Implementing Birthing on Country Services for Aboriginal and Torres Strait Islander Families - Management Assignment Help

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Birthing on Country is an international movement to return maternity services to First Nations communities and community control for improved health and wellbeing. Question: How can we implement Birthing on Country services for Aboriginal and/or Torres StraitIslander families across Australia? Methods: We have developed a framework from theoretical, policy and research literature on Birthing on Country; Aboriginal and Torres Strait Islander voices from across Australia; reviews exploring programs that have improved outcomes for Indigenous mothers and infants; and the retrospective synthesis of learnings from two empirical studies that have redesigned maternal infant health services and improved outcomes for Aboriginal and Torres Strait Islander families. Results: The RISE Framework has four pillars to drive important reform:(1) Redesign the health service;(2) Invest in the workforce; (3) Strengthen families; and, (4) Embed Aboriginal and/or Torres Strait Islander community governance and control.We presentthe evidence base for eachpillarand practicalexamples of moving from the standard ‘western’ model of maternity care towards Birthing on Country services. Conclusions: Application of the RISE framework to plan, develop and monitor Birthing on Country services is likely to result in short and long-term health gains for Aboriginal and Torres Strait Islander families. © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Current maternity services in Australia Maternity services are highly centralised and medicallydominated. Only~8.0% Australian birthing women receive continuity of midwifery carer,14 only 1.8% of births occur in a Birth Centre each year and only 0.3% of women have a homebirth8 ; despite high-level evidence supporting these services.15,16 There is no data to report the number of Aboriginal and/or Torres Strait Islander women accessing these services; and there are no Aboriginal or Torres Strait Islander Birth Centres operating in Australia today. Closure of maternity services across Australia is correlated with increasing rates of babies being born before arrival to hospital17; and has resulted in many remote, and some rural communities, being left without resident midwives or doctors with maternity skills. These closures disproportionately impact Aboriginal and/or Torres StraitIslander women,18 who are 14 times more likely to live in remote locations than non-Aboriginal women (21% of birthing women compared to 1.5%, respectively),8 with approximately onefifth of all Indigenous women living more than one hour’s drive from the nearest birthing facility.19 Women who live in remote and rural areas are often required to relocate from community and families for birth, traditional midwives and cultural birthing practices are rarely accommodated in birthing rooms, and many women report culturally unsafe care.2,3,10,13,20–22 Women may reduce antenatal visits, to avoid being evacuated from their community for birth.23 Women do not make these decisions lightly, often weighing up the risks of leaving their other (sometimes breastfeeding) children behind, being removed from family and culture, and worrying that child protection agencies will place their children into out of home care.23,24 Poor integration across tertiary and primary care also places women at risk.25 Maternal death rates are 4.6 times higher in Aboriginal and/or Torres Strait Islander women compared to non-Indigenous women,7 with avoidable risk factors contributing to this statistic including: poor communication, failing to accommodate culturally safe practices, a lack of interpreters or Aboriginal health workers/ liaison staff, multiple unlinked information systems and delays in care.26,27 Perinatal indicators highlight an urgent need for innovation and redesign, and include: preterm birth rates of 136% for Indigenous women compared to 8.4% for non-Indigenous women and perinatal deaths that are 1.7 times higher.

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