Picture of the health status of Aboriginal children living in an urban setting of Sydney.

Objectives The aims of the present study were to: (1) describe the health status and health indicators for urban Aboriginal children (age 0-16 years) in south-east Sydney; and (2) evaluate the quality of routinely collected clinical data and its usefulness in monitoring local progress of health outcomes. Methods Aboriginal maternal and child health routine data, from multiple databases, for individuals accessing maternal and child health services between January 2007 and December 2012 were examined and compared with state and national health indicators. Results Reductions in maternal smoking, premature delivery and low birthweight delivery rates were achieved in some years, but no consistent trends emerged. Paediatric services had increased referrals each year. The most frequent diagnoses were nutritional problems, language delay or disorder and developmental delay or learning difficulties. Twenty per cent of children had a chronic medical condition requiring long-term follow-up. Aboriginal children were more likely to be discharged from hospital against medical advice than non-Aboriginal children. Routinely collected data did not include some information essential to monitor determinants of health and health outcomes. Conclusions Aboriginal children living in this urban setting had high levels of need. Routinely recorded data were suboptimal for monitoring local health status and needed to reflect national and state health indicators. Routinely collected data can identify service gaps and guide service development. What is known about this topic? Despite improvements in some areas, there continue to be significant gaps in maternal and child health outcomes between Aboriginal and non-Aboriginal Australians. These are poorly documented at a local service level. What does this paper add? Intensive, local services offered to Aboriginal women and children can result in rapid service engagement. Health service data routinely collected by local services can be used to demonstrate reductions in antenatal risk factors in pregnant Aboriginal women, even within the short time frame of 6 years. However, improvements in child health outcomes may require longer time frames. In this urban setting, the most frequent diagnoses in Aboriginal children attending the service were nutritional problems, language delay or disorder and developmental delay or learning difficulties. What are the implications for practitioners? Key information regarding determinants of health should be routinely monitored at a local level to understand local rates and health needs in addition to evaluating and quantifying the effectiveness of service delivery or health promotion activities.

The St. George Homebirth Program: an evaluation of the first 100 booked women.

BACKGROUND: The St. George Homebirth Program was the first publicly funded homebirth model of care set up in New South Wales. This program provides access to selected women at low obstetric risk the option of having their babies at home. There are only four other publicly funded homebirth programs operating in Australia. AIMS: To report the outcomes of the first 100 women booked at the St. George Homebirth Program. METHODS: A prospective descriptive study was undertaken. Data were collected on the first 100 women who gave birth between November 2005 and March 2009. Two databases were accessed and missing data were followed up by review of the relevant charts. RESULTS: Of the first 100 booked women, 63 achieved a homebirth, 30 were transferred to hospital or independent midwifery care in the antenatal period and seven were transferred intrapartum. Two women were transferred to hospital in the early postnatal period, one for a postpartum haemorrhage and one for hypotension. One baby suffered mild respiratory distress, was treated in the emergency department and was discharged home within four hours. CONCLUSION: The St. George Hospital homebirth program has provided reassuring outcomes for the first 100 women it has cared for over the past four years. Wider availability of this service could be achieved provided there is the appropriate close collaboration between providers and effective processes for consultation, referral and transfer. The outcomes of women and babies in publicly funded homebirth programs deserve further study, and the development of a national prospective database of all planned homebirth would contribute to this knowledge.

Evaluation of an Australian Aboriginal model of maternity care: The Malabar Community Midwifery Link Service.

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.

What do midwives fear?

BACKGROUND: There is evidence that a significant number of women are fearful about birth but less is known about the fears of maternity health providers and how their fear may impact on the women they care for. AIM: The aim of this study was to determine the top fears midwives in Australia and New Zealand hold when it comes to caring for childbearing women. METHOD: From 2009 to 2011, 17 workshops were held in Australia and New Zealand supporting over 700 midwives develop skills to keep birth normal. During the workshop midwives were asked to write their top fear on a piece of paper and return it to the presenters. Similar concepts were grouped together to form 8 major categories. FINDINGS: In total 739 fears were reported and these were death of a baby (n=177), missing something that causes harm (n=176), obstetric emergencies (n=114), maternal death (n=83), being watched (n=68), being the cause of a negative birth experience (n=52), dealing with the unknown (n=36) and losing passion and confidence around normal birth (n=32). Student midwives were more concerned about knowing what to do, while homebirth midwives were mostly concerned with being blamed if something went wrong. CONCLUSION: There was consistency between the 17 groups of midwives regarding top fears held. Supporting midwives with workshops such as dealing with grief and loss and managing fear could help reduce their anxiety. Obstetric emergency skills workshops may help midwives feel more confident, especially those dealing with shoulder dystocia and PPH as they were most commonly recorded.

'It's more than just having a baby' women's experiences of a maternity service for Australian Aboriginal and Torres Strait Islander families.

OBJECTIVE: the Malabar Community Midwifery Link Service was developed to meet the needs of women from Aboriginal and Torres Strait Islander communities in suburban Sydney, Australia. This paper reports the evaluation from the perspective of the Aboriginal and Torres Strait Islander women who accessed the service. METHODS: a descriptive study using quantitative and qualitative approaches was undertaken for the first two years of the service. Clinical outcomes for women who gave birth in 2007 and 2008 were collected prospectively. A focus group with Aboriginal and Torres Strait Islander women was conducted, then tape recorded, transcribed verbatim and analysed qualitatively. FINDINGS: 353 women gave birth through the Malabar service during 2007 and 2008. Over 40% of the babies born were identified as Aboriginal and Torres Strait Islander. Almost all the women had their first antenatal visit before 20 weeks of pregnancy. The service was successful in reducing the number of women smoking cigarettes during pregnancy. Women felt the service provided ease of access, continuity of care and caregiver, trust and trusting relationships. CONCLUSIONS: the Malabar service is an excellent example of a primary health care model of care that is meeting the needs of the community. Improving maternal and neonatal outcomes takes considerable time as the underlying causes of the disparities are complex. IMPLICATIONS: further research into ways to ensure that services like Malabar can address issues like smoking in pregnancy and the range of social and emotional issues faced by Australian Aboriginal and Torres Strait Islander women and families needs to be undertaken. More community-based appropriate services should be developed for these families.

Birth centers in Australia: a national population-based study of perinatal mortality associated with giving birth in a birth center.

BACKGROUND: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in "alongside hospital" birth centers in Australia during 1999 to 2002 using nationally collected data. METHODS: This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. RESULTS: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. CONCLUSIONS: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother's parity.