Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban settingSue Kildea A B L , Sophie Hickey A , Carmel Nelson C , Jody Currie D , Adrian Carson C , Maree Reynolds E , Kay Wilson E , Sue Kruske B C , Megan Passey F , Yvette Roe C , Roianne West G , Anton Clifford H , Machellee Kosiak I , Shannon Watego E and Sally Tracy J K
A Mater Medical Research Institute, Midwifery Research Unit, Level 2 Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia.
B University of Queensland, School of Nursing and Midwifery, St Lucia, Qld 4072, Australia.
C Institute for Urban Indigenous Health, 23 Edgar Street, Bowen Hills, Qld 4006, Australia.
D Aboriginal and Torres Strait Islander Community Health Service Brisbane Limited, 55 Annerley Road, Woolloongabba, Qld 4102, Australia.
E Mater Misericordiae Health Services Brisbane Ltd, Raymond Terrace, South Brisbane, Qld 4101, Australia.
F The University of Sydney, University Centre for Rural Health North Coast, 61 Uralba Street, Lismore, NSW 2480, Australia.
G Griffith University School of Medicine, First Peoples Health Unit, Gold Coast, Qld 4222, Australia.
H University of Queensland, Queensland Alcohol and Drug Research Centre, Herston Road, Herston, Qld 4006, Australia.
I Australian Catholic University, School of Nursing Midwifery and Paramedicine, 1100 Nudgee Road, Banyo, Qld 4014, Australia.
J University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia.
K Poche Centre for Indigenous Health, University of Sydney, NSW 2006, Australia.
L Corresponding author. Email: email@example.com
Australian Health Review - https://doi.org/10.1071/AH16218
Submitted: 30 September 2016 Accepted: 24 January 2017 Published online: 7 April 2017
Developing high-quality and culturally responsive maternal and infant health services is a critical part of ‘closing the gap’ in health disparities between Aboriginal and Torres Strait Islander people and other Australians. The National Maternity Services Plan led work that describes and recommends Birthing on Country best-practice maternity care adaptable from urban to very remote settings, yet few examples exist in Australia. This paper demonstrates Birthing on Country principles can be applied in the urban setting, presenting our experience establishing and developing a Birthing on Country partnership service model in Brisbane, Australia. An initial World Café workshop effectively engaged stakeholders, consumers and community members in service planning, resulting in a multiagency partnership program between a large inner city hospital and two local Aboriginal Community-Controlled Health Services (ACCHS). The Birthing in Our Community program includes: 24/7 midwifery care in pregnancy to six weeks postnatal by a named midwife, supported by Indigenous health workers and a team coordinator; partnership with the ACCHS; oversight from a steering committee, including Indigenous governance; clinical and cultural supervision; monthly cultural education days; and support for Indigenous student midwives through cadetships and placement within the partnership. Three years in, the partnership program is proving successful with clients, as well as showing early signs of improved maternal and infant health outcomes.
What is known about the topic? Birthing on Country has been described as a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies, and services that incorporate Birthing on Country principles can improve outcomes for mothers and babies. Currently, few such models exist in Australia.
What does this paper add? This paper demonstrates that Birthing on Country principles can be successfully applied to the urban context. We present a real case example of the experience of setting up one such best-practice, community-engaged and informed partnership model of maternity and child healthcare in south-east Queensland. We share our experience using a World Café to facilitate community engagement, service delivery and workforce planning.
What are the implications for practitioners? Health professionals providing maternity care for Aboriginal and Torres Strait Islander families are encouraged to incorporate Birthing on Country principles into their model of care to address the specific needs and demands of the local Indigenous community and improve maternal and infant health outcomes.
Additional keywords: health services, Indigenous health.
References Humphrey M, Bonello M, Chughtai A, Macaldowie A, Harris K, Chambers G, editors. Maternal deaths in Australia 2008–2012. Canberra: Australian Institute of Health and Welfare; 2015.
 Australian Institute of Health and Welfare (AIHW). Australia’s mothers and babies 2013 – in brief. Perinatal Statistics Series no. 31. Catalogue no. PER 72. Canberra: AIHW; 2015.
