Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women.

BACKGROUND: The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. METHOD: A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus-driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. FINDINGS: Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women-centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. CONCLUSIONS: Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman-centered care models as a means of addressing racism in health care.

Disability "In-Justice": The Benefits and Challenges of "Yarning" With Young People Undergoing Diagnostic Assessment for Fetal Alcohol Spectrum Disorder in a Youth Detention Center.

Undertaking research with young people presents an array of methodological challenges. We report the findings from a qualitative study that took place alongside a fetal alcohol spectrum disorder (FASD) prevalence study among detainees in Australia. Of 38 participants, 27 were Aboriginal youth. Interviews were conducted using "social yarning" and "research topic yarning," an Indigenous research method which allows for data collection in an exploratory, culturally safe way. A complex interplay emerged between social yarning and research topic yarning which provided a space to explore responsively with participants their experiences of FASD assessments. Flexibility, including language adaptation and visual descriptions about assessments, was utilized to assist participants recall and retell their experiences. There were, however, challenges in gathering data on the assessment experiences of some participants. We describe how employing a "yarning" method for collecting data could benefit children and young people undergoing neurodevelopmental assessments in the future.

Maternity-care: measuring women's perceptions.

PURPOSE: Achieving maternity-care outcomes that align with women's needs, preferences and expectations is important but theoretically driven measures of women's satisfaction with their entire maternity-care experience do not appear to exist. The purpose of this paper is to outline the development of an instrument to assess women's perception of their entire maternity-care experience. DESIGN/METHODOLOGY/APPROACH: A questionnaire was developed on the basis of previous research and informed by a framework of standard service quality categories covering the spectrum of typical consumer concerns. A pilot survey with a sample of 195 women who had recent experience of birth was undertaken to establish valid and reliable scales pertaining to different stages of maternity care. Exploratory factor analysis was used to interpret scales and convergent validity was assessed using a modified version of the Client Satisfaction Questionnaire. FINDINGS: Nine theoretically informed, reliable and valid stand-alone scales measuring the achievement of different dimensions of women's expectancies of public maternity care were developed. The study scales are intended for use in identifying some potential areas of focus for quality improvement in the delivery of maternity care. RESEARCH LIMITATIONS/IMPLICATIONS: Reliable and valid tools for monitoring the extent to which services respond to women's expectations of their entire maternity care form part of the broader toolkit required to adequately manage health-care quality. This study offers guidance on the make-up of such tools. ORIGINALITY/VALUE: The scales produced from this research offer a means to assess maternity care across the full continuum of care and are brief and easy to use.

Development of a scale to evaluate midwives' beliefs about assessing alcohol use during pregnancy.

BACKGROUND: Prenatal alcohol exposure is an important modifiable cause of adverse fetal outcomes during and following pregnancy. Midwives are key providers of antenatal care, and it is important to understand the factors which influence their ability to provide appropriate advice and support to women about alcohol use in pregnancy. The main aim of this study was to develop a psychometrically valid scale to evaluate midwives' beliefs about assessing alcohol use during pregnancy. METHOD: A self-administered questionnaire was developed to evaluate midwives' beliefs about assessing alcohol use during pregnancy, including beliefs about positive and negative consequences of asking about alcohol use, and beliefs about capacity to assess alcohol use. The questionnaire was sent to 245 midwives working for a state-wide country health service in Western Australia. Exploratory factor analysis was used to identify the latent constructs assessed by the 36 belief items and provide initial construct validation of the Asking About Alcohol (AAA) Scale. RESULTS: Of the 166 (67.8 %) midwives who responded to the survey, 160 (96.4 %) completed one or more of the belief items and were included in this analysis. Factor analysis identified six subscales which assessed beliefs about discomfort, capacity, effectiveness, role, trust and knowledge. Midwives held the most positive beliefs about their capacity to ask and the effectiveness of asking about alcohol use, and the least positive beliefs about women's knowledge about alcohol use and discomfort associated with asking about alcohol use in pregnancy. Midwives' beliefs about their role and the effectiveness of asking were most strongly associated with the intention to ask all pregnant women about alcohol use during pregnancy (r = -0.59, p < 0.001 and r = -0.52, p < 0.001). CONCLUSIONS: Our analysis has identified key constructs underlying midwives' beliefs about the assessment of alcohol use during pregnancy. The AAA Scale provides a basis for improved clarity and consistency in the conceptualisation and measurement of midwives' beliefs which can be used to enhance our understanding of factors influencing midwives' ability to deliver interventions to prevent alcohol use during pregnancy. The constructs identified in this exploratory analysis require confirmatory analysis to support their validity and generalizability.

Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder.

BACKGROUND: Midwives are an influential profession and a key group in informing women about alcohol consumption in pregnancy and its consequences. There are no current quantitative Australian data on midwives' knowledge, attitudes and practice in relation to alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorder. We aimed to reduce this knowledge gap by understanding midwives' perceptions of their practice in addressing alcohol consumption during pregnancy. METHODS: This cross-sectional study was conducted at 19 maternity sites across the seven health regions of country Western Australia. A questionnaire was designed following review of the literature and other relevant surveys. Midwifery managers of the maternity sites distributed questionnaires to all midwives working in their line of management. A total of 334 midwives were invited to participate in the research and (n = 245, 73.4%) of these were eligible. RESULTS: The response fraction was (n = 166, 67.8%). Nearly all (n = 151, 93.2%) midwives asked pregnant women about their alcohol consumption during pregnancy and (n = 164, 99.4%) offered advice about alcohol consumption in accordance with the Australian Alcohol Guideline, which states "For women who are pregnant or planning a pregnancy, not drinking is the safest option". Nearly two thirds (n = 104, 64.2%) of the midwives informed pregnant women about the effects of alcohol consumption in pregnancy, they did not always use the recommended AUDIT screening tool (n = 66, 47.5%) to assess alcohol consumption during pregnancy, nor conduct brief intervention when indicated (n = 107, 70.4%). Most midwives endorsed professional development about screening tools (n = 145, 93.5%), brief intervention (n = 144, 92.9%), and alcohol consumption during pregnancy and FASD (n = 144, 92.9%). CONCLUSION: Nearly all midwives in this study asked and advised about alcohol consumption in pregnancy and around two thirds provided information about the effects of alcohol in pregnancy. Our findings support the need for further professional development for midwives on screening and brief intervention. Policy should support midwives' practice to screen for alcohol consumption in pregnancy and offer brief intervention when indicated.

First Nations Peoples' perceptions, knowledge and beliefs regarding stillbirth prevention and bereavement practices: A mixed methods systematic review.

BACKGROUND: First Nations Peoples endure disproportionate rates of stillbirth compared with non-First Nations Peoples. Previous interventions have aimed at reducing stillbirth in First Nations Peoples and providing better bereavement care without necessarily understanding the perceptions, knowledge and beliefs that could influence the design of the intervention and implementation. AIM: The aim of this review was to understand the perceptions, knowledge and beliefs about stillbirth prevention and bereavement of First Nations Peoples from the US, Canada, Aotearoa/New Zealand, and Australia. METHODS: This review was conducted in accordance with the JBI methodology for a convergent integrated mixed method systematic review. This review was overseen by an advisory board of Aboriginal Elders, researchers, and clinicians. A search of eight databases (PubMed, MEDLINE, PsycInfo, CINAHL, Embase, Emcare, Dissertations and Theses and Indigenous Health InfoNet) and grey literature was conducted. All studies were screened, extracted, and appraised for quality by two reviewers and results were categorised, and narratively summarised. RESULTS: Ten studies were included within this review. Their findings were summarised into four categories: safeguarding baby, traditional practices of birthing and grieving, bereavement photography and post-mortem examination. The results indicate a diversity of perceptions, knowledge and beliefs primarily around smoking cessation and bereavement practices after stillbirth. However, there was a paucity of research available. CONCLUSIONS: Further research is needed to understand the perceptions, knowledge and beliefs about stillbirth among First Nations Peoples. Without research within this area, interventions to prevent stillbirth and support bereaved parents and their communities after stillbirth may face barriers to implementation.

