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Objective: to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth., Design: a mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically., Setting: the 'top end' of the Northern Territory of Australia., Participants: a total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior Aboriginal Woman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service., Findings: the study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service., Key Conclusions and Implications for Practice: there was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote dwelling women transferred to a regional centre for birth., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Low breastfeeding duration rates reflect the pain and distress experienced by many women who discontinue breastfeeding in the early weeks and months of life. This paper explores modern key historical events that have significantly influenced Australian breastfeeding education and practice., Method: Relevant literature reviewed from 1970 to 2010 identified key events that appear to have contributed to the decrease in Australian breastfeeding rates and the increase in women experiencing breastfeeding complications, particularly nipple pain and trauma., Findings and Discussion: The rise in institutionalisation and medical intervention in labour and birth has also medicalised midwifery practice. Technocratic intrusion and institutionalised care is contributing to the separation of the mother and newborn at birth. Delayed mother-baby initiation of breastfeeding and interruption of the duration of the first, and subsequent breastfeeds, negatively affects the innate ability of the mother and newborn to establish and sustain breastfeeding. The 'pathologising' of breastfeeding that involve midwives teaching women complicated and unnatural breastfeeding techniques interfere with instinctive sensory and mammalian behaviours and further contributes to the high complication rates., Conclusion: Midwives are encouraged to reflect on their role as 'experts' in the breastfeeding process and give confidence to women so that they utilise their instinctive ability to breastfeed by self-determined techniques that encourage mammalian skills for newborn sustenance and survival., (Copyright © 2010 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Within maternity services, collaboration between maternity care professionals appears problematic in spite of widespread support for collaborative practice amongst stakeholders., Objective: The objective of this paper was to examine and to clarify what the key elements of interprofessional collaboration are and how they relate to maternity care in Australia., Method: A review of the literature was performed to identify key characteristics of collaboration. All papers, theoretical and empirical, that discussed the concept of collaborative practice between professionals were considered., Findings: Currently there are inconsistencies around the concept of collaboration in terms of definitions, characteristics and language. A comprehensive definition was developed that incorporates elements of collaboration suitable for the various professions involved in the provision of maternity care in Australia. The recently developed national criteria for 'collaborative arrangements' in maternity care, however, does not contain the elements of our proposed definition and may discourage collaboration between primary maternity care providers., Conclusion: The proposed definition could be useful in further development of collaborative arrangements within maternity care and assist to further inform research on collaborative practice., (Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: To improve the maternity emergency skills and knowledge of health service providers, without midwifery qualifications, in remote Australia., Design: A descriptive paper utilising data from a needs assessment and course evaluations used to develop and refine a short course in maternity emergencies., Subjects: Remote area health providers., Interventions: A multidisciplinary short course, targeting non-midwives in remote areas, aimed at improving knowledge and skills in detection, management and referral of maternity emergencies., Results: Ten courses have been delivered to 175 participants. Evaluations demonstrate a highly valued program, well received and supported by remote health staff., Conclusions: The course is an important strategy to improve the maternity services offered to women in remote Australia.

Traditional birth attendant (TBA) training commenced in many places in the non-Western world in the 1970s, supported by the World Health Organization and other funding bodies. By 1997, senior policy makers decided to refocus priorities on the provision of "skilled attendants" to assist birthing women. The definition of skilled attendants excluded TBAs and resulted in the subsequent withdrawal of funding for TBA training globally. A review of the health and sociological literature and international policy documents that address TBA training revealed how international policy and professional orientation are reflected in education programs designed for the TBA. Policy makers risk ignoring the important cultural and social roles TBAs fulfill in their local communities and fail to recognize the barriers to the provision of skilled care. The provision of skilled attendants for all birthing women cannot occur in isolation from TBAs who in themselves are also highly skilled. This article argues a legitimacy of alternative worldviews and acknowledges the contribution TBAs make to childbearing women across the world.