Study Protocol and Overview of the BOOSt Study on Birthing on Country Services for First Nations Australians

Study Objective

  • Establish Birthing on Country (BoC) services to improve maternal and neonatal health outcomes for First Nations Australians.
  • Focus on community governance and culturally safe services.

Background

  • First Nations families face significant health disparities:
    • Higher maternal mortality (3-5 times more likely).
    • Increased rates of preterm births and low birth weight.
  • Birthing on Country is a model aimed at providing integrated, holistic care that respects cultural practices and governance.
    • Includes continuity of care, support during pregnancy, and safe birthing environments.

Key Concepts of BoC Model

  • Community Governance: Local control of birthing services.
  • Cultural Safety: Services designed and delivered in alignment with First Nations cultural practices.
  • Integrated Care: Continuity of care from antenatal to postnatal support with involvement of local health workers.

Study Methodology

  • Mixed Methods Approach: Using both qualitative and quantitative research.
  • Conduct a prospective birth cohort study comparing outcomes of women having First Nations babies with historical controls.
  • Data sources to include:
    • Women’s experiences (surveys, interviews).
    • Clinical records.
    • Staff and community perspectives.
    • Evaluations of clinical and cultural safety, cost-effectiveness, etc.

Key Components for BoC Service Design

  • Governance: Involvement of First Nations health organizations.
  • Workforce Strategy: Recruitment and training of First Nations midwives and healthcare workers.
  • Continuity of Midwifery Care: A dedicated midwife from early pregnancy through postpartum.
  • Cultural Connection: Incorporate traditional practices in maternity care, aligned with community values.

Evaluation Framework

  • Process Evaluation: Assess the enactment of governance and service implementation.
  • Impact Evaluation: Measure clinical outcomes and cultural safety improvements.
  • Outcome Measures: Include maternal satisfaction, health outcomes, and economic evaluations.

Study Sites

  1. Urban Site: Brisbane (Meanjin), in collaboration with local Aboriginal health organizations.
  2. Rural Site: Nowra, New South Wales (NSW), working with Waminda Women's Corporation.

Expected Outcomes

  • Reduction in adverse outcomes like preterm births.
  • Improved maternal and infant health outcomes compared to historical controls.
  • Greater engagement from First Nations communities in health services.
  • A model that can be replicated in other settings.

Keywords

  • Midwifery, Health Services Research, Aboriginal and Torres Strait Islander populations, Indigenous Health Disparities, Holistic Care, Cultural Competence.