Too many First Nations mothers and babies are being traumatised and dying during childbirth, according to Indigenous health professor Yvette Roe.
First Nations women are almost twice as likely to have a preterm birth and almost four times more likely to die during childbirth than other Australian women.
Prof Roe, a proud Njikena Jawuru woman and director of the Molly Wardaguga Research Centre at Charles Darwin University, told AAP that data on stillbirths, which are more frequent for Indigenous women, also showed the current structures are not working for First Nations women.
"It's failing, because what we're seeing is an increase in these horrible statistics," she said.
"So when I talk about redesigning these services, it's actually dismantling a system that is harming and traumatising our mothers and babies."
The centre has received nearly $5 million in funding to expand support for Birthing on Country services for First Nations mothers and babies, as part of the federal government's Medical Research Future Fund.
The Birthing on Country program supports Aboriginal community controlled health services and other partners to establish and evaluate three demonstration projects in rural (Nowra, NSW), remote (Alice Springs) and very remote (Galiwin'ku, NT) sites.
"It means the best start to life for First Nations mothers and babies," Prof Roe said, because the research grant would enable them to extend the program from an urban setting.
"We need to be able to show you get similar evidence in rural, remote and very remote communities because we know when all the ducks line up, we can change life trajectory for mothers and babies in First Nations communities."
Prof Roe said the centre's research has shown that when maternity services are redesigned in partnership with First Nations communities, there are profound improvements in clinical outcomes, cost savings and, most importantly, families thrive and flourish.
"Redesigning a system so that it wraps around mothers and babies, is protective, is culturally and clinically responsive to the needs of women can change the story very dramatically," she said.
"It takes a lot of work, but also the research that we're doing is essentially generating the evidence about why it's good practice."
Aboriginal health workers and embedding cultural safety in maternity are key to Birthing on Country, like the djakamirrs, Yolngu pregnancy and birthing companions from Arnhem Land.
"They're not clinicians, they're cultural supporters, they're not interpreters, but they speak the same language, there's a kinship there," Prof Roe said.
"Imagine going into a very foreign system where no-one understands you, let alone understands your cultural values.
"And you've got a djakamirr who understands all those elements and they're your advocate - we've got evidence that when that has occurred in Nhulunbuy and Darwin hospitals they've got better clinical outcomes."
Prof Sue Kildea, also from the centre, said they were developing an educational program and a clinical midwifery program as First Nations midwifery staff transition from standard care to Birthing on Country services.
"The goal of this next stage is to help organisations and communities implement Birthing on Country services that are underpinned by evidence, and for them to be able to transition to, and sustain these services into the future," she said.
Research shows that First Nations women experience poorer maternal outcomes when compared to other Australian women, and, if living in geographically remote areas, health inequalities are further increased.
"Preterm birth is one of the largest causes of stillbirth, infant and child mortality, and a significant contributor to lifelong disability and chronic diseases in First Nations Australians," Prof Roe said.
"Our goal in these three demonstration sites is to reduce preterm babies.
"This has already been done in an urban setting, where a study has found a 38 per cent reduction in preterm babies.
"So ensuring that this is done in partnership with and centring the aspirations of Aboriginal communities has to be heard loud and clear because the numbers story is unacceptable."
