Translating evidence into practice: Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia
Creators: name: McLachlan, Helen
name: Newton, Michelle
name: McLardie-Hore, Fiona
name: McCalman, Pamela
name: Jackomos, Marika
name: Bundle, Gina
name: Kildea, Sue
name: Chamberlain, Catherine
name: Browne, Jennifer
name: Ryan, Jenny
name: Freemantle, Jane
name: Shafiei, Touran
name: Jacobs, Susan E
name: Oats, Jeremy
name: Blow, Ngaree
name: Ferguson, Karyn
name: Gold, Lisa
name: Watkins, Jacqueline
name: Dell, Maree
name: Read, Kim
name: Hyde, Rebecca
name: Matthews, Robyn
name: Forster, Della
Publisher: name: La Trobe
Year: 2022
Subjects: classificationCode: 420599
subject: Nursing not elsewhere classified
classificationCode: 420699
subject: Public health not elsewhere classified
classificationCode: 450499
subject: Aboriginal and Torres Strait Islander health and wellbeing not elsewhere classified
classificationCode: 420499
subject: Midwifery not elsewhere classified

description: Background: Strategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service. Methods: A prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020. Findings: The model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model. Interpretation: Key enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas. Funding: Partnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.