That’s how hospitals can do better’: Shaping Maternity Care for First Nations Mums and Bubs

Introduction: The aim of this project was to identify ways maternity services can meet the needs of Aboriginal and Torres Strait Islander families. Specifically, focussing on what is important to mums and bubs before, during and after bubs birth, particularly in birthing facilities that do not offer a Birthing On Country model of care.

Background: Evidence highlights the need for a global shift to provide culturally safe and unbiased healthcare. Engaging consumers is essential to this process. This research was instigated in response to feedback from Aboriginal and Torres Strait Islander women who birthed in mainstream maternity services in South Australia, and organisational desire to meet the needs and enhance the experiences of these families.

Method: Qualitative data were collected from thirteen participants who identified as Aboriginal or Torres Strait Islander or who were carrying an Aboriginal or Torres Strait Islander baby. A knowledge interface methodology employing yarning was used for data collection. A novel culturally safe data analysis method ensuring cultural continuity in data analysis was utilised.

Key Findings: All participants acknowledged the ‘colonial load they carry’ and suggested ways of addressing this within maternity services, which included health systems engagement with communities to tackle racism and culturally unsafe practices. They also proposed strategies to support families to ‘feel safe’ within maternity services, which included involvement of family members. Most acknowledged that ‘many non-Aboriginal staff wanted to help, but did not know how’ and identified community involvement in educational practices that could address this. Many identified previous experiences of themselves, or family members influenced their current negative feelings of ‘dreading birthing in such a system’ highlighting that authentic change would take time and innovative practices, which they were willing to contribute to. Most stated that a Midwifery Continuity of Care Model for Aboriginal and Torres Strait Islander women would address many of their concerns.

Overall participants contributed practical and systemic interventions that in their opinion could make maternity services safer, more culturally welcoming, and improve the experience for Aboriginal and Torres Strait Islander service users. Participants highlighted issues caused by medical evacuation from rural and remote areas, and while these may be outside the remit of the mainstream health system, suggested that better communication between health care and other agencies could improve the experience of medical evacuation for women and their families.

Conclusion: Participants provided actionable recommendations for what needs to change in mainstream health and maternity care. There was a strong feeling among participants that Aboriginal and Torres Strait Islander women deserve better care.