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

doi:10.1016/S2214-109X(21)00061-9

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

CDU College of Nursing and Midwifery

Research output: Contribution to journal › Article › peer-review

67 Downloads (Pure)

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 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	https://doi.org/10.1016/S2214-109X(21)00061-9 https://doi.org/10.1016/S2214-109X(21)00061-9
Publication status	Published - May 2021

Access to Document

361043296-oaFinal published version, 524 KBLicence: CC BY-NC-ND

Cite this

Kildea, S., Gao, Y., Hickey, S., Nelson, C., Kruske, S., Carson, A., Currie, J., Reynolds, M., Wilson, K., Watego, K., Costello, J., & Roe, Y. (2021). Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial. The Lancet Global Health, 9(5), e651-e659. https://doi.org/10.1016/S2214-109X(21)00061-9, https://doi.org/10.1016/S2214-109X(21)00061-9

@article{baabbeb0086345f493900be47ef312e1,

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

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.InterpretationThis 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.",

keywords = "maternity, midwifery, health services research, co-design, First Nations, Aboriginal and Torres Strait Islander, Birthing on Country, intervention, Prospective, smoking in pregnancy, preterm birth, breastfeed, child mortality, Aboriginal Community Controlled Health Services, the Indigenous Birthing in an Urban Setting (IBUS) study",

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

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: {\textcopyright} 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.",

year = "2021",

month = may,

doi = "10.1016/S2214-109X(21)00061-9",

language = "English",

volume = "9",

pages = "e651--e659",

journal = "The Lancet Public Health",

issn = "2214-109X",

publisher = "The Lancet Publishing Group",

number = "5",

}

Kildea, S , Gao, Y, Hickey, S, Nelson, C, Kruske, S, Carson, A, Currie, J, Reynolds, M, Wilson, K, Watego, K, Costello, J & Roe, Y 2021, 'Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial', The Lancet Global Health, vol. 9, no. 5, pp. e651-e659. https://doi.org/10.1016/S2214-109X(21)00061-9, https://doi.org/10.1016/S2214-109X(21)00061-9

TY - JOUR

T1 - Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians

T2 - a prospective, non-randomised, interventional trial

AU - Kildea, Sue

AU - Gao, Yu

AU - Hickey, Sophie

AU - Nelson, Carmel

AU - Kruske, Sue

AU - Carson, Adrian

AU - Currie, Jody

AU - Reynolds, Maree

AU - Wilson, Kay

AU - Watego, Kristie

AU - Costello, Jo

AU - Roe, Yvette

N1 - 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.

PY - 2021/5

Y1 - 2021/5

N2 - 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.InterpretationThis 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.

AB - 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.InterpretationThis 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.

KW - maternity

KW - midwifery

KW - health services research

KW - co-design

KW - First Nations

KW - Aboriginal and Torres Strait Islander

KW - Birthing on Country

KW - intervention

KW - Prospective

KW - smoking in pregnancy

KW - preterm birth

KW - breastfeed

KW - child mortality

KW - Aboriginal Community Controlled Health Services

KW - the Indigenous Birthing in an Urban Setting (IBUS) study

UR - http://www.scopus.com/inward/record.url?scp=85104118606&partnerID=8YFLogxK

U2 - 10.1016/S2214-109X(21)00061-9

DO - 10.1016/S2214-109X(21)00061-9

M3 - Article

C2 - 33743199

AN - SCOPUS:85104118606

VL - 9

SP - e651-e659

JO - The Lancet Public Health

JF - The Lancet Public Health

SN - 2214-109X

IS - 5

ER -

Kildea S , Gao Y, Hickey S, Nelson C, Kruske S, Carson A 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. The Lancet Global Health. 2021 May;9(5):e651-e659. https://doi.org/10.1016/S2214-109X(21)00061-9, https://doi.org/10.1016/S2214-109X(21)00061-9

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

Abstract

Access to Document

Other files and links

Fingerprint

Cite this