Birthing in our community

Preventing avoidable preterm birth in Aboriginal and Torres Strait Islander families is a major public health priority in Australia, according to the National Aboriginal and Torres Strait Islander Health Plan 2013–2023’s Maternal Health and Parenting Goal.

And a group of UQ researchers and their partner agencies – Aboriginal & Torres Strait Islander Community Health Service Brisbane, Institute for Urban Indigenous Health, and Mater Mothers’ Hospital – have done something about it.

Designing a new program, Birthing in Our Community, they are helping ensure that Aboriginal and Torres Strait Islander mothers and babies get the best possible care and support for a good start to life, as evidenced by a reduction in preterm births (<37 weeks gestation) – from 11.6 per cent to 6.9 per cent – for those participating in the program.

This has excellent implications for long-term Indigenous health as, according to the Australian Department of Health, "Birth weight is important—in a sense, it is the first outcome. It reflects the influence of a number of parental factors, is directly linked with foetal death and is the earliest indicator of proneness to ill health during childhood and to later adult diseases, such as high blood pressure."

In essence, the longer a baby is in-utero, the more likely it is to have a healthy birth weight, and the less likely it will be to die in infancy or develop chronic disease later in life.

Professors Kildea and Kruske and their team began devising a plan that would also help improve the health outcomes of urban Aboriginal and Torres Strait Islander mothers and their babies.

"To do this, they need a team who wraps around support to ensure they have secure housing, are free from financial stress and are emotionally resilient.

“Having a trusted source to make health recommendations – such as stopping smoking – can make a big difference in delivering a healthy, full-term baby."

Initiative

The program developed by UQ researchers and their colleagues in 2013 is a continuity-of-care model that enables all Aboriginal and Torres Strait Islander mothers planning to birth at the Mater to have the same team of people providing care and assistance from early pregnancy through to around six weeks post-birth.

Mater Research Institute–UQ postdoctoral research officer Dr Sophie Hickey, who has worked on the research evaluation study since its inception, says that every woman has her own midwife on-call 24 hours a day, and a support team that includes Indigenous family support workers, Aboriginal student midwives, social workers, perinatal psychology, doctors and other health professionals.

"With help from our partner organisations, all care provision and government structures are culturally sensitive and provide ‘add-on’ services, such as Aboriginal and Torres Strait Islander family support workers and access to social workers, that enhance the program,” she says.

“We conducted the Indigenous Birthing in an Urban Setting (IBUS) study over a five-year period (2014–2019) to determine whether the new model could indeed reduce the rising rates of preterm births.

Dr Hickey says the team recommends that the program be tested in other settings as a key strategy to reduce Indigenous preterm birth rates in Australia.

“Strategies to address disparities are more likely to succeed if they are led by, or conducted in partnership with, Indigenous organisations and build Indigenous capacity and engagement.”

Impending

While the IBUS study focused on Aboriginal and Torres Strait Islander women and their children in urban settings and achieved positive outcomes, results were not as strong for Indigenous women from remote areas who relocated to an urban setting.

Although these mothers received quality care and caseload midwifery, no reductions in preterm births occurred.

This was possibly because little changed in their home communities in terms of antenatal care and community support services.

The IBUS results suggest that reducing preterm birth is possible when Indigenous mothers receive culturally safe, antenatal care early in their pregnancy and close to home, which fits into Birthing on Country, a concept that is taking on a greater significance worldwide.

Birthing on Country is an international movement to return maternity services to First Nations communities and community control for improved health and wellbeing and its elements are fully embraced within the IBUS research.

“It's not just a matter of ‘place’ (where the birth occurs) but the broader considerations for birthing in a culturally safe, respectful and secure context,” says Dr Hickey.

“We recommend a RISE framework to implement future Birthing on Country services and believe our results from the IBUS study back this up: Redesign the health service, Invest in the workforce, Strengthen families, and Embed Aboriginal and/or Torres Strait Islander community governance and control.

“The best start to life is a social investment in community wellbeing for generations.”

Visit the Institute for Urban Indigenous Health website to find out more about the Birthing in Our Community program.