Molly Wardaguga Research Centre, Charles Darwin University, Ann Street, Brisbane, QLD, 4000, Australia.
Waminda South Coast Women's Health & Wellbeing Aboriginal Corporation, Kinghorne Street, Nowra, NSW, 2541, Australia.
BMC Pregnancy Childbirth. 2023 Jan 28;23(1):77. doi: 10.1186/s12884-022-05277-8.
With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3-5 times more likely than other mothers to experience maternal mortality; babies are 2-3 times more likely to be born preterm, low birth weight or not to survive their first year. 'Birthing on Country' incorporates a multiplicity of interpretations but conveys a resumption of maternity services in First Nations Communities with Community governance for the best start to life. Redesigned services offer women and families integrated, holistic care, including carer continuity from primary through tertiary services; services coordination and quality care including safe and supportive spaces. The overall aim of Building On Our Strengths (BOOSt) is to facilitate and assess Birthing on Country expansion into two settings - urban and rural; with scale-up to include First Nations-operated birth centres. This study will build on our team's earlier work - a Birthing on Country service established and evaluated in an urban setting, that reported significant perinatal (and organisational) benefits, including a 37% reduction in preterm births, among other improvements.
Using community-based, participatory action research, we will collaborate to develop, implement and evaluate new Birthing on Country care models. We will conduct a mixed-methods, prospective birth cohort study in two settings, comparing outcomes for women having First Nations babies with historical controls. Our analysis of feasibility, acceptability, clinical and cultural safety, effectiveness and cost, will use data including (i) women's experiences collected through longitudinal surveys (three timepoints) and yarning interviews; (ii) clinical records; (iii) staff and stakeholder views and experiences; (iv) field notes and meeting minutes; and (v) costs data. The study includes a process, impact and outcome evaluation of this complex health services innovation.
Birthing on Country applies First Nations governance and cultural safety strategies to support optimum maternal, infant, and family health and wellbeing. Women's experiences, perinatal outcomes, costs and other operational implications will be reported for Communities, service providers, policy advisors, and for future scale-up.
Australia & New Zealand Clinical Trial Registry # ACTRN12620000874910 (2 September 2020).
在澳大利亚两百多年殖民影响下，原住民家庭承受着不成比例的不良妊娠和分娩结果的负担。原住民母亲死于妊娠或分娩相关并发症的风险比其他母亲高 3-5 倍；婴儿早产、低体重或无法存活到一岁的风险比其他母亲高 2-3 倍。“在本土生育”有多种解释，但都传达了在原住民社区恢复以社区为基础的母性服务，以实现最佳的生命开端。重新设计的服务为女性及其家庭提供了综合的、整体的护理，包括从初级到三级服务的护理连续性；服务协调和高质量护理，包括安全和支持性空间。“强化优势（BOOST）”的总体目标是促进和评估“在本土生育”扩展到两个环境——城市和农村；扩大规模包括原住民运营的生育中心。这项研究将建立在我们团队早期的工作基础上，即在城市环境中建立和评估“在本土生育”服务，该服务报告了显著的围产期（和组织）效益，包括早产率降低 37%，以及其他改善。
使用基于社区的参与式行动研究，我们将合作开发、实施和评估新的“在本土生育”护理模式。我们将在两个环境中进行一项混合方法、前瞻性的出生队列研究，将有原住民婴儿的女性与历史对照进行比较。我们对可行性、可接受性、临床和文化安全性、有效性和成本的分析将使用包括以下内容的数据：（i）通过纵向调查（三个时间点）和交谈访谈收集的女性体验；（ii）临床记录；（iii）员工和利益相关者的观点和经验；（iv）现场笔记和会议记录；（v）成本数据。该研究包括对这种复杂的卫生服务创新进行过程、影响和结果评估。
“在本土生育”应用原住民治理和文化安全策略，以支持产妇、婴儿和家庭的最佳健康和福祉。社区、服务提供者、政策顾问以及未来的扩大规模将报告女性的体验、围产期结果、成本和其他运营影响。
澳大利亚和新西兰临床试验注册中心 #ACTRN12620000874910（2020 年 9 月 2 日）。
