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Bingji Bingji Booris: An Indigenous Maternity Model of Care

Project Added:
1 December 2015
Last updated:
3 December 2015

Bingji Bingji Booris: An Indigenous Maternity Model of Care

Summary

This project encourages Indigenous women to visit the Aboriginal Maternal Infant Health Service (AMIHS) during their first trimester of pregnancy, to enable a discussion of care choices, early screening, interventions, referrals and support. It also delivers training, support and clinical supervision of staff, to ensure they provide culturally-appropriate care at all times.

View a poster of this project from the Centre for Healthcare Redesign graduation, December 2015.

Bingji Bingji Booris poster

Aim

To develop a culturally-appropriate maternity model of care for the AMIHS, so women receive continuity of care from their first trimester to two weeks after birth.

Benefits

  • Improves continuity of care.
  • Improves engagement between women and maternity staff.
  • Give women confidence in the health service, so they will choose to return in the future.
  • Provides safe, effective, culturally-appropriate and women-centred care.
  • Increases appropriate consultations and referrals.
  • Provides better health screening and outcomes for women and babies.
  • Increases the number of women breastfeeding at the time of discharge from hospital.
AMIHS staff and pregnant women
  • Reduces smoking, illicit drugs and alcohol in women during pregnancy.
  • Reduces costs of emergency care such as transfers to tertiary services.
  • Improves the confidence and satisfaction of maternity staff working with AMIHS consumers.
  • Improves staff retention and provides back-filling during staff leave, to improve continuity of care.
  • Supports key Commonwealth and local health district performance indicators in relation to maternity continuity of care programs.

Project status

Key dates

  • Project started:  13 March 2015

Status

Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.

Background

The Eurobodalla Shire on the south coast of NSW has an average of 318 births a year. 29.4% of women admitted to the Moruya Maternity Service identify as Aboriginal and Torres Strait Islander or have babies that will have Aboriginal Torres Strait Islander heritage. The AMIHS provides care for approximately 53 women a year, with the number increasing each year.

Historically, the choices for maternity care included the AMIHS team for pregnancy care, Moruya Hospital for labour and birth care and Building Strong Foundations program for Aboriginal postnatal care. Women also visited medical officers, specialist obstetricians, midwives clinics, adolescent pregnancy programs such as ‘Hatched’, allied health services and mental health, drug and alcohol programs.

Aboriginal and Torres Strait Islander women often found it confronting to repeat their personal stories to multiple care providers who did not have the cultural awareness or sensitivities required to support their needs.  As a result, there was a reluctance to access healthcare services early in their pregnancy, which impacted health outcomes.

In addition, many of these women had social and emotional wellbeing issues, with complex histories related to trauma and generational trauma. The care environment was often culturally-inappropriate and the language used by staff was sometimes discriminating towards AMIHS women and families. The clinical language used was often not understood by Aboriginal and Torres Strait Islander women, which compounded when emergency presentations occurred.

Prior to the project, Aboriginal and Torres Strait Islander women were not consulted about cultural practices, such as taking placentas home. A number of complaints about the AMIHS service were reported and discussed with the women, however these complaints were not formally progressed as the women were concerned that their care could be compromised by causing trouble. These incidents often occurred many months after the episode of care, when women felt more confident in talking about the issue.

Implementation 

  • Promoted AMIHS and value of early access to maternity care via Facebook posts and advertising.
  • Increased communication with local general practitioners about AMIHS and value of services to Aboriginal and Torres Strait Islander women.
  • Incorporated culturally-appropriate services in local clinical pathways, such as diabetes screening and kidney health checks, with staff education to ensure compliance.
  • Maternity clinicians completed mandatory ‘Respecting the Difference’ training and e-learning through Health Education and Training Institute (HETI) NSW, with appropriate supervision to support clinicians.
Plaster body cast painting session
  • Created a standing expression of interest for relief of clinical staff at AMIHS, while they are on leave.
  • Aboriginal Family Violence Core Training to be introduced in March 2016.
  • Developed ‘Cultural Competency Checklist’ to improve the aesthetics of the maternity service.
  • Applied for funding through New Directions, to support AMIHS program and grow workforce.
  • Collaborated with women and families by encouraging participation in intake meetings and perinatal reviews.

