Tracy Reibel

Aboriginal and Torres Strait Islander infants currently have one of the highest rates of Sudden Unexpected Death in Infancy (SUDI) and infant death of any population in a developed nation. Prompt initiation of cardiopulmonary resuscitation (CPR) is crucial for survival in an emergency situation. This is particularly relevant in remote communities where delayed response times from trained personnel could affect survival and parents are likely to be the first responders in these instances. In the neonatal intensive care unit (NICU) and special care nursery (SCN) health-related education is offered to parents prior to discharge, which includes Sudden Infant Death Syndrome (SIDS) and safe sleeping guidelines; however, it rarely includes infant cardiopulmonary resuscitation. Although some health-related education is also offered in maternity units, infant CPR is generally not included. By talking with Aboriginal parents in Western Australia who were discharged from the NICU/SCN or the maternity units within the first 12 months of the infant’s life, this study aims to determine what they understand about infant resuscitation and their perspectives on learning the skills to perform it. This will also include the views of grandparents, aunties and extended family of the participants. Using community participatory action research (CPAR), this study will utilise a well-established Indigenous research practice of yarning to gain a detailed understanding of Aboriginal parents’ perspectives and understanding of infant cardiopulmonary resuscitation. Whether these perspectives differ depending on if the mother and baby spent time in the NICU/SCN or the maternity unit in the postnatal period will also be identified. It is anticipated that a culturally responsive infant CPR education program and framework could result from the findings of the research.

Background: Aboriginal women experience poor maternity outcomes compared with other women in Australia. Few mechanisms and resources exist to support health services and professionals to provide culturally responsive care to Aboriginal women. The right of Aboriginal women to express their diverse cultural needs during pregnancy and birthing requires maternity services to be culturally secure as well as clinically safe. Existing policies state that Cultural Competence (CC) of hospital services and staff is ‘critical to achieve positive outcomes for both mother and baby' and a priority reform area in closing the gap in Aboriginal maternal and child health outcomes. Yet an audit of antenatal care in Western Australia (WA)in 2010 found that 75% of services fail to provide culturally competent care to Aboriginal women. Methods: The audit findings were provided to key health services personnel and Aboriginal women during an extensive consultation. Based on their feedback and a review of the literature, an individual and organisational Cultural Competence Assessment Toolkit (CCAT) was developed, trialled and evaluated with 75 staff in two hospitals. Results: All participants found the CCAT highly relevant and useful to effectively enhance organisational and workforce CC in health services and policy sectors with great potential to be effective if embedded as part of the CQI mechanism in maternity services. Conclusion: A review of the maternity services framework and indicators recommended the CCAT be implemented as part of the National Maternity Services Plan. Building on these recommendations our current study is investigating how to support Aboriginal women's diverse needs to ensure their cultural security in an urban maternity setting: and evaluating the cultural competency, workforce and education needs of midwives. This involves conducting culturally sensitive, semi-structured interviews with Aboriginal women using a personal and conversational manner yarning and deep listening practices to explore the meaning of birthing on country with Aboriginal women. The findings will be used to refine and validate the CCAT and inform CC policies and practice, midwifery education and services reform to enhance the quality of and access to maternal health services and improve health and wellbeing outcomes for Aboriginal and other marginalised populations.