Photograph: Pat Josse
Birthing on Country
Centre for Research Excellence
Achieving equity in birth outcomes, health status and life expectancy for Aboriginal and Torres Strait Islander families in urban Southeast Queensland.
Indigenous Birthing in an Urban Setting
In 2010, an evaluation of Mater Mothers’ Hospital specialist antenatal clinic for Aboriginal and Torres Strait Islander women (the ‘Murri Clinic’) revealed that although women were very satisfied with the service, they were unhappy with the lack of continuity by a known carer during labour/birth and the early weeks of the baby’s life. Added to this was a strong desire to improve maternal and infant health outcomes for Indigenous mothers and babies.
This led to the development of a partnership between three Brisbane-based organisations: Institute for Urban Indigenous Health (IUIH), Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) Brisbane Limited and Mater Health Service (MHS). These organisations agreed to share resources to redesign maternal and infant health services in a program called Birthing in our Community (BiOC). This is an enhanced midwifery group practice-based model specifically tailored to the needs and preferences of Aboriginal and Torres Strait Islander families. This new model has been operating since 2013 and is already making a difference to the families who access the services. It has also seen an increase in our Indigenous workers with some training to be midwives.
The BiOC program includes:
24/7 midwifery care in pregnancy to six weeks postnatal by a named midwife supported by Indigenous family support workers, as well as transport, childcare, social work and mental health support, allied health, and women’s health doctor available at a designated community-based Mums and Bubs hub
Partnership with the Aboriginal community health services
Oversight from a Steering Committee, including Indigenous governance
Clinical/cultural supervision monthly cultural education days
Support for Indigenous student midwives through cadetships and placement within the partnership.
For more information about the history of the Birthing in Our Community partnership, click here.
The IBUS Study is a five-year research evaluation that compares different models of care for women having Aboriginal and Torres Strait Islander babies at two major maternity hospitals in urban South East Queensland, Australia. Pregnant women were recruited from the Mater Mothers Hospital and the Royal Brisbane Women’s hospital. Surveys were conducted with over 600 families to know what women thought of the different programs. Clinical data are being analysed to see whether the programs made a difference to health outcomes. The study will also include an economic analysis to test cost effectiveness as well as qualitative yarns (interviews) with families and staff involved for an in-depth understanding of what works best for families and how to best implement this sort of program. For more information about what the study involves, click here.
The Statement of Commitment
The partners signed a Statement of Commitment that through partnership, they are able to advance more effectively than as individuals towards the shared goal of achieving equity in birth outcomes, health status and life expectancy for Aboriginal and Torres Strait Islander families in urban Southeast Queensland.
Reduction in Preterm Birth
The IBUS Study recorded a profound reduction in preterm birth for women accessing the Birthing in Our Community service. This is a huge achievement that could not have been possible without the three partner organisations: the Institute for Urban Indigenous Health, the Aboriginal and Torres Strait Islander Health Services, Brisbane, and the Mater Hospital. Preterm birth can be stressful and can increase the chance of illness or chronic disease in later life. Having more babies born full-term is a social and intergenerational investment in community well being. For more information about how this was achieved, read our paper published in E-Clinical Medicine, a Lancet publication.
"I think there's other parts of the State and other parts of the country that could learn a lot with what's happened here, [the partnership comes] from very humble beginnings. No one went and dropped a bucket of millions into [the region]. We've had to work for every single cent and it's amazing what happens when relationships are based on, on real commitment, because... dollars don't buy commitment. [SP8]"
Stop Smoking in Its Tracks
“Stop Smoking in its Tracks” (SST) is a smoking cessation program designed specifically for pregnant Aboriginal and Torres Strait Islander women or women with Aboriginal and Torres Strait Islander partners, in collaboration with a community reference group of Aboriginal women and Aboriginal Health Workers (Passey and Stirling 2018). The main components of the program include: intensive support for cessation for women; free nicotine replacement therapy; financial rewards for confirmed abstinence; support for household members to support the woman’s quit attempt and to quit themselves. The program continues for six months post-partum. It will be provided to pregnant women who smoke as an integral component of the BiOC model, by the midwives and Indigenous workers. It is a single arm intervention study that aims to assess the effectiveness, acceptability, and feasibility of the SST program to achieve smoking cessation and quit attempts among pregnant women who report currently smoking at the booking-in visit and are receiving antenatal care through the Birthing in Our Community Service, Brisbane.
Experiences of health service providers establishing an Aboriginal-Mainstream Partnership to improve maternity care for Aboriginal and Torres Strait Islander families in an urban setting. Evaluation Program and Planning.
Hickey, S., Couchman, K., Stapleton, H., Roe, Y. & S. Kildea (accepted, in press)
Establishing new teams aiming to provide culturally safe care. Women and Birth, 32(5):466–475.
Hickey, S, Kildea, S., Couchman, K, Watego-Ivory, K., West, R., Kruske, S., Blackman, R., Watego, S. & Y. Roe (2019)
Implementing Birthing on Country services for the best start in life for Aboriginal and Torres Strait families: The RISE Framework. Women and Birth, 32(5):449–459.
Kildea, S., Hickey, S., Barclay, L., Kruske, S., Nelson, C., Sherwood, J., Allen, J., Gao, Y., Blackman, R. & Y. Roe (2019)
Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia. EClinical Medicine - Published by The Lancet, 12:43-51.
Kildea, S., Hickey, S., Gao, Y., Kruske, S., Nelson, C., Blackman, R., Tracy, S., Hurst, C., Williamson, D. & Y. Roe (2019
The Indigenous Birthing in an Urban Setting Study: The IBUS study (Study Protocol). BMC Pregnancy and Childbirth, 18:431.
Hickey, S., Roe, Y., Gao, Y., Nelson, C., Carson, A., Currie, J., Reynolds, M., Wilson, K., Kruske, S,. Blackman, R., Passey, M., Clifford, A., Tracy, S., West, R., Williamson, D., Kosiak, M., Watego, S., Webster, J. & S. Kildea (2018)
Participatory action research opens doors: Mentoring Indigenous researchers to improve midwifery in urban Australia. Women and Birth, 31(4): 263–268.
Hickey, S., Maidment, S., Heinemann, K., Roe, Y., & S. Kildea (2018) Participatory action research opens doors: Mentoring Indigenous researchers to improve midwifery in urban Australia. Women and Birth, 31(4): 263–268.
Birthing on Country (in Our Community): A case study of engaging stakeholders and developing a best practice Indigenous maternity service in an urban setting. Australian Health Review, 42(2):230-238.
Kildea, S., Hickey, S., Nelson, C., Currie, J., Carson, A., Reynolds, M., Wilson, K., Kruske, S., Passey, M., Roe, Y., West, R., Clifford, A., Kosiak, M., Watego, S., & S. Tracy (2018)
Estimating the life long impact of the Birthing in Our Community (BiOC) Service on health adjusted l
The Birthing on Country CRE Team
A/Prof Yu Gao
Dr Anton Clifford-Motopi
Dr Sophie Hickey
Dr Sarah Ireland
Dr Penny Haora, midwife
Ms Virginia Barnyarla, Representative for Molly Wardaguga's family