The maternal and neonatal outcomes for an urban Indigenous population compared with their non-Indigenous counterparts and a trend analysis over four triennia

Abstract

BackgroundIndigenous Australians experience significantly disproportionate poorer health outcomes compared to their non-Indigenous counterparts. Despite the recognised importance of maternal infant health (MIH), there is surprisingly little empirical research to guide service redesign that successfully addresses the disparities. This paper reports on a service evaluation that also compared key MIH indicators for Indigenous and non-Indigenous mothers and babies over a 12-year period 1998–2009.MethodsTrend analysis with logistic regression, using the independent variables of ethnicity and triennia, explored changes over time (1998–2009) between two cohorts: 1,523 births to Indigenous mothers and 43,693 births to non-Indigenous mothers. We included bivariate and multivariate analysis on key indicators (e.g. teenage births, preterm birth, low birth weight, smoking) and report odds ratios (ORs), 95% CIs and logistic regression adjusting for important confounders. We excluded transfers in from other areas which are identified within the database.ResultsBivariate analysis revealed Indigenous women were statistically more likely to have spontaneous onset of labour and a non-instrumental vaginal birth. They were less likely to take epidurals for pain relief in labour, have assisted births, caesarean sections or perineal trauma. Despite better labour outcomes, Indigenous babies were more likely to be born preterm (< 37 weeks) and be low birth weight (< 2500 g); these differences remained significant in multivariate analysis. The trend analysis revealed relatively stable rates for teenage pregnancy, small for gestational age, low birth weight babies, and perinatal mortality for both cohorts, with the gap between cohorts consistent over time. A statistical widening of the gap in preterm birth and smoking rates was found with preterm birth demonstrating a relative increase of 51% over this period.ConclusionsThe comprehensive database from a large urban hospital allowed a thorough examination of outcomes and contributing factors. The gap between both cohorts remains static in several areas but in some cases worsened. Alternative models for delivering care to Indigenous women and their babies have shown improved outcomes, including preterm birth, though not all have been sustained over time and none are available Australia-wide. New models of care, which recognise the heterogeneity of Indigenous communities, incorporate a multiagency approach, and are set within a research framework, are urgently needed.

Survey of women's perceptions of information provided in the prevention or treatment of iron deficiency anaemia in an Australian tertiary obstetric hospital

“…This has many concomitant issues for these women including: cost, childcare, transport, accommodation and isolation. [42][43][44][45][46] It is critically important to prevent this dislocation. We firmly believe adopting proactive targeted strategies to improve the prevention, detection and management of iron deficiency anaemia can begin to address some of our unique problems as a tertiary referral centre responding to a preventable volume of antenatal anaemia.…”

“…40 Remote areas are associated with poorer maternity outcomes in comparison to less remote populations, particularly with indigenous mothers. [41][42][43] Transfer to a tertiary centre because of iron deficiency has significant financial, cultural and emotional impact on the pregnant woman. 41 This transient relocation results in detrimental separation from the family group and support network at a time of the greatest need.…”

Unmet Needs of Aboriginal Australians With Musculoskeletal Pain: A Mixed‐Method Systematic Review

“…Holiday et al reported that Aboriginal patients were more than twice as likely to be prescribed opioids in primary care (odds ratio 2.2 [95% CI 1.6–2.9]) despite increasing concerns regarding efficacy, addiction, and overdose. Disparities in pharmacologic pain management have also been reported for Aboriginal women during labor (increased likelihood of opioid prescription) and postoperatively (less likelihood of receiving more complicated analgesia techniques such as epidural analgesia) . This situation contrasts with the US, where prescriptions for opioids or other analgesia are similar between indigenous and white Americans, with black Americans less likely to receive analgesic prescription than white Americans .…”

Indigenous birth outcomes at a Victorian urban hospital, a retrospective 5-year cohort study 2010-2014

“…Children born preterm have higher rates of morbidity and long‐term sequelae, including educational difficulties, which further widens the gap between nonindigenous and indigenous Australians . Studies from states with larger indigenous populations have shown an increase in the rate of preterm birth and a widening of the gap between indigenous and nonindigenous preterm births . The long‐term ramifications of preterm birth highlight the need for considered and comprehensive obstetric care particularly of indigenous women.…”