Returning birthing services to communities and Aboriginal control: Aboriginal women of Shoalhaven Illawarra region describe how Birthing on Country is linked to healing

Background: For almost three decades, Waminda South Coast Women’s Health and Welfare Aboriginal Corporation has provided culturally safe and holistic wellbeing services to the Illawarra Shoalhaven region, New South Wales. Work towards “Birthing on Country” has been a longstanding part of the Waminda’s strategic direction.  Method: Aboriginal ways of knowing and doing informed the multiple methods used. A desktop review of the grey literature and online public databases, then six community yarning circles were conducted in the region. Participants were mothers, grandmothers, community-controlled service providers, and government health providers. A thematic analysis was conducted by two researchers and a Waminda staff member.  Results: Five broad themes were identified and informed the recommendations: (a) redesign maternity and child services, (b) establish a specific wellbeing and birthing place, (c) invest in a clinically and culturally exceptional workforce, (d) strengthen family capacity as pivotal to long-term health and wellness for mother and baby, and (e) community ownership is fundamental.  Discussion: This service model reflects Aboriginal women’s aspiration to have a choice for more culturally safe care during pregnancy and birth. The new model privileges Aboriginal knowledge of pregnancy,  childbirth, and early parenting; which is contrary to the current biomedical model of maternity services available for Australian women. Conclusion: Waminda is best placed to work strategically to implement and evaluate the aspirations of the women and in doing so, has the potential to change the life trajectory of Aboriginal babies born in the Illawarra Shoalhaven region.

A comparison of inpatient suicides in Australian psychiatric and non-psychiatric hospital units between 2009 and 2018

Hospitalisation is designed to protect patients from harm; however, patients have been reported to take their own lives during hospital admissions. While a significant healthcare concern, few studies have analysed inpatient suicides in general and psychiatric hospital units. Understanding these deaths is important for informing future prevention initiatives. Here we investigate a national sample (n = 367) of inpatient suicides in general (24%, n = 87) and psychiatric (76%, n = 278) hospital units. Patient characteristics, suicide location, timing, and suicide methods were assessed and compared. Patients who died from suicide were mostly male and admitted into psychiatric units. General hospital patients were less likely to have a known history of mental illness or previous self-harm and were often admitted for mental illness-related presentations. Suicides frequently occurred outside of the hospital by hanging. Patients in psychiatric units were more likely to be on approved leave at their death, and general patients were more likely to have absconded. These results indicate the need to identify risk factors relevant to each setting and address broader system-level factors. Removing obvious ligature points, preventing absconding, and assessing patients before episodes of leave, could contribute to preventing inpatient suicides

The experiences of Aboriginal and Torres Strait Islander Bachelor of Midwifery students : an integrative literature review

Issue: There is an underrepresentation of Aboriginal and Torres Strait Islander midwives across Australia and an inadequate number of graduating midwives to redress this. A major pillar for the Birthing on Country Model is maternity care workforce development. Aim: The purpose of this review is to examine the enablers and barriers that Aboriginal students experience while undertaking the Bachelor of Midwifery degree in Australia. Methods: A search of the literature was undertaken through electronic databases. When only three papers were found looking at the experiences of Aboriginal midwifery students the search was broadened to include Aboriginal undergraduate health students. Findings: The literature review reported a strong need for cultural safety in both the clinical and education systems. Students with access to cultural supports, relationships with Aboriginal mentors and academics and Aboriginal clinical placements felt empowered and were able to navigate the ‘two worlds’ in a meaningful way. Discussion: This review highlights a significant gap in the literature. Despite the expanded search terms to include Aboriginal health students, a relatively narrow range of papers were found. Interestingly, the combined search revealed similar themes: kinship, personal factors, and cultural issues. Conclusion: Empowering and supporting Aboriginal Peoples to become midwives is essential. While systems and societies aim for cultural safety, this review shows there is still a way to go. Further research is essential to decolonise higher education and health care systems, and provide strong, well supported pathways for Aboriginal midwifery students

Factors influencing Aboriginal and Torres Strait Islander women's breastfeeding practice:A scoping narrative review

BACKGROUND: The nutritional and health benefits of breastfeeding for infants and young children are well-established however rates of breastfeeding initiation and duration for Aboriginal and Torres Strait Islander children are lower than non-Indigenous children. AIM: To describe factors influencing breastfeeding practice amongst Aboriginal and Torres Strait Islander women. METHODS: A scoping narrative review was conducted using the Joanna Briggs Institute framework. A search was conducted in four online databases (PubMed, Scopus, ANU SuperSearch, and Science Direct). Findings were analysed using [30] narrative synthesis. FINDINGS: This review included 9 journal articles, a conference summary and a book. This review identified four factors influencing women's breastfeeding practice; sources of support, culturally appropriate care, intention to breastfeed and social determinants. CONCLUSION: Multiple social determinants resulting from colonization have interrupted traditional infant feeding practices and women's sources of support. Although Aboriginal and Torres Strait Islander women have strong intention to breastfeed, their breastfeeding outcomes are impacted by lack of pro-breastfeeding support when encountering breastfeeding challenges as well as norms surrounding the use of infant formula milk. Culturally appropriate care is essential for identifying women's needs and avoiding stereotyping. Further research is needed to investigate the effectiveness of breastfeeding interventions for this group of women

