The effect of culturally tailored continuity of midwifery care on perinatal outcomes for women having a first Nations baby in Victoria, Australia: a prospective non-randomised translational study

Background: Perinatal morbidity and mortality are substantially higher for Aboriginal and Torres Strait Islander (hereafter called First Nations) mothers and babies compared with non-First Nations peoples. Women birth in systems designed and informed by Western values, and many report negative interactions with health professionals and a lack of cultural safety in the mainstream maternity system. To redress unacceptable health outcomes and system challenges, we implemented a culturally tailored caseload midwifery care programme called Baggarrook Yurrongi, at three tertiary maternity services in Melbourne, Australia. The model included continuity throughout pregnancy, labour, birth and the early postnatal period, recognition of culture as central to identity, and respecting and acknowledging the cultural background, beliefs and values of First Nations peoples. This paper describes maternal and infant health outcomes. Methods: This prospective non-randomised translational study used routinely collected clinical outcome data to explore whether, for women expecting a First Nations baby, receiving the new model was associated with improved clinical outcomes compared with usual care prior to and since implementation (adjusted for age, Body Mass Index, marital status, parity, diabetes and hypertensive disorders). Specifically, would the model decrease the proportion of First Nations babies born low birthweight (