Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia; Mater Research Institute and School of Nursing and Midwifery, University of Queensland, Brisbane, QLD, Australia.
Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia; Mater Research Institute and School of Nursing and Midwifery, University of Queensland, Brisbane, QLD, Australia.
Lancet Glob Health. 2021 May;9(5):e651-e659. doi: 10.1016/S2214-109X(21)00061-9. Epub 2021 Mar 17.
There is an urgency to redress unacceptable maternal and infant health outcomes for First Nations families in Australia. A multi-agency partnership between two Aboriginal Community-controlled health services and a tertiary hospital in urban Australia designed, implemented, and evaluated the new Birthing in Our Community (BiOC) service. In this study, we aimed to assess and report the clinical effectiveness of the BiOC service on key maternal and infant health outcomes compared with that of standard care.
Pregnant women attending the Mater Mothers Public Hospital (Brisbane, QLD, Australia) who were having a First Nations baby were invited to receive the BiOC service. In this prospective, non-randomised, interventional trial of the service, we specifically enrolled women who intended to birth at the study hospital, and had a referral from a family doctor or Aboriginal Medical Service. Participants were offered either standard care services or the BiOC service. Prespecified primary outcomes to test the effectiveness of the BiOC service versus standard care were the proportion of women attending five or more antenatal visits, smoking after 20 weeks of gestation, who had a preterm birth (<37 weeks), and who were exclusively breastfeeding at discharge from hospital. We used inverse probability of treatment weighting to balance confounders and calculate treatment effect. This trial is registered with the Australian New Zealand Clinical Trial Registry, ACTRN12618001365257.
Between Jan 1, 2013, and June 30, 2019, 1867 First Nations babies were born at the Mater Mothers Public Hospital. After exclusions, 1422 women received either standard care (656 participants) or the BiOC service (766 participants) and were included in the analyses. Women receiving the BiOC service were more likely to attend five or more antenatal visits (adjusted odds ratio 1·54, 95% CI 1·13-2·09; p=0·0064), less likely to have an infant born preterm (0·62, 0·42-0·93; p=0·019), and more likely to exclusively breastfeed on discharge from hospital (1·34, 1·06-1·70; p=0·014). No difference was found between the two groups for smoking after 20 weeks of gestation, with both showing a reduction compared with smoking levels reported at their hospital booking visit.
This study has shown the clinical effectiveness of the BiOC service, which was co-designed by stakeholders and underpinned by Birthing on Country principles. The widespread scale-up of this new service should be prioritised. Dedicated funding, knowledge translation, and implementation science are needed to ensure all First Nations families can access Birthing on Country services that are adapted for their specific contexts.
Australian National Health and Medical Research Council.
急需改善澳大利亚原住民家庭不可接受的母婴健康结果。澳大利亚两家原住民社区控制的医疗服务机构和一家城市三级医院之间建立了多机构合作伙伴关系，设计、实施和评估了新的社区生育（BiOC）服务。在这项研究中，我们旨在评估和报告 BiOC 服务在关键母婴健康结果方面与标准护理相比的临床效果。
在 Mater Mothers 公立医院（澳大利亚昆士兰州布里斯班）就诊的怀有原住民婴儿的孕妇被邀请接受 BiOC 服务。在这项针对该服务的前瞻性、非随机、干预性试验中，我们特别招募了那些打算在研究医院分娩且已获得家庭医生或原住民医疗服务转诊的女性。参与者可选择接受标准护理服务或 BiOC 服务。为了检验 BiOC 服务与标准护理相比的有效性，我们预先设定了主要结局，即接受五次或更多产前检查的女性比例、20 周后吸烟的女性比例、早产（<37 周）的女性比例以及出院时纯母乳喂养的女性比例。我们使用逆概率治疗加权来平衡混杂因素并计算治疗效果。这项试验在澳大利亚和新西兰临床试验注册中心注册，注册号为 ACTRN12618001365257。
2013 年 1 月 1 日至 2019 年 6 月 30 日期间，在 Mater Mothers 公立医院出生了 1867 名原住民婴儿。排除后，共有 1422 名女性接受了标准护理（656 名参与者）或 BiOC 服务（766 名参与者），并纳入了分析。接受 BiOC 服务的女性更有可能接受五次或更多次产前检查（调整后的优势比 1.54，95%CI 1.13-2.09；p=0.0064），婴儿早产的可能性较小（0.62，0.42-0.93；p=0.019），且更有可能在出院时纯母乳喂养（1.34，1.06-1.70；p=0.014）。两组在 20 周后吸烟的情况没有差异，与入院预约时的吸烟水平相比，两组都有所下降。
这项研究表明了 BiOC 服务的临床效果，该服务由利益相关者共同设计，并以在国家土地上分娩的原则为基础。应该优先广泛推广这项新服务。需要专门的资金、知识转化和实施科学，以确保所有原住民家庭都能获得适应其特定情况的在国家土地上分娩的服务。
澳大利亚国家卫生和医学研究委员会。
