Name of Fellow:	Rhonda Bradley
Position:	Registered Midwife
Organisation:	Geraldton Health Campus of WACHS
Project title:	Evaluation of the Geraldton Regional Aboriginal Medical Service (GRAMS) in-reach antenatal clinic
Year of Fellowship:	2006

Fellowship Summary:

The study tested the hypothesis that the provision of antenatal care by the Geraldton Regional Aboriginal Medical Service (GRAMS) In-Reach antenatal clinic can provide better maternal health screening and contribute to better maternal and neonatal outcomes for Aboriginal women and babies of Geraldton.

This cross-sectional retrospective study compared the documented antenatal care and birth outcomes of Aboriginal women giving birth at Geraldton Health Campus (GHC) during two time periods: before and after the commencement of the antenatal clinic.  The study is modeled on the work of Panaretto et al. (2005).

The data was entered in SPSS 14.0 for Windows. Numerical data is described by relative risk and proportions with 95% confidence interval (CI).  A two-tailed p-value below 0.05 is regarded as significant.
 
Data was analyzed to determine the demographics of each group, patterns of antenatal care of each group, the proportion of women undertaking key antenatal screening and a number of maternal and neonatal outcomes.

The evaluation found that the GRAMS In-Reach antenatal clinic is providing best practice antenatal care to pregnant Aboriginal women of Geraldton.  This has resulted in a significantly greater number of women presenting to this service for antenatal care with better maternal screening and opportunities for improved maternal care. However not all these opportunities are being taken and there is no evidence of improved neonatal outcomes.

The evaluation also demonstrates some weakness in documentation and the integration of the in – reach service within the host organization GRAMS. Opportunities to improve this integration and build the capacity of the service include:

• Use of Communicare computer program by all care givers to document antenatal care given.
• Introduction of a female Aboriginal Health Worker to the service.
• Integration of antenatal clinic activities with other services provided at GRAMS.
• Implementing strategies to encourage women to attend the antenatal clinic at regular intervals through-out their pregnancy.

What are you doing now and what has your fellowship led to in terms of your practice and research?”

I have retuned to working on the maternity ward of Geraldton Health Campus, two nights a week.  My fellowship has given me the confidence to tackle further academic studies.  I have applied to Curtin University to complete a Masters of Midwifery, commencing in February of this year.

With regard to my practice, the fellowship has led me to question institutionalised maternity care, in favour of providing a more individualised women-centred approach.  This philosophy of care has sometimes placed me at odds with other staff members, in-order to meet the needs of the woman I am caring for.