‘These people are on your side... this is a safe space.’ Aboriginal women’s stories of having a baby through culturally tailored continuity of midwife care programs in Naarm (Melbourne), Australia

Background
Perinatal inequities experienced by Aboriginal and Torres Strait Islander (First Nations) women and newborns are impacted by colonisation. As a redress, government health policies recommend the implementation of evidence-based, co-designed models of care. Maternity services that are committed to meeting the needs of First Nations communities must centre the voices of First Nations women in program planning, implementation, and evaluation. The purpose of the study was to explore the views and experiences of First Nations women who gave birth at one of the health services where new models had been implemented.

Methods
The study design was developed with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), the partner sites, staff from their respective Aboriginal Health Units and the project Aboriginal Advisory Committee. Using an overall framework underpinned by Critical Race Theory and Indigenous methodologies, a descriptive qualitative design integrated with ‘yarning’ was used. Women were interviewed by a First Nations researcher and data analysed thematically.

Main findings
Ten women participated in an interview. Overall, women reported having very positive experiences of the culturally tailored caseload midwifery models. Key contributing factors were ‘relationships’ (continuity and accessibility of their known midwife), ‘trust’ (with their midwife and the program) and ‘culture’ (acknowledging identity and a safe space). These elements were considered as essential for culturally safe maternity care. Women reported challenges within the broader maternity system if trust, relationships or culture were missing. Women also reported that support and care from First Nations staff was important.

Principal conclusions
Women in this study endorsed the implementation of culturally tailored continuity of midwife models of care. Trust, relationships and culture were the trifecta for a safe and positive maternity care experience.