Implementing midwifery continuity of care models in regional Australia : a constructivist grounded theory study

Problem/background: Strong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings. Aim: To develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings. Methods: A Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants. Results: Three concepts of theory emerged: ‘engaging the gatekeepers’, ‘midwives lacking confidence’ and ‘women rallying together’. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models. Discussion: The findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives’ reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers. Conclusion: Implementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits

The impact of three-dimensional visualisation on midwifery student learning, compared with traditional education for teaching the third stage of labour: A pilot randomised controlled trial

Background: Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Aim: To investigate the impact of using three-dimensional (3D) visualisation in midwifery education on student\u27s experience of learning, and retention of knowledge at three points in time. Design: A pilot study involving a two-armed parallel Randomised Controlled Trial (RCT) comparing the retention of knowledge scores between the control and intervention groups. Setting: An Australian University in the Northern Territory. Participants: The sample included second year Bachelor of Midwifery students (n = 38). All received traditional midwifery education before being randomly allocated to either the intervention (n = 20) or control (n = 18) group. Methods: A new immersive virtual environment was introduced to complement existing traditional midwifery education on the third stage of labour. This intervention was evaluated using a demographic survey and multiple-choice questionnaire to collect baseline information via Qualtrics. To measure change in knowledge and comprehension, participants completed the same multiple-choice knowledge questionnaire at three time points; pre, immediately post and at 1 month post intervention. In addition, the intervention group completed a 3D student satisfaction survey. Results: Baseline knowledge scores were similar between the groups. A statistically significant increase in knowledge score was evident immediately post intervention for the intervention group, however there was no significant difference in knowledge score at one month. Conclusions: The results support the creation of further three-dimensional visualisation teaching resources for midwifery education. However, a larger randomised controlled study is needed to seek generalisation of these findings to confirm enhanced student learning and retention of knowledge post 3DMVR, beyond the immediate exposure time

The motivation and capacity to go ‘above and beyond’ : qualitative analysis of free-text survey responses in the M@NGO randomised controlled trial of caseload midwifery

Objective to explore whether women allocated to caseload care characterise their midwife differently to those allocated to standard care. Design multi-site unblinded, randomised, controlled, parallel-group trial. Setting the study was conducted in two metropolitan teaching hospitals across two Australian cities. Population women of all obstetric risk were eligible to participate. Inclusion criteria were: 18 years or older, less than 24 week's gestation with a singleton pregnancy. Women already booked with a care provider or planning to have an elective caesarean section were excluded. Interventions participants were randomised to caseload midwifery or standard care. The caseload model provided antenatal, intrapartum and postnatal care from a primary midwife or ‘back-up’ midwife; as well as consultation with obstetric or medical physicians as indicated by national guidelines. The standard model included care from a general practitioner and/or midwives and obstetric doctors. Measurements and findings participants’ responses to open-ended questions were collected through a 6-week postnatal survey and analysed thematically. A total of 1748 women were randomised between December 2008 – May 2011; 871 to caseload midwifery and 877 to standard care. The response rate to the 6-week survey including free text items was 52% (n=901). Respondents from both groups characterised midwives as Informative, Competent and Kind. Participants in the caseload group perceived midwives with additional qualities conceptualised as Empowering and ‘Endorphic’. These concepts highlight some of the active ingredients that moderated or mediated the effects of the midwifery care within the M@NGO trial. Key conclusion caseload midwifery attracts, motivates and enables midwives to go Above and Beyond such that women feel empowered, nurtured and safe during pregnancy, labour and birth. Implications for practice the concept of an Endorphic midwife makes a useful contribution to midwifery theory as it enhances our understanding of how the complex intervention of caseload midwifery influences normal birth rates and experiences. Defining personal midwife attributes which are important for caseload models has potential implications for graduate attributes in degree programs leading to registration as a midwife and selection criteria for caseload midwife positions

Why Aboriginal women want to avoid the biomedical system : Aboriginal and Torres Strait Islander women's stories

In this chapter, four Aboriginal women tell stories about their births, their choices and the racism and abuse they received. They discuss the importance of culturally sensitive care and how this keeps women both culturally and physically safe. Some made choices (such as to homebirth) to protect themselves and their babies, and to ensure they received the care they needed. Some were failed badly by the system and tell a story of trauma and pain. Others are driving forces behind setting up services to help Aboriginal women reclaim their cultural rights in maternity care. Birthing on Country is one way this is happening in Australia. In some ways, birthing in the biomedical model for Aboriginal women is, as Dea states above, birthing outside the system. Birthing on Country is a way to place birth within the Aboriginal system again, combining cultural safety as a central principle with the added support of the medical care when needed