Stronger connections for better outcomes: Exploring the views and experiences of midwives working in a culturally tailored caseload midwifery model for women having a First Nations baby in Australia

Culturally safe maternity care is a key strategy to reduce health inequities for Australian First Nations mothers and babies. Midwifery-led continuity of care (i.e., caseload) is associated with improved perinatal and psychosocial outcomes compared to other models and has been shown to improve women's experiences of care. Little is known about midwives' views and experiences of working in these models. We aimed to explore midwives' experiences of providing care in a new culturally tailored caseload model for women having a First Nations baby at three tertiary maternity services in Melbourne, Australia. Using a descriptive qualitative design, 20 semi-structured interviews were conducted with midwives working in the new model and analysed thematically. The global theme 'Stronger connections for better outcomes' comprised four sub-themes: Strengthened connections between woman and midwife; Strengthened connections to navigate systems and services; Strong connections amongst caseload midwives; and Strong connections and sustainability require responsive systems and management. The connections between women and midwives provided a greater understanding of culture and the context of women's lives, and the model facilitated co-ordination and navigation of complex services. The strong connections were jeopardised when the organisational support and resources required to provide care in the model was not provided. Midwives reflected positively about working in the model that they believed made a difference for First Nations families. Sustaining midwives in this model requires cultural training and support, a caseload that accommodates clinical and psychosocial contexts of the women, and organisational commitment and support.