Implementation sites

  • Aboriginal Maternal Infant Health Services (AMIHS)
  • Eurobodalla Community Health Centres
  • Katungul Aboriginal Medical Services
  • General practitioners in Eurobodalla Shire 

Partnerships

  • University of Wollongong
  • South Eastern NSW Primary Health Network
  • Katungul Aboriginal Medical Services
  • Perinatal Services Network

Results

  • $275,000 was received by the NSW Ministry of Health for refurbishing accommodation.
  • All maternity and AMIHS staff have undertaken the HETI e-learning or 'Respecting the Difference' training with 100% compliance.
  • Facebook advertising highlighted the importance of early access to maternity care and has received high levels of engagement.
  • New Directions funding for Allied Health support is currently in the process of being confirmed.

Lessons Learnt

  • Change takes time, energy and a champion to drive the project.
  • It is important to consider research that will inform evidence-based practice, data collection, program evaluation and processes for increasing quality service provision.
  • There can be difficulty in getting ‘buy in’ from staff about the necessity of e-learning, given time constraints.
  • People are creatures of habit and it’s often difficult for them to accept change without reward or positive outcomes.
  • Prioritising the project needs with competing workloads is a delicate balancing act.

Further Reading

  • Australian College of Midwives. National Midwifery Guidelines for Consultation and Referral. 3rd ed. Canberra: Australian College of Midwives; 2013.
  • Australian Health Ministers' Advisory Council. Characteristics of culturally competent maternity care for Aboriginal and Torres Strait Islander women. Canberra: Standing Council on Health; 2011.
  • Australian Health Ministers’ Advisory Council. Clinical Practice Guidelines: Antenatal Care – Module 1. Canberra: Australian Government Department of Health and Ageing; 2012.
  • Australian Health Ministers’ Advisory Council. Clinical Practice Guidelines: Antenatal Care – Module 2. Canberra: Australian Government Department of Health and Ageing; 2014.
  • Commonwealth of Australia: National Maternity Services Plan. Canberra: Australian Government Department of Health and Ageing; 2011.
  • NSW Agency for Clinical Innovation. Roles and Responsibilities. Centre for Healthcare Redesign; 2015.
  • NSW Ministry of Health. NSW Mothers and Babies 2012. Sydney: Centre for Epidemiology and Evidence; 2014.
  • NSW Ministry of Health. Midwifery Continuity of Care Model Toolkit. NSW Government; 2012.
  • NSW Ministry of Health. The health of Aboriginal people of NSW: report of the Chief Health Officer 2012. NSW Government; 2012.
  • NSW Ministry of Health. Healthy Safe and Well: a strategic health plan for children, young people and families 2014-24. NSW Government; 2014.
  • NSW Ministry of Health. Towards Normal Birth in NSW. Policy: PD 2010_045.
  • Southern NSW Local Health District. ObstetriX Data Base Report; 2014.
  • Southern NSW Local Health District. AMIHS Eurobodalla Annual Report; 2013.
  • Southern NSW Local Health District. Southern NSW Local Health District Strategic Plan 2013-16. Queanbeyan; 2013.
  • Standing Council on Health. National Maternity Service Capability Framework; 2012.

Contacts

Amanda Gear
Clinical Midwifery and Maternity Risk Management Consultant
Southern NSW Local Health District
Phone: 02 6124 9823 / 0408 658 643
Amanda.gear@gsahs.health.nsw.gov.au

Jackie Jackson
Manager, Aboriginal Health Services
Southern NSW Local Health District
Phone: 0467 764 194
Jackie.jackson@gsahs.health.nsw.gov.au

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