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Table 1 Key components of exemplary Birthing on Country (BoC) services and differences between standard care (control) and BoC model (new service - complex innovation)

From: Developing and evaluating Birthing on Country services for First Nations Australians: the Building On Our Strengths (BOOSt) prospective mixed methods birth cohort study protocol

Differences between care modelsa

 

Standard Maternity Care (Control Group)

Birthing on Country service (Innovation Group)

Governance

No First Nations governance mechanism that actively engages local Community and supports oversight of maternity services and outcomes.

First Nations governance of the service (ownership through governance committee with oversight mechanisms).

Workforce strategy

No specific pathways to support First Nations MIH workforce.

Supportive career pathways with First Nations MIH workers embedded in the team with cadetships (or similar) to support midwifery education for First Nations persons. Aboriginal Family Support Workers (or similar) work side-by-side with midwives.

Continuity

No continuity of midwifery carer through antenatal, intrapartum and postnatal continuum. Care is fragmented and women see multiple providers.

Continuity of midwifery carer networked from community to a higher-level service, offering 24/7 care from a named midwife from first presentation in pregnancy until handover to child health services 6 weeks after birth. Midwifery Group Practice (caseload) midwife providing clinical care in collaboration with the extended workforce based on need (e.g. psychologist, social worker, obstetrician, paediatricians, sexual and reproductive health).

Strengthening family capacity

No maternity programs focussed on strengthening family capacity and/or cultural connection in relation to services offered through this hospital. Women may enrol in external programs.

Programs that focus on strengthening family capacity and cultural connection in relation to MIH, integrated with the BoC service.

Place of birth

No out-of-hospital option. Hospitals do not recognise or incorporate the knowledge, values and birth aspirations of First Nations people.

During the first and second phase of the new care model, all intrapartum care will occur in hospitals. If feasible, a free-standing, community-based birth centre will be set up and available for First Nations women with uncomplicated pregnancies (Category A according to consultation and referral guidelines) [18]; women with complex pregnancies (Category B or C) will birth in the local or tertiary hospital. Birth care will incorporate traditional practice; recognise the connection with Land and Country; incorporate holistic health; value both First Nations and non-First Nations ways of knowing, learning and risk assessment; and will provide a culturally competent service.

  1. Note: MIH Maternal and Infant Health
  2. aSome sections reproduced from Kildea, Gao et al. [19] Permission not required under licence CC BY-NC-ND 4.0