Closing the gap for childbirth
First Nations mothers are 3-5 times more likely to die in childbirth than other mothers. Their babies are almost 2 times more likely to die in their first year, often because they were born too soon (preterm).
Changing this is a priority for closing the gap in First Nations health outcomes. Closing the Gap Target 2 is ‘Children are born healthy and strong’.
Success in Brisbane’s Birthing in Our Community service
Yvette led the Indigenous Birthing in an Urban Setting study (IBUS) to help close the gap in Brisbane. The exemplar Birthing in Our Community service reduced First Nations preterm births from 14.3% to 8.9%. There were other improvements:
- more First Nations women were seen in early pregnancy
- women needed less intervention during birthing
- more mothers were breastfeeding
- fewer babies were admitted to neonatal units.
‘We saw all these amazing clinical outcomes that we have not seen before in Australia,’ Yvette says. ‘The Birthing in Our Community service also saw a cost saving of $4810 for every mother-baby pair to the health system, compared to standard care.’
Redesigning maternity services
‘These outcomes were the result of redesigning maternity services,’ Yvette explains. ‘A mainstream service, Mater Hospital, partnered with two First Nations community-controlled health services. They were the Institute of Urban Indigenous Health and Aboriginal and Torres Strait Islander Health Service Brisbane.
‘The community-controlled services created a community hub to provide services outside the hospital. Feedback from the women about the hub was it “feels like home” and “feels like a black space”. This safety net for women was critical to the outcomes.’
Translating the study across Australia
With funding from the MRFF, Yvette is translating IBUS in the Birthing on Country project. Birthing on Country will transform maternity care for better outcomes for First Nations mothers and babies across Australia.
Yvette is working with multiple partners who want to redesign maternity care in their rural, remote and very remote settings. The partners include:
- South Coast Women's Health and Wellbeing Aboriginal Corporation (Waminda), NSW.
- Central Australian Aboriginal Congress Alukura Maternity Services, NT.
- Yalu Aboriginal Corporation in Galiwin’ku and Miwatj Health Aboriginal Corporation, NT.
- NT Health, NSW Health, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Australian Doula College, Care Flight, Australian Red Cross, My Midwives, and DK Legal.
First Nations values
The partners are using the RISE SAFELY implementation framework. ‘RISE SAFELY is underpinned by First Nations values, ways of seeing, doing, and being,’ Yvette says. Services are redesigned in 3 phases:
- antenatal and postnatal programs are informed by First Nations knowledge.
- redesigned services incorporate continuity of midwifery care, modified for the remote context, and include a First Nations workforce.
- new services with 6 components operate from community-based hubs:
- multiagency partnerships and First Nations governance
- continuity of midwifery care
- First Nations workforce
- cultural safety framework
- holistic wrap around services
- coordinated care integrating primary care with tertiary services.
‘Each activity happens at a different pace, but we need to work on all activities to have sustainable outcomes,’ Yvette explains.
Birthing on Country gives mothers cultural safety
‘Birthing on Country gives First Nations mothers and mothers carrying First Nations babies cultural safety where they give birth,’ Yvette says.
‘If I’m in a remote community and I am at high risk, I might choose to fly out to a hospital at 36 weeks. But I want a safe place to land when I'm there. I want to be able to have an interpreter. I want to be able to stay in a place I feel safe. I want to eat food that I'm familiar with. I want to know my midwife.
‘At the moment, the hospital biomedical model, what we call standard care, denies a lot of women those choices. But the evidence tells us the biomedical model is failing First Nations and non-First Nations women.’
There are still barriers to Birthing on Country
Implementing Birthing on Country faces barriers in each location. ‘Barriers include legislation that stops us from rolling out some of the approaches that we know work best,’ Yvette says.
‘In some First Nations communities having small babies is almost normalised. We need to break through this by people understanding what the number story means. They need to know our babies are born too small or too early and their sickness is not normal.
‘Providing an avenue for Indigenous knowledge makes that discussion richer and the solutions even more dynamic.’
Following in her mother’s footsteps
Yvette is following in her mother’s footsteps. ‘I had a mother who was a community midwife. All the families would birth each other's children,’ Yvette tells us.
‘Birthing is our first ceremony where we've passed from mum into the world, so it's a very symbolic and powerful ceremony. It is unacceptable that our women and babies are dying prematurely. The system sometimes traumatizes them, hurts them and in an extreme case kills them. This is a human rights issue. I am passionate about it.’
The MRFF funded The Birthing on Country: RISE SAFELY in rural, remote and very remote Australia program with $5 million.