Cathryn M Josif1, Lesley Barclay2, Sue Kruske3, Sue Kildea4. 1. University Centre for Rural Health, School of Medicine, The University of Sydney, NSW 2006, Australia. Electronic address: cfar3313@uni.sydney.edu.au. 2. University Centre for Rural Health, School of Public Health, The University of Sydney, NSW 2006, Australia. Electronic address: Lesley.barclay@usyd.edu.au. 3. Queensland Centre for Mothers and Babies, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: sue.kruske@uq.edu.au. 4. Australian Catholic University and Mater Medical Research Institute, Women's Health and Newborn Services (Maternity), Mater Health Services, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia. Electronic address: sue.kildea@acu.edu.au.
Abstract
OBJECTIVE: to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth. DESIGN: a mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically. SETTING: the 'top end' of the Northern Territory of Australia. PARTICIPANTS: a total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior Aboriginal Woman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service. FINDINGS: the study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: there was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote dwelling women transferred to a regional centre for birth.
OBJECTIVE: to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth. DESIGN: a mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically. SETTING: the 'top end' of the Northern Territory of Australia. PARTICIPANTS: a total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior AboriginalWoman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service. FINDINGS: the study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: there was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote dwelling women transferred to a regional centre for birth.