TY - JOUR
T1 - Translating evidence into practice
T2 - Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia
AU - McLachlan, Helen L.
AU - Newton, Michelle
AU - McLardie-Hore, Fiona E.
AU - McCalman, Pamela
AU - Jackomos, Marika
AU - Bundle, Gina
AU - Kildea, Sue
AU - Chamberlain, Catherine
AU - Browne, Jennifer
AU - Ryan, Jenny
AU - Freemantle, Jane
AU - Shafiei, Touran
AU - Jacobs, Susan E.
AU - Oats, Jeremy
AU - Blow, Ngaree
AU - Ferguson, Karyn
AU - Gold, Lisa
AU - Watkins, Jacqueline
AU - Dell, Maree
AU - Read, Kim
AU - Hyde, Rebecca
AU - Matthews, Robyn
AU - Forster, Della A.
N1 - Funding Information:
We are grateful for the funding from the Australian National Health and Medical Research Council that allowed us to conduct this study.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/5
Y1 - 2022/5
N2 - BackgroundStrategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service.MethodsA prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020.FindingsThe model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model.InterpretationKey enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas.FundingPartnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.
AB - BackgroundStrategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service.MethodsA prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020.FindingsThe model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model.InterpretationKey enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas.FundingPartnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.
KW - First nations
KW - Implementation science
KW - Midwifery
UR - http://www.scopus.com/inward/record.url?scp=85130586004&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2022.101415
DO - 10.1016/j.eclinm.2022.101415
M3 - Article
C2 - 35747161
AN - SCOPUS:85130586004
SN - 2589-5370
VL - 47
SP - 1
EP - 13
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 101415
ER -