Midwife-led continuity of care program supports First Nations mothers and babies

The team from the Baggarrook midwifery care program at the Royal Women's Hospital in Melbourne

Midwife-led continuity of care throughout pregnancy, labour, birth and the early postnatal period achieves substantially better perinatal health outcomes, yet few First Nations women receive it.

Investigating the gap, La Trobe University researchers assessed the capacity of four maternity services in Victoria to implement, embed, and sustain a culturally responsive caseload midwifery service.

The landmark study, published in the Lancet, eClinicalMedicine, has revealed that maternity care for First Nations mothers and babies can be improved through access to culturally safe continuity of midwifery care.

The study was conducted in partnership with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), and three Melbourne public hospitals.

As part of the research, a continuity of midwifery care program was offered to women having a First Nations baby between 2017 and 2020, with remarkable program uptake – of the 844 women offered the model, 90% accepted it. Prior to this, over a similar period, just 5.8% of First Nations women had ever received caseload midwifery at the three hospitals combined, compared with over 4,800 non-First Nations women.

Continuity of midwifery care, or ‘caseload midwifery’, is where women have a known midwife care for them throughout their pregnancy, labour, birth and in the early postnatal period.

According to the study’s authors, the caseload midwifery model offers a collaborative and coordinated approach, providing First Nations women the opportunity to have a known midwife who has appropriate cultural training to help them navigate their journey through the maternity care system, while maintaining their community and family supports.

Lead researcher Professor Helen McLachlan, from La Trobe University’s Judith Lumley Centre, said although the model is associated with substantially better health outcomes, very few First Nations women currently have access to this type of care.

“Women with access to midwife-led continuity of care – compared with standard maternity care – are less likely to experience preterm birth, a low birthweight baby or infant loss,” Professor McLachlan explained.

“Yet the availability of these models for First Nations women has been limited, and little is known about the capacity of large maternity services to implement culturally specific models for First Nations women.”

Professor McLachlan said the high uptake of First Nations women who accepted caseload midwifery when it was offered demonstrated that the need is clearly there.

“We argue that there should be a national push to implement, embed and sustain a culturally responsive caseload midwifery model for all First Nations women.”

Study co-lead, Professor Della Forster, Professor of Midwifery at the Royal Women’s Hospital and La Trobe University, added that women who have midwife-led continuity are more likely to report being satisfied with their care, and to feel safe, informed, supported emotionally, and that their concerns are taken seriously.

“The enormous uptake of caseload midwifery by First Nations women in our study is likely to result in similar positive health outcomes for both mothers and babies,” Professor Forster said.

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