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The Aboriginal Mothers and Babies Service (AMBS) was designed to enhance the physical, psychological, social and emotional health and well being of Aboriginal women and their infants through monitoring, education, early detection, intervention and referral strategies. 

Since the service began in 2006, dramatic improvements have been seen in antenatal and postnatal contacts of mothers and babies. Prior to the commencement of the program, 18% of Aboriginal women in HNEH Northern Sector did not access antenatal health services until late in their pregnancy (after 20 weeks). Since the commencement of the AMBS, the number of Aboriginal women who have accessed health services prior to 20 weeks gestation has risen to 98%. Postnatal contacts have increased to 98% of all births registered within the program. These contacts between HNE Health staff and Aboriginal mothers and babies have increased infant birth weights, increased breastfeeding and increased infant immunisation rates together with decreasing smoking in mothers. The inclusion of an Aboriginal Health Education Officer in early 2007 increased the acceptance of this program by the Aboriginal community.

The AMBS also has a strong link with the Aboriginal Health Plan 2007-2011. Strategies drawn from this plan include working more with families, including external partners and the improvement of services for mothers and babies. The service plan was also developed to incorporate strategies which addressed culturally appropriate access to services.

The idea of an AMBS was first raised by two Aboriginal women who were members of the Armidale Local Health Advisory Committee in 2006. The nature of the problem was that Aboriginal women were not readily accessing mainstream maternal or infant health services. This was identified as a primary health concern.

An application for funding was developed and submitted to the Community Services Grants program Families First Strategy in 2006. This was followed by a further application for funding to employ a full time Aboriginal Health Officer to work in partnership with the midwives.

The proposed model (a midwife working in conjunction with Aboriginal health workers) is consistent with the recommendations from the NSW Aboriginal Perinatal Health Report (2003). This report stated: "Targeted (midwifery) programs increase the use of services by Aboriginal women and improve the health outcomes for mother and babies. These programs employ midwife/Aboriginal health worker teams who work in collaboration with medical practitioners to provide: individualised, family centred care, outreach and home visiting services, transport and referral to specialists."

The aim of the Armidale Community Health Aboriginal Mothers and Babies Program is to provide primary health support, education and access to services for Aboriginal mothers and babies in the Armidale community. This was to be achieved by:

• increasing the number of Aboriginal women accessing antenatal and post natal services before 20 weeks gestation.
• increasing empowerment of Aboriginal women, while raising self esteem and decreasing stress in relation to pregnancy.

Key objectives included:

• To improve the appropriateness of maternity services for Aboriginal clients through the provision of a multidisciplinary team including midwives, Aboriginal Health workers, Specialists and General Practitioners.
• To provide an individualised family centred service.
• To promote opportunities for Aboriginal women to access the full range of antenatal, postnatal and community support services, including transport from Armidale, Guyra and Uralla.
• To provide information, options and referrals.
• To provide support and group work to women and families.
• To participate in the community service system networks.

Key indicators for the program included:

• Gestational stage at first antenatal visit (before 20 weeks gestation).
• Frequency of antenatal visits.
• Identification of birth-weight as a issue as the Midwives Data Collection (MDC) reported that 10.6% of Aboriginal births in the HNE Northern Sector were under 2500 grams.
• Age of mother. 70% of Aboriginal women who birthed in Armidale during 2004 were aged 12 to 19 years.
• Smoking during pregnancy. MDC reported that more Aboriginal women smoked 10+ cigarettes per day during the second half of their pregnancy.
• Home visits. Aboriginal women will be offered a home visit following the birth of their baby.
• Offering of NSW Immunisation schedule.
• Encouragement and support for Birth registration. It is understood that Aboriginal children are sometimes not registered at birth.
• Encouragement for ongoing child health checks. The program encourages Aboriginal families to access Child and Family Health nurses for ongoing child developments checks as per the blue book.

The funding application for a 2 year period was successful and the program commenced in October 2006. This funding included a midwife for 32 hours per week. In early 2007 funding was secured for the Aboriginal Health Education Officer.

