Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

Abstract

BackgroundAustralia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities.MethodsWe undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems.ResultsThe proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician.ConclusionParticipating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice

“…Challenges are further increased by the significant socio-economic disadvantage experienced by Aboriginal Australians [15]. Aboriginal women tend to present later in pregnancy for care than other Australian women [16], [17], rates of folic acid use are considerably lower than national averages [18] and Aboriginal mothers selfreport higher cigarette and alcohol consumption during pregnancy [14].…”

Bir Göçmen Olarak Anneliğe Geçiş: Riskler ve Engeller

“…Göçün beraberinde getirdiği zorluklara ek olarak gebelik ve doğum sonu dönemde artan sorumluluklar ve annelik rolüne uyum süreci göçmen annelerde anksiyete ve strese neden olabilmektedir. Göçle ilişkili olan stresörler doğumdan sonra postpartum blues, postpartum depresyon, posttravmatik stres ve psikoz gibi önemli psikopatolojik durumlara neden olabilir (Rumbold 2011). Göçmen kadınların doğum sonu dönemde yaşadığı psikolojik problemlerin nedenlerine bakıldığında; kişisel özellikler, göçün neden olduğu stres, sosyal destek yetersizliği, aileden kültürden ayrı kalma, sosyal izolasyon, antenatal depresyon, planlanmamış gebelik, aile büyükleri ile ya da kalabalık bir ortamda yaşıyor olmak ve yetersiz ebeveynlik bilgisi olarak sıralanabilir (McMurray 2004, Ahmed ve ark.…”

Assessing maternal healthcare inequities among migrants: a qualitative study

“…The scientific literature indicates how often migrants tend to be the most vulnerable population groups, especially women of childbearing age, that regularly show greater foetal and neonatal mortality, and more complications during pregnancy and postpartum 5,6,7,8 . Their health indicators are frequently worse, which is explained by interactions between socio-material deprivation factors aggravated by stressors involved in the migration process.…”