Background: In Australia, maternal mortality, low birthweight, preterm birth, perinatal death and infant mortality are substantially higher for Aboriginal and Torres Strait Islander (called ‘Aboriginal’ hereafter) mothers and babies. Numerous government reports and inquiries have recommended that strategies to improve outcomes are urgently needed. Caseload midwifery (where women have continuity of care from a ‘known’ midwife during pregnancy, labour, birth and postpartum) is considered to be the ‘gold standard’ in maternity care, and is associated with better clinical and psychosocial outcomes, however few Aboriginal women have access to this model.
Aim and method: We are undertaking a large National Health and Medical Research Council funded Partnership Project which aims to assess the research translation capacity of maternity services to implement, embed and sustain a caseload model specifically for Aboriginal women (and non-Aboriginal women having Aboriginal babies).
Commencing in 2016, one regional and three metropolitan Victorian public hospitals will implement and proactively offer caseload midwifery to Aboriginal women. We will measure clinical outcomes, caseload uptake, economic impact, and acceptability of the model. We will explore model sustainability, including developing and implementing a cultural competence evaluation framework, and cultural competency training. Models will be developed iteratively, be site specific and will enhance, not replace current systems. Aboriginal Health Workers and Liaison Officers, and Koori Maternity Service workers will continue to be closely involved. The aim is to provide a known care provider within the hospital system.
Results: Each of the sites has an existing caseload model, but to date Aboriginal women have not been proactively offered caseload care. Of the women who have received caseload care at the four participating hospitals up to mid 2015, 0.8% (42/5549) were Aboriginal. Of all women birthing at the sites, non-Aboriginal women were more than twice as likely to receive caseload compared with Aboriginal women (9.4% vs 4.5%).
Conclusion: This prospective mixed-methods study will assess the research translation capacity of maternity services to implement, embed and sustain a culturally responsive caseload midwifery model for Aboriginal women. The overall aim is to help 'close the gap' in maternal and infant outcomes for Aboriginal people.