The availability and delivery of culturally responsive Australian Aboriginal infant resuscitation education programmes: a structured literature review.

AIM: To critically appraise the literature to determine availability and identify the cultural responsiveness of infant resuscitation education for Aboriginal and Torres Strait Islander populations. BACKGROUND: Despite overall reductions in infant mortality in the last two decades, Aboriginal people have some of the highest rates of infant mortality of any developed nation. One of the key factors that has attributed to improvements in infant mortality rates is parent and carer education around risk factors and actions of first responders. Identifying gaps in the current basic first-aid initiatives available to Aboriginal communities may contribute to developing resources to contribute to reductions in Aboriginal neonatal mortality rates. METHOD: The review used key terms and Boolean operators across an 11-month time frame searching for research articles utilising the databases of CINAHL, Scopus, Ovid Emcare, Informit, Pubmed and Proquest. After review, 39 articles met the inclusion criteria, 25 articles were discarded due to irrelevant material and 14 articles were included in the structured literature review. The search process was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Articles were assessed for validity and inclusion using the Critical Appraisal Skills Program checklist. RESULTS: Research literature relating to First Nation community-based CPR and first-aid education programmes in Canada, USA, India, UK and Europe, Asia and Africa were identified; however, none pertaining specifically to CPR and first-aid education in Australian Aboriginal communities were found. DISCUSSION: Despite the lack of research evidence relating to infant cardiopulmonary resuscitation (CPR) education for Australian Aboriginal populations, the reviewed studies noted the importance of culturally responsive education designed in collaboration with First Nation peoples, using novel ways of teaching CPR, that align with the language, culture and needs of the communities it is intended for. CONCLUSION: Further research is required to create a framework for the delivery of culturally responsive infant resuscitation education for Australian Aboriginal parents and communities.

The perinatal and childhood outcomes of children born to Indigenous women with mental health problems: A scoping review.

OBJECTIVE: Maternal mental health problems are common during the perinatal period and have been associated with several negative outcomes in children. However, few studies have examined the associations between maternal mental health problems and offspring outcomes among Indigenous people, and the findings across these studies have been inconsistent. This scoping review examined the birth and childhood (≤12 years) health and development outcomes of the children of Indigenous women with mental health problems. METHODS: A scoping review was conducted following the methodological framework developed by Arksey and O'Malley and based on the PRISMA-ScR guidelines. Eight databases were searched electronically for studies examining the associations between any perinatal maternal mental health problems and birth and childhood outcomes among the Indigenous populations of Australia, Canada, New Zealand, and the USA. Two authors reviewed studies for inclusion. A narrative synthesis approach was adopted. RESULTS: Of 2,836 records identified, 10 were eligible. One of three studies evaluating maternal depression and anxiety problems found a negative (adverse) association with birth and childhood behavioural outcomes. Six of seven studies that examined the associations between maternal substance use disorder (mainly alcohol use disorder) and several birth and childhood outcomes found at least one negative association. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Maternal substance use disorder appears to be associated with adverse birth and childhood outcomes among some Indigenous populations. However, there is preliminary evidence for the other common maternal mental health problems. Further research is critically required to draw definitive conclusions regarding the impact of maternal mental health problems on the birth and childhood outcomes.

Coupling Machine Learning Models with Innovative Technology-based Screening Tool for Identifying Psychological Distress among Aboriginal Perinatal Mothers.

