Maternity care for First Nations people
One of the strategic directions outlined in Woman-centred care: strategic directions for Australian maternity services is the development and implementation of culturally safe, evidence-based models of care in partnership with Aboriginal and Torres Strait Islander (First Nations) peoples and communities (COAG 2019).
These models of care are focused on improving maternal health outcomes for First Nations mothers and babies and contribute to progress made against outcome 2 under the National Agreement on Closing the Gap – that First Nations babies are born healthy and strong, and the associated Target that 91% of babies born in 2031 are a healthy birthweight (NIAA 2020).
Culturally safe maternity services are important for improving a broad range of health and wellbeing outcomes and experiences for First Nations mothers and babies (Kildea et al. 2016). Midwifery continuity of care and having the same named maternity carer for all, or part of the maternity period is an important part of culturally safe care for First Nations women (Hickey et al. 2018; McCalman 2024). In Australia, models of care that provide continuity of midwifery care for the whole maternity period have been shown to improve outcomes and increase childbirth satisfaction for women (McLachlan et al. 2012). In 2025:
- Around 125 (11%) models of care across 94 maternity services were designed for those who identify as First Nations, an increase from 117 models in 2024.
- Most of these models (76%) were designed for First Nations women only, while 24% were designed for more than one group of women, for example, they also support women living in remote areas.
- Around 75 (6.8%) models across 64 maternity services have an Aboriginal healthcare practitioner or Aboriginal maternal infant care practitioner as a collaborative carer, which means they have a recognised and planned role for all women using this model of care.
- Around 58 (5.3%) models across 45 maternity services offer antenatal care at an Aboriginal Community Controlled Health Service, providing holistic, comprehensive, and culturally appropriate health care to the local First Nations community.
- Nearly half of models designed for First Nations women (47%) were classified as public hospital maternity care and one-quarter (25%) were midwifery group practice caseload care (Figure 9). This compares to 42% and 16% of models overall.
- Around one-quarter (26%) of models designed for First Nations women have continuity of carer for the whole maternity period, compared with 29% of models overall. A higher proportion of models designed for First Nations women have continuity of carer for some part of the maternity period (62%, compared with 37% of models overall), and a smaller proportion have no continuity of carer (12%, compared with 35% of models overall).
Figure 9: Models of care designed for First Nations women, by model category, Australia, 2025
The bar chart shows that nearly half (48%) of models that were designed for First Nations women were classified as public hospital maternity care, and 23% were classified as midwifery group practice caseload care.
| Major model category | Per cent |
|---|---|
| Public hospital maternity care | 47.2% |
| Midwifery group practice caseload care | 24.8% |
| Remote area maternity care | 10.4% |
| Shared care | 9.6% |
| Combined care | 3.2% |
| General practitioner obstetrician care | 1.6% |
| Team midwifery care | 1.6% |
| Public hospital high risk maternity care | 0.8% |
| Private midwifery care | 0.8% |
Notes
- Includes models of care that are designed for women who identify as Aboriginal or Torres Strait Islander (First Nations) women. Models of care not specifically designed for this group of women may also be used by First Nations women.
- Based on the models of care being used by maternity services with birthing facilities in April 2025
Source: AIHW analysis of the Maternity Model of Care Data Set.
Birthing on Country models of care
Birthing on Country increases access to culturally safe care for First Nations women. It has been described as a metaphor for the best start in life for First Nations babies and their families and aims to improve outcomes for First Nations mothers and babies (Kildea et al. 2013). Birthing on Country models have the same clinical requirements as standard maternity care. A key feature of Birthing on Country models is embedded First Nations governance, as models are developed in partnership with First Nations people and communities. The Molly Wardaguga Research Institute within Charles Darwin University have developed a Birthing on Country implementation framework in partnership with key Aboriginal and Torres Strait Islander stakeholders. This framework identifies factors for enabling Birthing on Country models to be developed including:
- continuity of midwifery care
- a First Nations maternity, health, allied health, and community support workforce
- culturally safe and competent maternity health professionals who are supported to work to their full scope of practice
- cultural strengthening and wellbeing programs and services
- First Nations governance and control (Kildea et al. 2019).
Research suggests women pregnant with an Aboriginal or Torres Strait Islander baby receiving a Birthing on Country model of care are more likely to attend five or more antenatal visits, less likely to have an infant born preterm and more likely to exclusively breastfeed on discharge from hospital compared with those in standard public hospital maternity care models (Kildea et al. 2021).
Box 1: Examples of Birthing on Country and First Nations designed models of care
Baggarrook Yurrongi caseload midwifery is a program developed through partnership between La Trobe University and the Victorian Aboriginal Controlled Health Organisation. Three tertiary hospitals in Melbourne offer continuity of midwifery care across the whole maternity period for women having a First Nations baby. Women may also enter a shared care arrangement between the hospital midwives and the Victorian Aboriginal Health Service or Koori maternity service. For more information, see Woman's Journey: Baggarrook Yurrongi, Nurragh Manma Buliana.
Birthing in our Community (BiOC) is a model of care developed through a partnership between the Institute for Urban Indigenous Health, the Brisbane Aboriginal and Torres Strait Islander Community Health Service and the Mater Health Service in Brisbane. It is a midwifery group practice model tailored to the preferences of Aboriginal and Torres Strait Islander families, and provides whole maternity period continuity of carer supported by a First Nations family support worker, allied health professionals, and a women’s health doctor. It is overseen by an Indigenous governed steering committee and provides First Nations student midwife cadetships and placement opportunities. There are 5 BiOC hubs across Queensland, partnering with Logan Hospital, Mater Mothers Hospital and Redland Hospital for birthing. For more information, see Birthing in our Community – Institute for Urban Indigenous Health.
