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Rural maternity services

The crisis in rural health, especially in the provision of maternity care has become a critical issue, for those who live in the country in Australia and also for service providers. Although almost all of Australia’s population live within 100 kilometres of the oceans that surround us, there are still many people that live in remote areas, often many hundred of kilometres from the nearest large town. For these people, getting medical help may mean a long drive over dirt roads or else reliance on the Flying Doctor Service who provide emergency care and some regular clinics in small townships in rural areas. For pregnant women, the need to attend check-ups during their pregnancy may mean several long round trips by road to the nearest hospital, and a journey in labour that may end with an unexpected birth on the side of the road.

Service providers face the problem of attracting and retaining staff in rural areas. The long hours required to cover staff shortages, the need to provide schooling for their own children, and the lack of locums to allow time off are some of the issues that make living and working in country areas less attractive in the long term. Obstetricians are in short supply - most prefer to work in the cities where access to the latest equipment, a group of colleagues and wealthy women, make private practice more lucrative and comfortable. For hospital based doctors, there is the prospect of a wide variety of patient problems and conditions that are useful for honing skills.

Last December a meeting was convened in Canberra by the National Rural Health Alliance to discuss these issues and to explore the issues inherent in “Birthing in the Bush”. The group was widely representative of all stakeholders and they worked together to address these issues: women’s birth experience; safety and quality; workforce shortages; job satisfaction; and education and training. Of particular concern was how the varying needs of pregnant women could be addressed - from those who want to stay close to their families when giving birth to those who want access to all forms of technology and the private health care they expect, having paid for private health insurance.

A proposal was formulated that will go some way to meeting the needs of parents and of care givers. In essence, it involves the development of “triage-type” teams operating out of Regional Maternity Services Divisions that would

* coordinate all the maternity services in their region

* arrange for community midwives to screen all pregnant women and to assist them develop a birth plan

* provide obstetric consultation (perhaps remotely via video-link etc) so that midwives can operate Community Birthing Centres for all low risk women, and

* arrange for transfer for those women needing or wanting secondary or tertiary care involving specialists or anaesthetists.

The basic concept of the plan is that midwives will provide the bulk of the care for pregnant women, in their own communities, referring as required and when necessary to the Regional Maternity Service. This is a big step forward for midwives and offers them the possibility of working more autonomously and providing primary health care for the majority of women through a network of Community Birthing Centres.

A discussion paper outlining the proposals is now circulating for comment, with phone teleconferences planned in the coming weeks. Eventually, this proposal will be presented to the Federal Government, who will be responsible for providing the funding for the Regional Maternity Service Divisions. The State Health Department would fund the Birth Centres in each State. A bold plan that deserves support from all tiers of Government but will no doubt take the usual lobbying and struggle to achieve.

Posted by andrea at May 17, 2005 06:20 PM