-designed bystakeholders and underpinned by Birthing on Country principles. The widespread scale-up of this new service shouldbe prioritised. Dedicated funding, knowledge translation, and implementation science are needed to ensure all FirstNations families can access Birthing on Country services that are adapted for their specific contexts.

Original languageEnglish
Pages (from-to)e651-e659
Number of pages9
JournalThe Lancet Global Health
Volume9
Issue number5
Early online date17 Mar 2021
DOIs
Publication statusPublished - May 2021

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