Indigenous Birthing in an Urban Setting

Achieving equity in birth outcomes, health status and life expectancy for Aboriginal and Torres Strait Islander families in urban Southeast Queensland.

Photograph: Pat Josse

Indigenous Birthing in an Urban Setting

(IBUS)

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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.

5th Birthday of the Birthing in Our Community Service

Pictured L-R:Dr Carmel Nelson, Shannon Watego, Kyleigh Brown-Lolohea, Dr Sue Kildea, Karina Hogan and Elliot Dunn

Sub-Studies

Stop Smoking in Its Tracks 

IBUS sub-study

“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.

The Organisational Cultural Competence (OCC) Study

IBUS sub-study

This project aimed to describe and provide recommendations for organisational approaches to better meet the needs of Aboriginal and Torres Strait Islander people in a large tertiary hospital in South East Queensland. It employed a combination of mixed-methods and participatory approaches to describe the “current state” of organisational cultural competency, as it relates to staff reported efforts to respond to the needs of Aboriginal and Torres Strait Islander people. Study findings are based on data from a document analysis of policies and procedures, routinely collected clinical data, an online staff survey (n=350), and qualitative staff interviews (n=30). The data collection period broadly occurred between October 2018 and January 2020, and did not focus on the work being done through the Birthing in Our Community program and maternity as this is covered extensively elsewhere (Hickey et al. 2018).

 

The 94 page report includes 25 recommendations across key five themes:

  • Demonstrate strong organisational commitment through a comprehensive strategic approach and facilitated change management

  • Systematically integrate consumer engagement and feedback in service planning and delivery at all levels

  • Provide culturally safe care and a welcoming environment

  • Develop training resources and organisational support for a culturally competent workforce

  • Harmonise documents, implement and monitor initiatives to improve Aboriginal and Torres Strait Islander status in patient records

This study was funded by Mater Research and Charles Darwin University.

 

Hickey, S., O'Dea, B., Kildea, S. & Y. Roe (2020) The Organisational Cultural Competence (OCC) study: Describe, measure and improve organisational approaches to meet the needs of Aboriginal and Torres Strait Islander people in a tertiary healthcare setting (Final report). Brisbane: Mater Research and the Molly Wardaguga Research Centre, Charles Darwin University.

Hearing from the Dads

IBUS sub-study

This study was conducted in response to the voices of First Nation mothers who attended a Birthing on Country maternity service who wanted to ensure that the voices of First Nation men to be heard in regard to service planning and delivery of maternity, birthing and parenting services. We believe strengthening family capacity and holistic wellbeing is an essential pillar to ensuring the best start in life for First Nation babies.

This study has two aims: firstly, to describe the lived experiences of new and expectant Aboriginal and Torres Strait Islander fathers and explore their perceptions of a good father; and secondly, to identify practical strategies for building the strengths of Aboriginal and Torres Strait Islander men to enable them to become the best father they can be. 

 

This study was funded by the Lowitja Institute.

 

Publication coming shortly.

Tell My Story

IBUS sub-study

For this substudy, our community researchers yarned with a smaller number of IBUS women about their experiences of maternity care. These yarns were more in-depth than the surveys and focused on the things that were really important to mum and her family. We yarned with some of the women over different timepoints to see how she was going before and after baby was born. We talked about how the pregnancy was going and her experiences of motherhood. We wanted to know what is important to women during this time, what is culturally safe care. We were also interested in where women got their support, what is important to families and was the care they were getting from the health providers what they needed and how we could make it better.

 
 
 

IBUS Publications

In the Media​

ABC News, 4 July 2019
SBS News, 13 Feb 2018
ABC Radio Norman Swan Health Report, 20 Jan 2020
UQ Research Impact, 27 November 2019
Mater News, 5 Jul 2019
Croakey, 4 Apr 2019
The Conversation, 12 Feb 2018
On research as "a political act of our sovereignty"
Jody Currie, CEO, ATSICHS Brisbane
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Birthing on Country acknowledges the traditional custodians across the lands on which we live and work, and we pay our respects to Elders both past and present.

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UQ Research Impact, 27 November 2019

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