Aboriginal perinatal mothers are at a significant risk of experiencing mental health problems, which can have profound negative impacts, despite their overall resilience. This work aimed to build prediction models for identifying high psychological distress among Aboriginal perinatal mothers by coupling machine learning models with an innovative and culturally-safe screening tool. The original dataset of 179 Aboriginal mothers with 337 variables was obtained from twelve perinatal health settings at Perth metropolitan and regional centers in Western Australia between July and September 2022, using a specifically designed web-based rubric for the perinatal mental health assessment. After data preprocessing and feature selection, 23 variables related to emotional manifestations, the problematic partner, worries about daily living, and the need for follow-up wraparound support were identified as significant predictors for the high risk of psychological distress measured by the Kessler 5 plus adaptation. The selected predictors were used to train prediction models, and most of the chosen machine learning models achieved satisfactory results, with Random Forest and Support Vector Machine yielding the highest AUC of over 0.95, accuracy over 0.86, and F1 score above 0.87. This study demonstrates the potential of using machine learning-based models in clinical decision-making to facilitate healthcare and social and emotional well-being for Aboriginal families.

First Nations populations' perceptions, knowledge, attitudes, beliefs, and myths about prevention and bereavement in stillbirth: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this review is to investigate First Nations populations' perceptions, knowledge, attitudes, beliefs, and myths about stillbirth. INTRODUCTION: First Nations populations experience disproportionate rates of stillbirth compared with non-First Nations populations. There has been a surge of interventions aimed at reducing stillbirth and providing better bereavement care, but these are not necessarily appropriate for First Nations populations. As a first step toward developing appropriate interventions for these populations, this review will examine current perceptions, knowledge, attitudes, beliefs, and myths about stillbirth held by First Nations people from the United States, Canada, Aotearoa/New Zealand, and Australia. INCLUSION CRITERIA: The review will consider studies that include individuals of any age (bereaved or non-bereaved) who identify as belonging to First Nations populations. Eligible studies will include the perceptions, knowledge, attitudes, beliefs, and myths about stillbirth among First Nations populations. METHODS: This review will follow the JBI methodology for convergent mixed methods systematic reviews. The review is supported by an advisory panel of Aboriginal elders, lived-experience stillbirth researchers, Aboriginal researchers, and clinicians. PubMed, MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), Emcare (Ovid), PsycINFO (EBSCOhost), Indigenous Health InfoNet, Trove, Informit, and ProQuest Dissertations and Theses will be searched for relevant information. Titles and abstracts of potential studies will be screened and examined for eligibility. After critical appraisal, quantitative and qualitative data will be extracted from included studies, with the former "qualitized" and the data undergoing a convergent integrated approach. REVIEW REGISTRATION: PROSPERO CRD42023379627.

It takes a village: Influencing policy and practice to prevent alcohol use in pregnancy and promote better outcomes for individuals living with Fetal Alcohol Spectrum Disorder.

Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by exposure to alcohol in utero. It has pervasive, lifelong impacts and is recognised as a major public health concern in many countries where alcohol is used. The FASD Research Australia Centre of Research Excellence (CRE) was funded by the National Health and Medical Research Council to generate and translate evidence to address prevention, diagnosis, and management of FASD in Australia. The current paper describes the approach to policy and practice impact taken by our CRE, including our stakeholder engagement processes and the key principles that underlie our approach. We provide examples of policy and practice influence in FASD prevention, diagnosis and management that have been achieved over the past five years and discuss challenges that are routinely faced in the translation of our work.

GP 'grand round' - a hospital tradition modified for general practice.

BACKGROUND: The hospital 'grand round' concept was applied to a general practice continuing professional development activity. Interactive learning sessions were developed to deliver evidence based medicine clinical education for general practitioners and general practice learners (registrars/medical students). The acceptability of the GP grand round format was examined through analysis of participant responses to learning objectives. OBJECTIVE: The article explores some of the issues associated with delivery of small group case based discussion. DISCUSSION: Evaluations demonstrated that participants in the grand round valued the opportunity to interact with other participants in a small group format, exchanged and shared knowledge and had their learning needs met. The overall quality of the learning experience for the majority of participants was either good or excellent. The application of vertically integrated continuing professional development through a grand round format appears acceptable and effective.

