The effect of culturally tailored continuity of midwifery care on perinatal outcomes for women having a first Nations baby in Victoria, Australia: a prospective non-randomised translational study

Background
Perinatal morbidity and mortality are substantially higher for Aboriginal and Torres Strait Islander (hereafter called First Nations) mothers and babies compared with non-First Nations peoples. Women birth in systems designed and informed by Western values, and many report negative interactions with health professionals and a lack of cultural safety in the mainstream maternity system. To redress unacceptable health outcomes and system challenges, we implemented a culturally tailored caseload midwifery care programme called Baggarrook Yurrongi, at three tertiary maternity services in Melbourne, Australia. The model included continuity throughout pregnancy, labour, birth and the early postnatal period, recognition of culture as central to identity, and respecting and acknowledging the cultural background, beliefs and values of First Nations peoples. This paper describes maternal and infant health outcomes.

Methods
This prospective non-randomised translational study used routinely collected clinical outcome data to explore whether, for women expecting a First Nations baby, receiving the new model was associated with improved clinical outcomes compared with usual care prior to and since implementation (adjusted for age, Body Mass Index, marital status, parity, diabetes and hypertensive disorders). Specifically, would the model decrease the proportion of First Nations babies born low birthweight (<2500 g) and increase the proportion born ‘healthy’ (alive, at term, of normal weight and size, and not admitted to neonatal special or intensive care (NICU)). All births were included except multiple pregnancies, where babies had major congenital anomalies, and births occurring within the first six months of model implementation.

Findings
Baseline data were from 2012 to model commencement (2017) (99,952 non-First Nations and 1159 First Nations births). ‘After’ data were collected to 2022 (62,499 non-First Nations and 1038 First Nations births), and 669/1038 eligible women (64.5%) received the Baggarrook Yurrongi model. Fewer First Nations babies whose mothers received the model compared with those who received usual care ‘Before’ were low birthweight (AOR 0.67, 95% CI 0.47, 0.93) and more were born ‘healthy’ (AOR 1.45, 95% CI 1.14, 1.84).

Interpretation
Culturally tailored caseload midwifery care significantly improved perinatal outcomes for women and their First Nations babies. Given poor perinatal outcomes are major risk factors affecting short- and long-term health, we recommend widespread model implementation, adapted to the needs of local First Nations communities, and supported by policymakers. Future research should include monitoring implementation and outcomes of the programme, along with robust cost-effectiveness analysis data to inform scale-up.

Funding
Australian National Health and Medical Research Council.