As the funding body, Families First initiated specific service delivery activities and targets for the service to achieve (as listed above) which were overseen by the Tablelands Cluster General Manager, the Child Youth and Families Health Service Manager at Armidale Community Health Centre and the Area Child Youth and Family Manager.

Consultation to introduce the program included discussion with local community groups such as the Aboriginal Elders. These discussions identified the need for improvements and the ability to engage Aboriginal women in the community pre-natally and follow up post-natally.

NSW Midwives Data Collection (MDC) 2003-2004 was accessed to identify issues within the Northern Sector HNEH & to establish base line data.

• MDC 2004 reported that 18% of Aboriginal women access antenatal care for the first time greater than 20 weeks.
• Birthweight. MDC 2004 reported that 10.6% of Aboriginal births in the HNE Northern Sector were under 2500 grams.
• MDC 2004 reported that 70% of Aboriginal women who birthed in Armidale during 2004 were aged 12 to 19 years.
• As reported by the NSW MDC in 2003 over 56% of all Aboriginal women reported smoking at some time during their pregnancy, the majority smoking more than 10 cigarettes per day. MDC 2004 reported that more Aboriginal women smoked 10+ cigarettes per day during the second half of their pregnancy than women who smoked 1-10 cigarettes per day.

The target group for the Armidale Aboriginal Mothers and Babies Service is pregnant Aboriginal women or women who are partners of Aboriginal men from Armidale, Guyra and Uralla who are not accessing mainstream services and/or who experience a range of social and economic difficulties or geographic isolation. The Aboriginal Mothers and Babies Service provides a holistic, integrated and culturally appropriate model of care to Aboriginal women through pregnancy and 3 months post partum care. The service embraces the principles of integrated perinatal care which includes appropriate referrals to other relevant agencies such as community agencies, Child and Family Health services, Alcohol and Other Drugs and Mental Health Services.

Prior to implementation, discussion was held with both consumers and stakeholders. This included staff at Armidale Medical Service, Minimbah Preschool, Aboriginal Health Workers, General Practitioners at Armidale, Uralla, Guyra, New England Division of GPs, Obstetricians, Maternity Unit Staff, Child and Family Health Staff, Non government community groups and Aboriginal Women in the community, including Elders.  The aim of these discussions was to introduce and promote the service and at the same time ascertain the expectations of the community and the other health care providers.

Collaborations and partnerships were formed with a local General Practitioner who provides the majority of services to the Aboriginal community, a local Paedatritian, New England Division of General Practice, Armidale Aboriginal Medical Service, Minimbah Primary School, Armidale Hospital Midwifery Unit, Child and Family Health Unit, Dietitians, Immunisation Nurse from Armidale Community Health Centre, Department of Community Services (Brighter Futures), Women’s Shelter, Armidale Community Cottage, Women's Housing, Department of Housing and Aboriginal Health workers of HNEH.

Service provision commenced in October 2006 and has gained acceptance from the community over the past two years. Registrations and referrals have steadily increased as trust and confidence in the service has grown. The target was set at 35 clients per year, however this was exceeded in both the first and second year with 70 clients serviced in 2007 and 62 clients in 2008. During the first two months of the program in 2006, 6 clients were seen.

Maintaining trust and quality of service provision is paramount. The inclusion of an Aboriginal Health Education Officer in early 2007 increased the acceptance of this program by the Aboriginal community. This combined successfully with a high standard of care from the staff to the clients and a constant, reliable service provision with a consultative, transparent process within the local community.

Hunter New England Health provide an Aboriginal drop-in centre at Narwan Clinic, a culturally appropriate place, where clinical and booking-in to hospital services are provided to clients. This has proven to be very successful, with clinics held every week that include visits by GPs, a Paediatrician, Aboriginal Mothers and Babies (AMBS) team, the Armidale Community Health Dietitian and Immunisation Nurse.

The AMBS project commenced from a non existent service in 2006 to the accepted and trusted, now permanent service based at Armidale Community Health today.  The three team members have made huge inroads into supporting mothers and babies within the scope of the program.

