Effect of the implementation of a Birthing on Country service at a rural site, Waminda, compared to standard care for First Nations Australians: a prospective, non-randomised, interventional trial

Background: Clinical and cost-effectiveness of a Birthing on Country service has been demonstrated in a metropolitan centre. We sought to evaluate feasibility, clinical effectiveness and wrap-around supports in the rural setting by evaluating Waminda's Birthing on Country service. Methods: This prospective, non-randomised, interventional study was conducted in Nowra, Australia (ANZCTR: 12620000874910, study completed). Pre-defined primary outcomes were first assessment with health service in 1st trimester, ≥5 antenatal visits, normal birth, preterm birth, healthy baby and exclusive breastfeeding at discharge. Propensity score matching balanced confounders to calculate treatment effect. Waminda's wrap-around services and their interactions are represented using a network analysis. Findings: Relative to standard care, the Birthing on Country service was associated with significantly less women having ≥5 antenatal visits (80·6% versus 94·4%, odds ratio 0·22, 95% CI 0·10, 0·50) (with differences in measurements impacting this outcome), more normal births (32·8% versus 21·7%, odds ratio 1·77, 95% CI 1·08, 2·79), and exclusive breastfeeding at discharge (75·6% versus 63·3%, odds ratio 1·88, 95% CI 1·16, 3·05). No significant differences were observed in other primary outcomes. More than 90% of women accessing Waminda received at least one wrap-around service, some received intensive support. Interpretation: This study is the first to provide evidence towards successful implementation and effectiveness of a Birthing on Country service and the wrap around care in a rural setting and supports the urgent need for maternity service redesign for Aboriginal families. Funding: National Health Medical Research Council of Australia Partnership grant (grant 1135125).