McLachlan Helen L, Newton Michelle, McLardie-Hore Fiona E, McCalman Pamela, Jackomos Marika, Bundle Gina, Kildea Sue, Chamberlain Catherine, Browne Jennifer, Ryan Jenny, Freemantle Jane, Shafiei Touran, Jacobs Susan E, Oats Jeremy, Blow Ngaree, Ferguson Karyn, Gold Lisa, Watkins Jacqueline, Dell Maree, Read Kim, Hyde Rebecca, Matthews Robyn, Forster Della A
Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia.
School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia.
EClinicalMedicine. 2022 May 4;47:101415. doi: 10.1016/j.eclinm.2022.101415. eCollection 2022 May.
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.
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.
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 ( = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% ( = 758) accepted it, of whom 89% ( = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model.
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.
Partnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.
迫切需要制定战略来改善澳大利亚原住民母亲和婴儿的健康结局。个案管理助产模式是指女性在整个孕期、分娩期、产后期都由助产士提供持续照护，这种模式与显著更好的围产期健康结局相关，但很少有原住民女性能够享受到。我们评估了澳大利亚维多利亚州的四家产科服务机构实施、融入并维持一项具有文化适应性的个案管理助产服务的能力。
采用前瞻性、非随机研究转化设计。各机构的工作组与当地原住民健康部门以及维多利亚州原住民社区控制卫生组织合作，制定了针对特定地点的具有文化适应性的个案管理模式。主要结局是提高在项目实施前后主动接受并获得个案管理助产服务的原住民产妇比例。该研究在澳大利亚墨尔本进行。数据收集于2017年3月6日在皇家妇女医院开始，2017年10月1日在琼·柯纳妇女儿童医院开始，2018年4月16日在仁慈妇女医院开始，所有地点的数据收集于2020年12月31日完成。
该模式于2017年至2020年期间在三家主要的大都市产科服务机构成功实施。在此之前，在类似的时间段内，这三个地点的原住民女性中只有5.8%（n = 34）曾接受过个案管理助产服务。在844名被提供该模式的女性中，90%（n = 758）接受了该模式，其中89%（n = 663）获得了服务。另外40名女性接受了标准个案管理。包括持续的人员配备危机等因素，阻碍了维多利亚州农村地区的第四家机构实施该模式。
关键促成因素包括与原住民共同设计研究和项目实施、工作人员文化能力培训、识别原住民女性（和婴儿）以及个案管理助产士与原住民医院和社区团队之间的定期互动。进一步的工作应包括关注解决农村地区实施具有文化适应性的个案管理助产服务的文化和劳动力障碍。
合作基金（#1110640），澳大利亚国家卫生与医学研究委员会和拉筹伯大学。