The Aboriginal Mothers and Babies service initially received referrals for postnatal clients from Armidale Maternity Unit. Home visits were initiated for those in Armidale, Uralla and Guyra. The expectation from the funding body was to service 35 clients in the first year. The service exceeded this expectation by servicing 70 clients in the first year (2007) and 62 (2008) in the second year.

• Prior to the introduction of the program, 18% of Aboriginal women accessed antenatal care for the first time after 20 weeks. At the end of 2008, 98% of all clients received antenatal care prior to 20 weeks gestation.
• Antenatal visits are conducted weekly in accordance with antenatal visiting regime and also at the request of the individual clients.
• Prior to the introduction of the program, 10.6% of Aboriginal births in the HNE Northern Sector were under 2500 grams. At the end of 2008, 90% of Aboriginal births were over 2500 grams.
• Prior to the introduction of the program, 70% of Aboriginal women who birthed in Armidale during 2004 were aged 12 to 19 years. At the end of 2008, only 14.5%  women who birthed in Armidale were aged 12 to 19 years.
• Prior to the introduction of the program more Aboriginal women smoked 10+ cigarettes per day during the second half of their pregnancy. At the end of 2008, although clients were still smoking, they had reduced the number of cigarettes to between 1-10 cigarettes per day with no clients smoking 10+ cigarettes per day
• Prior to the introduction of the program, no Aboriginal women accepted the offer of a Universal Home Health Visit (UHHV). During 2008, UHHV is between 75-100%.
• At the end of 2008, immunization rates for babies was 98%.
• Prior to the introduction of the program birth registration was unknown, however anecdotal evidence indicated that it was extremely low. At the end of 2008, figures indicate that there has been a substantial increase in the number of Aboriginal babies registered.
• Improvements have been made in the number of babies breastfed. At the end of 2008, 95% of mothers had initiated breastfeeding at birth and 87% of women were still breastfeeding at 12 weeks.
• Prior to the introduction of the program, ongoing child health checks were not being accessed. At the end of 2008, 95% of babies were received child health checks. The remaining 5% had left the community and were not tracked.

The Annual Performance Report "Armidale Aboriginal Mothers & Babies Service" from the Department of Community Services congratulated the staff on providing an excellent service. The project met all outcomes and, on many occasions, exceeded the specified outcomes required of the project.  An evaluation of the project was undertaken using the Department of Community Services (DoCS) evaluation tool and were noted as:

• The service has exceeded client support and home visits and has established additional referral pathways.
• The service has exceeded client assisted outcomes.
• The service has met outcomes around birth weight, case closures & exceeded home visiting outcomes.
• The service regularly participates in network meetings.

Graphs showing increase in percentage of birth weights and increase in immunization. 2006 figures are not included as the program only commenced in late October 2006.

The AMBS project commenced from a non existent service in 2006 to the accepted and trusted, now permanent service based at Armidale Community Health.  The three team members have made huge inroads into the area of Universal Home Health Visiting (UHHV) in Armidale through keeping focused on the core business of supporting Aboriginal mothers and babies.

Feedback from clients of the service include:

"I was afraid and really scared until I found out about Aboriginal Mothers and Babies service…My partner and I enjoy going to antenatal classes….Cathy picks us up for appointments and ultrasounds which is really helpful."

"I have been a client of the Aboriginal Mothers and Babies program for the past 2 years. During this time, myself and my child have been provided with great support and excellent service…The program provided by HNEAHS is exceptional…"

"I had a new baby in February 2009, and Cathy and Pam have been of great service to both myself and my baby. I have two other children ages four and three … It was very difficult to take the three of my children to doctors appointments … So I am very grateful for the services … brought to my home … Now me and my baby use the clinic on Thursdays …"

The successful meeting of performance indicators reveals that the program is achieving the aims and objectives originally set for the Aboriginal Mothers and Babies program. Importantly, the nearly doubling of clients demonstrates trust and acceptance of the program within the Aboriginal community.

General Manager, Tablelands Cluster
Hunter New Engalnd Area Health Service
Phone: 02 6776 9781