 Kildea S, Tracy S, Sherwood J, Magick-Dennis F, Barclay LM. Improving maternity services for Indigenous women in Australia: moving from policy to practice. Med J Aust 2016; 205 374–9.
| Improving maternity services for Indigenous women in Australia: moving from policy to practice.CrossRef |
 Australian Health Ministers Advisory Council. National maternity services plan, 2011. Canberra: Australian Health Ministers Advisory Council; 2011.
 Kildea S, Magick Dennis F, Stapleton H. Birthing on Country workshop report, Alice Springs, 4th July. Brisbane: Australian Catholic University and Mater Medical Research Institute on behalf of the Maternity Services Inter-Jurisdictional Committee for the Australian Health Minister’s Advisory Council; 2013.
 “Jody Curry and Professor Sue Kildea.” Let’s Talk. 98.9FM Brisbane Indigenous Media Association. 18 February 2016. Radio. Available at: http://www.989fm.com.au/category/podcasts/lets-talk/page/6/ [verified 10 February 2016].
 Kildea S, Van Wagner V. ‘Birthing on Country’ maternity service delivery models: a review of the literature. Canberra: Maternity Services Inter-Jurisdictional Committee for the Australian Health Minister’s Advisory Council; 2013. Available at: https://www.saxinstitute.org.au/wp-content/uploads/Birthing-on-Country1.pdf [verified 10 February 2016].
 Kildea S, Stapleton H, Murphy R, Kosiak M, Gibbons K. The maternal and neonatal outcomes for an urban Indigenous population compared with their non-Indigenous counterparts and a trend analysis over four triennia. BMC Pregnancy Childbirth 2013; 13 167
| The maternal and neonatal outcomes for an urban Indigenous population compared with their non-Indigenous counterparts and a trend analysis over four triennia.CrossRef |
 Kildea S, Stapleton H, Murphy R, Low NB, Gibbons K. The Murri clinic: a comparative retrospective study of an antenatal clinic developed for Aboriginal and Torres Strait Islander women. BMC Pregnancy Childbirth 2012; 12 159
| The Murri clinic: a comparative retrospective study of an antenatal clinic developed for Aboriginal and Torres Strait Islander women.CrossRef |
 Lamb T, Stapleton H, Bily Low N, Kildea S. Mater Mothers’ Hospital Murri Antenatal Clinic: planning future services at the World Café workshop. Brisbane: Midwifery Research Unit, Mater Mothers’ Hospitals and Australian Catholic University; 2012.
 Brown J, Issacs D. The World Cafe Book: Shaping Our Futures Through Conversations that Matter. San Francisco: Berrett-Koehler Publishers, Inc; 2005.</bok
 Taylor K, Thompson S. Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services. Aust Health Rev 2011; 35 297–308.
| Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services.CrossRef |
 Donato R, Segal L. Does Australia have the appropriate health reform agenda to close the gap in Indigenous health? Aust Health Rev 2013; 37 232–8.
 Australian Government. National Aboriginal and Torres Strait Islander health plan 2013–2023. Canberra: Commonwealth of Australia; 2013.
 National Aboriginal Health Strategy Working Party. A national Aboriginal health strategy. Canberra: Department of Aboriginal Affairs; 1989.
 Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; 4 CD004667
 Allen J, Gibbons K, Beckmann M, Tracy M, Stapleton H, Kildea S. Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study. Int J Nurs Stud 2015; 52 1332–42.
| Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study.CrossRef |
 Stamp G, Champion S, Anderson G, Warren B, Stuart-Butler D, Doolan J, Boles C, Callaghan L, Foale A, Muyambi C. Aboriginal maternal and infant care workers: partners in caring for Aboriginal mothers and babies. Rural Remote Health 2008; 8 883
 Kildea S, Lockey R, Roberts J, Magick Dennis F. Guiding principles for developing a Birthing on Country service model and evaluation framework, Phase 1. Brisbane: Mater Medical Research Unit and the University of Queensland on behalf of the Maternity Services Inter-Jurisdictional Committee for the Australian Health Ministers’ Advisory Council; 2016.
 Squires J, Bricker D. Ages and stages questionnaires: a parent-completed, child-monitoring system. Third Edition. Baltimore: Paul H. Brookes; 2009.
 Bayley N. Bayley scale of infant and toddler development – third edition (Bayley III). San Antonio: Harcourt Assessments; 2006.