Antenatal services for Aboriginal women: the relevance of cultural competence.

BACKGROUND: Due to persistent significantly poorer Aboriginal perinatal outcomes, the Women's and Newborns' Health Network, Western Australian Department of Health, required a comprehensive appraisal of antenatal services available to Aboriginal women as a starting point for future service delivery modelling. A services audit was conducted to ascertain the usage frequency and characteristics of antenatal services used by Aboriginal women in Western Australia (WA). METHODS: Telephone interviews were undertaken with eligible antenatal services utilising a purpose specific service audit tool comprising questions in five categories: 1) general characteristics; 2) risk assessment; 3) treatment, risk reduction and education; 4) access; and 5) quality of care. Data were analysed according to routine antenatal care (e.g. risk assessment, treatment and risk reduction), service status (Aboriginal specific or non-specific) and application of cultural responsiveness. RESULTS: Significant gaps in appropriate antenatal services for Aboriginal women in metropolitan, rural and remote regions in WA were evident. Approximately 75% of antenatal services used by Aboriginal women have not achieved a model of service delivery consistent with the principles of culturally responsive care, with few services incorporating Aboriginal specific antenatal protocols/programme, maintaining access or employing Aboriginal Health Workers (AHWs). Of 42 audited services, 18 Aboriginal specific and 24 general antenatal services reported utilisation by Aboriginal women. Of these, nine were identified as providing culturally responsive service delivery, incorporating key indicators of cultural security combined with highly consistent delivery of routine antenatal care. One service was located in the metropolitan area and eight in rural or remote locations. CONCLUSION: The audit of antenatal services in WA represents a significant step towards a detailed understanding of which services are most highly utilised and their defining characteristics. The cultural responsiveness indicators used in the audit establish benchmarks for planning culturally appropriate antenatal services that may encourage Aboriginal women to more frequently attend antenatal visits.

Has a national policy guideline influenced the practice of raising the topic of alcohol and breastfeeding by maternal healthcare practitioners?

Globally, the public health recommendation for exclusive breastfeeding to the first 6 months of life is not being achieved by many low- and middle-income countries. Many factors have been determined to affect the early cessation of breastfeeding; however, little attention has been paid to the role of alcohol, an increasingly favoured commodity, particularly in these Westernised nations. Maternal healthcare practitioners play a pivotal role in a woman's breastfeeding journey by providing timely advice that can help support continued breastfeeding. Maternal healthcare practitioners (MHP) from across Australia were invited to take part in a semi-structured telephone interview (n = 19) to elicit their knowledge of a national alcohol policy guideline on alcohol and breastfeeding, their confidence to provide information on this topic, and if they were routinely incorporating conversations on alcohol and breastfeeding into their practice. The results affirmed that the majority of MHP were not aware of the national policy providing direction for safely consuming alcohol during lactation and were not incorporating this information into their practice. This study suggests having a national policy guideline for safe alcohol consumption during lactation has not promoted awareness of this topic among MHP as a potential strategy to support long-term breastfeeding duration.

"Our culture, how it is to be us" - Listening to Aboriginal women about on Country urban birthing.

BACKGROUND: Birth on Country is often assumed as relevant to Aboriginal women in rural/remote locations and not usually associated with urban environments. In Western Australia, one third of the Aboriginal population live in the greater metropolitan area. We wanted to know Aboriginal women's experiences of on Country urban births. METHODS: Indigenous qualitative data collection and analysis methods were used to learn about Aboriginal women's stories of contemporary and past experiences of maternity care and cultural practices associated with Birth on Country. RESULTS: Aboriginal Birthing, Senior and Elder women consistently reported ongoing cultural practices associated with childbirth including knowledge sharing across generations and family support, observance of extended family present at the time of or shortly after birth, and how their cultural security was improved when Aboriginal staff were present. Also noted, were the inflexibility of health systems to meet their needs and midwives lack of cultural awareness and understanding of the importance of Aboriginal kinship. CONCLUSION: The Birthing on Noongar Boodjar project Aboriginal women's data represents four generations of women's stories, experiences and expressions of childbearing, which highlighted that maternity care changes across time have failed to acknowledge and support Aboriginal women's cultural needs during childbearing. In terms of on Country urban birth, the women collectively expressed a strong desire to maintain cultural practices associated with childbirth, including birthing close to home (on Country); having family acknowledged and included throughout the perinatal period; and, having access to Aboriginal midwives, nurses, doctors, and other health care workers to support their cultural security.