Boordjari Yorgas Midwifery Group Practice (BYMGP) is a model of care by Armadale Health Service in Western Australia. BYMGP began in 2007, as a part of a community initiative to build strong, trusting relationships between midwives and women having Aboriginal babies. Midwifery continuity of carer is provided in collaboration with GP obstetricians, or specialist obstetricians in the Perth east metropolitan area. For more information, see Armadale Health Service - Boodjari Yorgas Midwifery Group Practice.
Minga Gudjaga is the child and maternal health program coordinated by Waminda, an Aboriginal Community Controlled Health Organisation in the South Coast region of NSW. In May 2024, Waminda launched their Birthing on Country Midwifery Practice (BoCMP). Waminda midwives provide full continuity of care to women through the antenatal period at their Minga Gudjaga Gunyah clinic in Nowra, during labour and birth as visiting endorsed midwives at Shoalhaven Hospital and in the home during the postnatal period. The team also provide sexual and reproductive health services and child and family health services. For more information, see Waminda Minga Gugjaga child and health program.
Tharawal Aboriginal Midwifery Group Practice at Campbelltown Hospital is a model of care that practices birthing on country principles in the South-Western Sydney area. It is coordinated by Aboriginal midwives with the Tharawal Aboriginal Medical Service and offers continuity of care for the whole duration of the maternity period for First Nations women and their babies. For more information, see South Western Sydney Local Health District Aboriginal health plan to 2027.
The Galiwin'ku Djäkamirr Program by the Charles Darwin University Molly Wardaguga Research Centre, seeks to regain control of childbirth for First Nations women in the island town of Galiwin’ku by combining evidence-based Western medical maternity care with cultural caring practices. The program aims to train a local workforce as Yolŋu djäkamirr (cultural birth companions) by embedding Yolŋu knowledge into the certificate IV Doula course (Ireland et al. 2022). The Yolnu Djakamirr support local women during pregnancy and travel off Country with them to give birth. For more information, see Caring for Mum on Country.
Council of Australian Government (COAG) Health Council (2019) Woman-centred care: Strategic directions for Australian maternity services, Department of Health, Australian Government, accessed 26 February 2024.
Hickey S, Roe Y, Gao Y, Nelson C, Carson A, Currie J, Reynolds M, Wilson K, Kruske S, Blackman R, Passey M, Clifford A, Tracy S, West R, Williamson D, Kosiak M, Watego S, Wester J & Kildea S (2018) ‘The Indigenous Birthing in an Urban Setting study: the IBUS study', BMC Pregnancy Childbirth,18(431), doi:10.1186/s12884-018-2067-8.
Ireland S, Roe Y, Moore S, Maypilama EL, Bukulatjpi DY, Bukulatjpi ED and Kildea S (2022) 'Birthing on Country for the best start in life: returning childbirth services to Yolŋu mothers, babies and communities in North East Arnhem, Northern Territory', Medical Journal of Australia, 217: 5-8, doi:10.5694/mja2.51586.
Kildea S, Stapleton H, Murphy R, Kosiak M and Gibbons K (2013) 'The maternal and neonatal outcomes for an urban Indigenous population compared with their non-Indigenous counterparts and a trend analysis over four triennia', BMC Pregnancy Childbirth, 13 (167), doi:10.1186/1471-2393-13-167.
Kildea S, Lockey R, Roberts J, Magick Dennis F (2016) Guiding Principles for Developing a Birthing on Country Service Model and Evaluation Framework, The University of Queensland and Australian Health Ministers Advisory Council, accessed 26 February 2024.
Kildea S, Hickey S, Barclay L, Kruske S, Nelson C, Sherwood J, Allen J, Gao Y, Blackman R and Roe YL (2019) 'Implementing Birthing on Country services for Aboriginal and Torres Strait Islander families: RISE Framework', Women and Birth, 32(5):466-475, doi:10.1016/j.wombi.2019.06.013.
Kildea S, Gao Y, Hickey S, Nelson C, Kruske S, Carson A, Currie J, Reynolds M, Wilson K, Watego K, Costello J & Roe Y (2021) ‘Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial’, The Lancet Global Health, 9(5):651-659, doi:10.1016/S2214-109X(21)00061-9.
McCalman P, Forster D, Newton M, McLardie Hore F and McLachlan H (2024)' “Safe, connected, supported in a complex system.” Exploring the views of women who had a First Nations baby at one of three maternity services offering culturally tailored continuity of midwife care in Victoria, Australia. A qualitative analysis of free-text survey responses', Women and Birth, 37(3), doi:10.1016/j.wombi.2024.01.009.
McLachlan HL, Forster DA, Davey MA, Farrell T, Gold L, Biro MA, Albers L, Flood M, Oats J, Waldenström U (2012) ‘Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial’, British Journal of Obstetrics and Gynaecology, 119(12):1483-92, doi:10.1111/j.1471-0528.2012.03446.x.
National Indigenous Australians Agency (NIAA) (2020) Closing the Gap Report 2020, Department of the Prime Minister and Cabinet, Australian Government, accessed 26 February 2024.