A study of 213 Aboriginal and Torres Strait Islander (First Nations) pregnant women having a First Nations baby at one of three maternity services in Naarm (Melbourne) found that culturally tailored continuity of midwife care models were met with high levels of satisfaction with care.
The study, led by Res McCalman, from La Trobe University’s Judith Lumley Centre and published in the journal, Women and Birth, was conducted at the Royal Women’s Hospital, Joan Kirner Women’s and Children’s Hospital and Mercy Hospital for Women.
The three hospitals proactively offer First Nations women continuity of midwifery care, sometimes called caseload midwifery care.
Caseload midwifery is a type of midwife-led continuity where a woman has 24/7 telephone access to a primary caseload midwife (and one or two backup midwives) who provides care throughout pregnancy, labour and birth, and in the early postnatal weeks.
Despite previous findings that this model is associated with substantially better health outcomes, very few First Nations women have access to this type of care (despite being more likely to experience a preterm birth, a low birthweight baby or infant loss), according to one of the study authors Professor Helen McLachlan.
“Prior to 2017, when these programs designed for First Nations women were put into place, only 5.8% of First Nations women had ever received caseload midwifery at the three sites combined, compared with over 4,800 non-First Nations women,” Professor McLachlan said.
From March 2017 to August 2021, 663 Aboriginal and Torres Strait Islander families were booked into the three dedicated programs.
In this study women having a First Nations baby who were booked for care at one of three study sites were invited to complete one questionnaire during pregnancy and then a follow up questionnaire, 3 months after the birth.
Follow up questionnaires were completed by 213 women, of whom 186 had received continuity of midwife care. Most women rated their pregnancy (80%) and labour and birth care (81%) highly (‘6 or ‘7′ on a scale of 1–7).
According to Res McCalman women felt informed and that they had an active say in decisions.
“Under this program, women felt that their concerns were taken seriously, that they received the physical care and emotional support they needed, and that the midwives were kind, understanding and there when needed,” Res McCalman said.
Ms McCalman said caseload midwifery programs for First Nations women have been associated with fewer preterm births, more frequent antenatal care, higher rates of exclusive breastfeeding at discharge, decreased levels of tobacco use, and increased feelings of trust and safety.
“These are important findings, as numerous studies have reported that First Nations women can experience challenges within the maternity system, such as culturally unsafe practices inhibiting access to appropriate care and experiences of racism contributing to inequitable outcomes,” Res McCalman said.
The researchers recommend that continuity of midwife care throughout pregnancy, birth and the postpartum period be implemented nationally as a strategy towards improving outcomes for First Nations women and newborns as “evidence demonstrates both physical and psychosocial benefits for women and babies generally, as well as culturally.”
Res McCalman said that there is an urgent need to extend continuity of care for all First Nations women in order to improve outcomes.
“From this study we know that women who had midwife-led continuity more often reported being satisfied with their care, feeling safe, informed, supported emotionally, and that their concerns were taken seriously,” Res McCalman said.
“It is a program that leads to better outcomes for First Nations’ babies and mothers and is urgently needed nationally.”
Media: Claire Bowers, c.bowers@latrobe.edu.au
