The Birthing on Country model represents a transformative approach to maternity care for First Nations women in Australia, emphasizing culturally safe, community-led services that reconnect birthing with traditional lands and practices. Recent research from Charles Darwin University (CDU) has highlighted positive clinical outcomes from a rural implementation, offering hope for addressing longstanding disparities in maternal and infant health. This study, conducted in partnership with Waminda South Coast Women's Health and Wellbeing Aboriginal Corporation, provides compelling evidence that such models can enhance birth experiences and health results without increasing preterm birth risks compared to standard care.

The Persistent Challenges in First Nations Maternity Care

First Nations women in Australia face significantly higher risks during pregnancy and birth. Preterm birth rates are approximately 1.6 to 1.7 times higher for First Nations babies compared to non-Indigenous ones, standing at around 14% versus 8% nationally. This disparity is even more pronounced in rural and remote areas, where access to culturally appropriate care is limited, contributing to elevated rates of low birth weight, neonatal intensive care unit (NICU) admissions, and maternal complications. Colonization has disrupted traditional birthing practices, leading to hospital-based care that often feels alienating and unsafe, exacerbating stress and poor outcomes.

Statistics from Closing the Gap reports underscore the urgency: First Nations mothers are 3-5 times more likely to experience maternal mortality, and babies 2-3 times more likely to be born preterm or low birth weight. In remote regions, healthy birthweight proportions drop to 85%, highlighting systemic failures in standard maternity services. These challenges are compounded by social determinants like poverty, family violence, and limited antenatal engagement, perpetuating a cycle of intergenerational trauma.

CDU's Pioneering Rural Birthing on Country Study

Charles Darwin University's Molly Wardaguga Institute for First Nations Birth Rights led a landmark prospective, non-randomised interventional trial evaluating Waminda's Birthing on Country service in Nowra, New South Wales—a rural area two hours south of Sydney. From January 2018 to June 2022, the study compared 185 women receiving Waminda's integrated care to 1,860 in standard hospital maternity services at Shoalhaven District Memorial Hospital and Wollongong Hospital. Led by Professor Yu Gao, with collaborators including Professor Yvette Roe and Waminda's Melanie Briggs, the research used propensity score matching to balance demographics and confounders.

The model provided continuity of midwifery care antenatally and postnatally, with births at local hospitals (partial implementation due to regulatory barriers preventing full intrapartum continuity). Wrap-around supports addressed holistic needs, from general practitioner visits to family preservation programs. This CDU-driven initiative builds on prior urban successes, adapting for rural contexts.

Key Clinical Outcomes and Statistics

The study revealed several positive clinical outcomes. While preterm birth rates were comparable (10.6% in both groups, OR 1.00, 95% CI 0.52-1.92), low birth weight showed no significant difference (6.7% vs 7.2%, OR 0.92, 95% CI 0.40-2.08). Notably, spontaneous vaginal births increased to 71.7% from 61.1% (OR 1.67, 95% CI 1.05-2.68, p=0.030), and epidural use dropped by 39% (38.9% vs 50.6%, OR 0.61, 95% CI 0.40-0.94, p=0.026). Exclusive breastfeeding at discharge rose significantly to 75.6% from 63.3% (OR 1.88, 95% CI 1.16-3.05).

• Spontaneous labour onset: 48.9% vs 38.3% (OR 1.51, p=0.050)
• Caesarean sections: No significant reduction (21.7% vs 30.0%, p=0.065)
• No differences in severe tears, episiotomy, or low Apgar scores
• Antenatal visits ≥5: Lower at 80.6% vs 94.4% (OR 0.22), attributed to different measurement (midwife vs GP focus)

These results indicate improved physiological birthing processes and newborn nutrition, key to long-term health.

Holistic Wrap-Around Supports: A Game-Changer

A standout feature was the network of wrap-around services, accessed by over 90% of women—some up to six programs. These included GP care (96.2%), allied health (85.4%), family preservation, healing from violence, and crisis support. Network analysis visualized how these interconnected supports tackled social determinants, fostering strength-based care. Professor Gao noted, "We’ve quantified how these programs interact to support women throughout pregnancy and beyond." This holistic approach differentiates BoC from fragmented standard care.

In 2024, Waminda advanced to 24/7 Minga Gudjaga Midwifery Practice, offering full continuity from conception to six weeks postpartum, promising further gains.Learn more about Waminda's services

Cost-Effectiveness and Broader Implications

Prior urban BoC studies, like those informing CDU's work, showed cost savings by reducing preterm births by 5.34% and NICU stays. While this rural study lacked direct cost data, the model's efficiency in boosting breastfeeding and vaginal births suggests similar benefits. Implementing BoC nationally could save millions while advancing Closing the Gap targets for healthy birthweights (91% non-Indigenous vs lower for First Nations).

CDU's research underscores Aboriginal Community-Controlled Health Organisations (ACCHOs) as pivotal, channeling funds directly to community-led redesign.Related cost-effectiveness analysis

Stakeholder Perspectives and Expert Insights

Melanie Briggs, Waminda Executive Manager, emphasized: "Wrap-around supports address social determinants... a key difference from hospital care." Professor Roe added, "Aboriginal leadership ensures culturally safe birthing." These views align with national calls for BoC sovereignty. Experts praise CDU's evidence as vital for policy, with the Molly Institute leading Australia's BoC research.

Real-World Case Studies: Waminda in Action

Waminda's program exemplifies success. Women self-refer or get referred, receiving tailored antenatal care, cultural healing, and postnatal support. One woman's journey involved multiple programs, leading to a spontaneous vaginal birth and exclusive breastfeeding. Similar sites, like urban IBUS models, report preterm reductions, paving replication in remote NT via CDU projects.

CDU's RISE SAFELY initiative evaluates rural/remote expansions, building on Waminda.Explore opportunities across Australian states

The National Roadmap: Scaling Birthing on Country

CDU's Molly Wardaguga Institute launched the National Roadmap for Birthing on Country Services 2025-2035, co-designed by 300+ stakeholders. It calls for a National Taskforce, 3-year funding for hubs and workforce growth (First Nations midwives from 1% to 5%), and KPIs to cut preterm births and removals by 2035. Aligns with Closing the Gap, targeting equity via ACCHOs.View the Roadmap

Future Outlook and Research Opportunities

Full BoC implementation, including intrapartum continuity, could amplify benefits. CDU continues trials in remote areas, informing policy. For academics and health professionals, this field offers impactful careers in Indigenous health research and midwifery.Discover higher ed jobs in health research Career advice for higher ed roles

As Australia commits to Closing the Gap, CDU's work positions universities as key players in health equity. Explore professor ratings at Rate My Professor or university jobs at University Jobs to join this vital research.

Photo by K A D M I E L on Unsplash