Malabar Community Midwifery Link Service - ARCHI

Malabar Community Midwifery
Link Service
Royal Hospital for Women
(Malabar Midwives)

Brought to you by:

OUR AIM
• To build upon the success of the existing
Aboriginal Maternal and Infant Health Service at
the RHW and provide a culturally appropriate and
accessible service for Aboriginal families.
• To develop strong links with the community.
• To provide a midwifery caseload practice model
where individualised care follows each woman on
her journey through pregnancy, labour, birth and
afterwards.

How we know we are on the right
track….
• Involvement of the local Aboriginal
community in both the development and
implementation of the service
• Our women are coming to see us earlier in the
pregnancy
• Aboriginal women are able to access care with
their own midwife and Aboriginal Health
Worker throughout pregnancy, labour, birth and
after the birth

• Better health for women and babies
• Women and families are involved in health
education activities
• Better child health outcomes for Aboriginal
children 0- 4 years
• Women get to know the Child and Family
Health Nurse during their pregnancy

Malabar Midwives
1B Prince Edward St Malabar
• Six midwives
• Mentored Aboriginal Midwife position
• An Aboriginal Health Worker.
• A Child and Family Health Nurse
• A Community Pediatrician
• Aboriginal Administration Assistant
• Strong links and partnerships with:
• Aboriginal Health Workers
• Child and Family Health
• Sydney Children's Hospital
• Women’s s Health and Sexual Health
• Community organizations

Type of Care
• Caseload – Continuous care from a midwife the woman
knows
• Choice of birth place, delivery suite or birth centre at
the RHW
• Choice of place for antenatal visits at Malabar, RHW,
La Perouse Aboriginal Health Centre, Redfern AMS,
home or a convenient location for the woman
• After the birth care in the home
• Outreach clinic at La Perouse Aboriginal Community
Health Centre

La Perouse Aboriginal Community
Health Centre

La Perouse Aboriginal Community
Health Centre

Aboriginal Health Worker
• Strong cultural and
community link
• Important for the success
Of the service
• Supports women and
families
• Health education
• Guided by what the women want
Bec's quote regarding care from the MCMLS:
It was the best thing you can have for your pregnancy. It's your support unit,
your back up for the hardest and the best thing in your life. I relaxed as soon
as I saw Trudy and Kate.

Health Education Activities
Trudy doing Belly Casts
First Aid/ CPR
Soap & Lotion
Making

Health Body Health Mind Camp

Evaluation
Comprehensive formal evaluation University of
Technology, Sydney measuring the following:
• Maternal and neonatal outcomes determined by
NSW Health funding agreement
• Child and Family Health outcomes
• Clinician experiences
• Women’s experience
• Cost analysis

Outcomes 2007
• 43 women cared for in the first year (30% of total
caseload of the service)
• 71% of Aboriginal women attending the RHW for
birth cared for by Malabar Service
• 65% of women attended for pregnancy care prior to
20 weeks and 10% of women after 20 weeks
• The majority of women had complex health and
psychosocial issues

Outcomes 2007
• Seventy two percent (72%) of the women who were
cared for by the Malabar service achieved a normal
vaginal birth. This compares with the latest published
data from the Royal Hospital for Women (MDC 2005)
where fifty three percent (53%) of women had a normal
vaginal birth.
• There were 23 percent (23%) of women who had a
caesarean section – of which six were emergency
caesareans. This is considerably lower than the overall
rate at RHW at present.

Outcomes 2007
• 8 (19%) preterm babies
• Average birth weight 3166gms
• 68% fully breastfeeding on discharge

Some things we are proud of…
• Women are having pap smears for the first time
• Women contacting us much earlier in their
pregnancy
• Women who are wanting contraception after the
birth are asking us for help
• Women are asking us about all aspects of their
health care

Some things the women say….
• We like having our own midwife and not having
to retell the story over and over to strangers
• Someone you know is always there when you
need them and you can call
• When you see the midwife it is relaxed and not
like coming to a hospital

Lessons learned
• Community engagement essential
• Be thorough in applications for funding to ensure
that the service keeps going
• Support from the top very important
• Caseload of 30-35/year per midwife due to the
needs of the women to avoid midwife burn out.
• Extending access to non Aboriginal families helps
the service to keep going
• One Aboriginal Health worker is not enough

Future Scope
• Ongoing funding
• Additional staff positions to enhance service:
1 FTE Aboriginal Midwife
1 FTE Aboriginal Health Education Officer with
health promotion as the focus
1 FTE Social worker
1 FTE Mental Health consultant
• Community support and acceptance

Winners 2008 NSW
Aboriginal Health Awards
Excellence In Program and Service Delivery
Director Generals Award

With thanks to: