Aboriginal maternal and infant care workers: partners in caring for Aboriginal mothers and babies

Introduction: Aboriginal Maternal and Infant Care (AMIC) workers and midwives work in intellectual and inter-cultural partnerships in a new perinatal care model the Anangu Bibi Family Birthing Program that aims to provide culturally focussed perinatal care for Aboriginal mothers and families at two sites in regional South Australia. This study investigated the views of the AMIC workers and midwives about their roles, their partnership and the program, following the first 45 births. Methods: Semi-structured interviews with all five AMIC workers and four of the five midwives working in the program were conducted. Tapes were transcribed and main themes extracted. Results: The AMIC workers’ role included clinical, cultural, social and aspects from the confirmation of pregnancy through to 6-8 weeks after the birth. Themes relating to their work role included: clinical work; social and emotional support; language and advocacy for the partnership: mutually equivalent roles and for the program: clinical benefits and cultural safety. The midwives’ role included clinical practice, skill-sharing and mentoring. Midwives were guided by AMIC workers’ social, cultural and community knowledge. Themes that emerged for the midwives on the partnership were: time and commitment to working inter-


Poorer outcomes for Indigenous babies
When compared with developing countries, Australia's perinatal mortality rate while low, is double for Aboriginal and Torres Strait Islander births 1,2 , and with remote residence increases exponentially 3 .
Aboriginal and Torres Strait Islander babies are also more likely to weigh less than 2.5 kg at birth or be small for gestational age (SGA) and born pre-term, factors that increase the risk of perinatal death 4 . In a recent study of birth outcomes for 456 Aboriginal and Torres Strait Islander women in Townsville, Queensland, predictors of pre-term birth were: a previous pre-term birth; a low BMI; inadequate antenatal care; urine infection; and non-local residence.
Tobacco use was predictive of SGA 5 .
There have long been concerns that Aboriginal & Torres Strait Islander women although having greater health risks, are less likely than others to attend mainstream health services for antenatal care [6][7][8][9] . Highlighting the issue almost Meanwhile, midwives in Western countries, including Australia, troubled by increasing medicalisation of birth and its associated role erosion, have trialled working in teams or booking of case loads to provide continuity of care [11][12][13] . The midwifery models show reductions in most interventions, increased satisfaction with their care and a higher likelihood of women knowing their midwife 11,12,14 . However, these models have not specifically addressed issues of cultural safety, the importance of which has been stressed in the provision of maternity care for Aboriginal and Torres Strait Islander Australians by health professionals 15 .

Partnership models
Aboriginal and Torres Strait Islander life is maintained by the kinship network which has roles and responsibilities that ensure the maintenance of essential protocols 16 . It is important that protocols are adhered to during interventions that aim to improve health of Aboriginal and Torres Strait Islander peoples 17 . Franks et al 18  These findings led to a successful funding application to introduce a birthing program in the regional towns of Whyalla and Port Augusta; both with highly respected Aboriginal communities.
The key principles, components and design of the program were: The AMIC workers and midwives working in the program who were interviewed for the investigation are also authors of this article.

Interviews with the midwives
Of the four midwives interviewed, three were employed in Port Augusta and one in Whyalla. All but one had been involved from the beginning either directly or indirectly. All Setting up the program: in which initially a number of challenges were posed is described by a midwife: There were problems with infrastructure… the biggest concern was to have our mobile phone to be on The following discussion summarises the findings from the key questions.

The roles of AMIC workers and midwives
The

Working in partnership
There was clear evidence from the interviews that that inter-

Benefits for mothers and babies
The employment of AMIC workers in a leading cultural role in the partnership appeared to result in a higher use of services 23  The AMIC worker role will continue to need promotion, acknowledgement, support and development. It is also important to acknowledge that AMIC workers, as members of their communities, have obligations and priorities within their own family systems as well as their work in the program. It is clear that building on the AMIC worker and midwives relationships will be essential in sustaining the program.
In conclusion, AMIC workers and midwives were successful in developing rewarding and equivalent inter-cultural partnerships. The model has the potential for wider introduction and evaluation, as attested by the words of an AMIC worker: 'That's the way it can work, you know, you feel like you can make a difference for our people if we work that way'.