Indigenous Birthing in an Urban Setting

IBUS

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

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Indigenous Birthing in an Urban Setting

(IBUS)

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, 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.

Recent IBUS publication in Lancet Global Health finds Birthing in Our Community partnership has reduced preterm birth, increased antenatal visits and breastfeed

Read our community report about building our First Nations workforce using Participatory Action Research. See our community report to find out how mentoring two First Nations women using PAR enhaced the quality of our research

Kyleigh with belly cast and daughters.JP

The IBUS Study provides evidence that working in collaboration with community-controlled organisations is the key to reducing pre-term birth and enables Aboriginal and Torres Strait Islander babies the best start to life

Resigning the Statement of Commitment, March 2020

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]"

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.

Hearing from First Nations Dads: Qualitative yarns informing service planning and practice in urban Australia. Family Relations, 1-16.

Clifford-Motopi A, Fisher I, Kildea S, Hickey S, Roe Y, & Kruske S. (2022)

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.

The IBUS team also helped IUIH develop a health information video about contraception for First Nations women in South East Queensland

IBUS Community Reports

Family Planning Community Report 2021

Sexual health is everyone's responsibility. Yarning about sexual health and wellbeing

Waminda Baby Calendar dates draft-05_preview.jpeg.jpg

IBUS Report, March 2021

New IBUS paper shows Birthing in Our Community program reduced preterm birth, more women attending antenatal care and more breastfeeding

IBUS Participatory Action Research, 2021

Reading about our building our First Nations workforce using Participatory Action Research (PAR). See our community report to find out how mentoring two First Nations women using PAR enhanced the quality of our research

IBUS Report, January 2021

Sub-Studies

Comm Reports

publications

IBUS Publications

Birthing on country service compared to standard care for First Nations Australians: A cost-effectiveness analysis from a health system perspective. The Lancet Regional Health - Western Pacific. Available online 3 March 2023.

Gao, Y., Roe, Y., Hickey, S., Chadha, A., Kruske, S., Nelson, C., Carson, A., Watego, K., Reynolds, M., Costello, J., Tracy, S. & Kildea, S. (2023)

Hearing from First Nations Dads: Qualitative yarns informing service planning and practice in urban Australia. Family Relations, 1-16.

Clifford-Motopi A, Fisher I, Kildea S, Hickey S, Roe Y, & Kruske S. (2022)

Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial. The Lancet Global Health, 9(5): e651-e659.

Kildea, S., Gao, Y., Hickey, S., Nelson, C., Kruske, S., Carson, A.,Currie, J., Reynolds, M., Wilson, K., Watego, K. Costello, J., & Y. Roe (2021)

Community-Based Sexual and Reproductive Health Promotion and Services for First Nations People in Urban Australia. International Journal of Womens Health.13:467-478
Hickey S, Roe Y, Harvey C, Kruske S, Clifford-Motopi A, Fisher I, Bernardino B, & Kildea S. (2021)

A call for action that cannot go to voicemail: Research activism to urgently improve Indigenous perinatal health and wellbeing. Women and Birth, 34(4): 303-305.

Hickey, S., Roe, Y., Ireland, S., Kildea, S., Haora, P., Gao, Y., Maypilama, E., Kruske, S., Campbell, S., Moore, S., Maidment, S., Heinemann, K., Hartz, D. and the IBUS and BOOST study teams, Adcock, A., Storey, F., Bennett, M. , Lambert, C., Sibanda, N., Lawton, B., Cram, F., Stevenson, K., Lavoie, J., Edmonds, L., Geller, S., Bourrassa, C., Smylie, J., Van Wagner, V., Bourgeois, C., Dion Fletcher, C., King, A., Briggs, M., Worner, F., Wellington, C., Carson, A., Nelson, C., Watego, K., Brown-Lolohea, K., Colman, K., Currie, J., Lowell, A., Chamberlain, C., Geia, L., and J. Sherwood (2019)

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, 77: 101705.
Hickey, S., Couchman, K., Stapleton, H., Roe, Y. & S. Kildea (2019)

Establishing new teams aiming to provide culturally safe maternity care for Indigenous families. Women and Birth, 32(5):449-459.
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)

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)