September 21, 2003

Geraldton, Western Australia

This weekend I am in Geraldton, a town on the west coast of Australia an hour’s flying time north of Perth. They have two maternity units, one in the public system and one in the private hospital and the GPs do most of the obstetric care in the town, along with the obstetrician.

The energy amongst the midwives here is very exciting. They have been working hard to keep birth normal and have managed t keep the caesarean rate at 19% (almost 10% less than the state average). The obstetrician is supportive of vaginal birth and they have an 80% vaginal birth after caesarean (VBAC) rate. Their next challenge is to get the induction rate down and to find a way of establishing a midwifery service - they hope they can get a midwives clinic going.

Although midwives working in these rural areas often feel they are rather cut off from the action in the big cities, they have many advantages to celebrate. With fewer staff it is easier to establish close working relationships and to share ideas and plans. Making changes is often easier because there are fewer people to convince and management is not as remote as it can be in a large hospital. The women often know the midwives and the community spirit is easier to tap into when support is needed from those quarters.

The GPs do wield extraordinary power, however, in a small town. The community is anxious to keep them happy in case they decide to move to greener pastures and the hospitals rely on them for many of their services, including minor surgery and some anaesthetics. For a General Practitioner, providing birthing services is often a pleasant aspect to their work, although the current pressure from high insurance premiums required for obstetric services is taking much of the gloss off. The time will come when the GPs decide that the costs outweigh the benefits and they may withdraw their birthing services. This will be crunch time for the midwives, who will have a wonderful opportunity to step in and set up a midwifery service at the hospital. It will mean that some women may have to be shipped out to larger units some distance away when there are complications, but with midwives as primary care givers, the statistics show that the numbers of women with complications usually falls. As long as the midwives don’t lose their cool and support each other as they rediscover their skills, it can work very well.

I get a strong feeling that here in Geraldton, the future is very bright for the midwives, even if it takes some time for them to achieve their goals. They have a vision, strong leadership and a strong commitment to improving birth for the women in this town. I am pleased to be playing a small part in their plans through presenting this workshop for their midwives.

Posted by andrea at September 21, 2003 10:13 AM

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