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.
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 language | English |
|---|---|
| Pages (from-to) | e651-e659 |
| Number of pages | 9 |
| Journal | The Lancet Global Health |
| Volume | 9 |
| Issue number | 5 |
| Early online date | 17 Mar 2021 |
| DOIs | |
| Publication status | Published - May 2021 |
Bibliographical note
Funding Information:We thank the First Nations families and all the staff who have contributed to, and participated in, the development of the BiOC service, particularly the members of the Steering Committee and the Indigenous Birthing in an Urban Setting investigators and research team. We would like to acknowledge all of the community researchers, particularly Kayla Heinemann and Sarah Maidment. The study was funded by the Australian National Health and Medical Research Council partnership (grant 1077036), and the service was funded by the Institute for Urban Indigenous Health, the Aboriginal and Torres Strait Islander Community Health Service Brisbane, and the Mater Mothers Hospital. Additional funding for service expansion was received from the Queensland Government, and for researchers' salaries from Charles Darwin University, Mater Research Institute, and the University of Queensland.
Funding Information:
The research team received an Australian National Health and Medical Research Council partnership grant, with the partner organisations funding delivery of the new health service, with additional funding from the Queensland Government to the Institute for Urban Indigenous Health (to AC, CN, and KWa) to expand health service delivery. SKi and YG were employed by Mater Research Institute and University Queensland, then Charles Darwin University during the course of the study. SH was employed by Mater Research Institute then Charles Darwin University. YR was employed by the Institute of Urban Indigenous Health, then Mater Research Institute, then Charles Darwin University, during the course of the study. CN, AC, JCu, KWa, and SKr were employed by Institute of Urban Indigenous Health, with JCu then employed by Aboriginal and Torres Strait Islander Community Health Service Brisbane, and SKr then employed by Charles Darwin University. MR, KWi and JCo were employed by Mater Hospital. Some of the National Health and Medical Research Council funding that supported the research contributed to salaries of YR, SH and YG. We declare no other competing interests.
Funding Information:
We thank the First Nations families and all the staff who have contributed to, and participated in, the development of the BiOC service, particularly the members of the Steering Committee and the Indigenous Birthing in an Urban Setting investigators and research team. We would like to acknowledge all of the community researchers, particularly Kayla Heinemann and Sarah Maidment. The study was funded by the Australian National Health and Medical Research Council partnership (grant 1077036), and the service was funded by the Institute for Urban Indigenous Health, the Aboriginal and Torres Strait Islander Community Health Service Brisbane, and the Mater Mothers Hospital. Additional funding for service expansion was received from the Queensland Government, and for researchers' salaries from Charles Darwin University, Mater Research Institute, and the University of Queensland.
Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
