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Rural Maternity Services

February 2007

Midwives make a vital contribution to the health and wellbeing of women and babies in rural Australia and are a part of a multidisciplinary team providing care.  In rural areas there is a need for an integrated network of professionals over a number of sites providing the comprehensive maternity care for women and their families.  Midwives are primary carers for healthy women and their families and must be utilised appropriately in rural areas.

Rationale:
The Australian College of Midwives (ACM) believe that the closure of maternity services in rural areas and resultant lack of provision of care for women in these areas is an unacceptable situation.  It is the view of the Australian College of Midwives that there is an urgent need for the development of a National Framework for Maternity Services to guide a range of initiatives which will improve access to maternity care for women in rural areas.

Figures indicate that around 130 rural services from across Australia have closed in the last 10 years however figures also indicate that the birth rate is rising and people are choosing to move to  country areas for the lifestyle.

Closing small maternity units puts the responsibility for accessing maternity care back to the clients.  The ACM believe that maternity service providers should take the responsibility to provide maternity care on an equal and equitable basis to all women regardless of their location.  Closure of rural services is only one way of dealing with workforce shortages and no formal examination of the safety and cost effectiveness of this method of dealing with this situation has occurred.  Evidence indicates that smaller maternity units are, at least, as safe as larger units.  Evidence does not indicate the need for all services (eg caesarean section capability) to be available on all sites of a rural unit. .

Guidelines:

  • All available workforce need to be effectively utilised in rural areas. All members of the maternity care team must have the support to fulfil the roles for which they are educated and registered.  Midwives should be seen as having the capability to provide full primary care for healthy women.
  • An integrated network of professionals working collaboratively in primary and secondary sites can provide comprehensive maternity care over a number of locations.
  • Women benefit from primary midwifery care close to home and are referred according to evidenced based guidelines during pregnancy and labour as required.
  • Continuity of care midwifery models supported by appropriate medical support from both GP proceduralists and obstetricians are a safe and cost effective option in rural areas.
  • Workforce strategies aimed at increasing satisfaction and increasing retention include access to continuing professional development to enable midwives who have not practice across all areas of maternity services to gain current experience across their full scope of practice. Resources for midwives to access CPD need to be allocated as a priority.
  • Evidence indicates that increasing continuity is one strategy which may increase satisfaction and increase the number of midwives in the workforce.
  • A National Maternity Services Framework is the first step to achieving improved access in rural areas.
  • ACMI supports the development and the implementation of Information Technology in rural and remote locations to improve diagnosis, clinical consultation and staff education.

References

Enkin M, Keirse JNC, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr J: 2000 A Guide to Effective Care in Pregnancy and Childbirth. 3rd Ed. Oxford. OUP http://maternitywise.org/guide/about.html

Flint C, Poulengeris P. 1989 The ‘Know Your Midwife’ scheme - a randomized trial of continuity of care by a team of midwives Midwifery 5:11-16

Hirst C. 2005. Re-birthing – report of the Review of Maternity Services QLD.

Hodnett E D, Gates S, Hofrney G and Sakala C. Continuous support for women during childbirth.The Cochrane Database of Systematic Reviews 2003, Issue 3.

Homer C, Davis G, Brodie P, Sheehan A, Barclay L, Wills J, Chapman G 2001. Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care Br J Obstet Gynaecol 2001;108:16-22

Kirkham M, Morgan RK and Davies C.  2006. Why do Midwives Stay. Executive Summary RCM. http://www.rcm.org.uk/info/docs/Why do Midwives Stay Exec summary and conclusions.doc

Rowley, M, Hensley, M, Brinsmead, M, & Wlodarczyk, J. 1995. Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial. The Medical Journal of Australia 1995; 163 (9): 289-293.

Rural Doctors Association of Australia and Australian Council Rural and Remote Medicine. 2005. “Birthing services in small rural hospitals:sustaining rural and remote communities”  Strategic outcomes for the RDAA and ACRRM symposium.  10 March 2005.

Tracy SK, Sullivan E, Dahlen H, Black D, Wang YA and Tracy MB.  2005.  Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women. Br J Obstet Gynaecol.