Cultural security in the perinatal period for Indigenous women in urban areas: a scoping review.

BACKGROUND: Culturally secure care is considered foundational for good perinatal outcomes for Indigenous women. It is unknown what literature reports on whether Indigenous women giving birth in urban areas receives appropriate cultural care. The aim of this scoping review was to examine and summarise relevant evidence which reports on culturally secure care for Indigenous women using urban maternity services at any time during the perinatal period. METHODS: Ten journal databases plus grey literature and theses databases were searched for relevant material dated 1986-2018. Articles were included if they were about Indigenous women from Australia, New Zealand, Canada or the USA; care was provided anytime during the perinatal period, in an urban area; and cultural security (or variations of this term) were used. RESULTS: 6856 titles and abstracts were screened, of these: 25 studies, 15 grey literature documents and 9 theses matched the search criteria. Studies were mostly qualitative (13/25) and from Australia (18/25). Studies showed women's access to and experiences of culturally secure maternity care in urban areas as variable. The grey literature originated from Australia (8/15); New Zealand (4/15); and Canada (3/15); while theses were from Canada (7/9) and Australia (2/9). CONCLUSION: The scoping review results showed substantial qualitative evidence on Indigenous women's experience during the perinatal period in urban areas. In-depth analysis of these studies is required to inform future practice and policy on what works and what needs improvement. Culturally secure midwifery care shows promising results.

How to conduct effective skill building workshops.

Skill building workshops need to be successful learning events that provide value for money. The strategies in this article are based on a review of the literature and evaluations received from workshop participants who have attended the many workshops conducted as part of the Primary Health Care Research Evaluation and Development (PHCRED) strategy.

A Novel Approach to Transforming Smoking Cessation Practice for Pregnant Aboriginal Women and Girls Living in the Pilbara.

Tobacco smoking during pregnancy contributes to a range of adverse perinatal outcomes; but is a potentially modifiable behavior. In Australia Aboriginal and Torres Strait Islander women face a range of barriers that hinder; rather than support smoking cessation. Few smoking cessation programs consider the broader social determinants of women's lives; the gendered nature of these or the complexities which impinge on behavior change in the presence of social and economic disadvantage and substantial individual and intergenerational trauma. Drawing on the salient gender and trauma-informed literature this paper describes the rationale underpinning formative research which will inform the design of a localized, culturally meaningful smoking cessation program for Aboriginal women living in the Hedland and Western Desert communities of the remote Pilbara region of Western Australia. We contend that a women-centered, trauma-informed approach to smoking cessation has much to offer those seeking to address this critical public health issue.

From Consultation to Application: Practical Solutions for Improving Maternal and Neonatal Outcomes for Adolescent Aboriginal Mothers at a Local Level.

Adolescent pregnancy has been typically linked to a range of adverse outcomes for mother and child. In Australia, Aboriginal and Torres Strait Islander women have a higher proportion of adolescent births compared with other adolescent Australian women, and are at greater risk of poorer psychosocial and clinical outcomes if they are not well supported during pregnancy and beyond. Drawing on existing literature and consultations with young Aboriginal women and health professionals supporting pregnant Aboriginal women in Western Australia, this paper discusses the importance of creating models of antenatal care using a "social determinants of health" framework. Destigmatizing young parenthood and providing continuity of caregiver in culturally safe services, with culturally competent health professionals provides a means to encourage engagement with the health system and improve health outcomes for young mothers and their babies.