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Innovation in rural Victorian maternity services

This weekend I am presenting an Active Birth workshop for the Corangamite Managed Clinical Care Network, in Timboon, Victoria.

This is an interesting two year project, initiated by the GPs who cover the three hospitals in this area: Camperdown, Timboon and Terang. These three small rural units have about 150 births per year between them. The GPs have Obstetric Diplomas and also are able to do anaesthetics and they see all the pregnant women for pregnant and intrapartum care.

The Managed Clinical Care Network is an initiative funded by a rural health grant and was established to encourage good communication, education and learning opportunities for the GPs and midwives in the region. The Co-ordinator is responsible for administering the program and arranging the educational events and meetings.

The workshop is well attended with two of the GPs and midwives from the local hospitals and Warrnambool, which is the tertiary referral centre, not far away. There are also two midwives who have travelled over 900 kms from Cooma to attend!

It is clear that there is much interest in promoting natural birth and in developing good working relationships between all the staff. The easy camaraderie and sharing has been notable and new ideas have been thoughtfully considered. As with many hospitals, there is a shortage of midwifery staff and this is an issue that the network is tackling, looking at ways of attracting and retaining new midwives so that the hospitals can remain open. Without midwifery staff, the GPs will not be able to continue offering maternity care.

All the midwives work as nurses, dividing their time according to the needs of the hospital to cover the inpatient cases. This presents a further problem for the future, as the new midwives graduating are all “direct entry” and will not be able to provide nursing care. From what I have seen so far in this area, the set up of the three hospitals (they are all relatively close together) provides the perfect opportunity to establish case loading midwifery care. This is being considered, but many of the midwives are reluctant to give up their nursing and many have also expressed concern about the commitment and changed working practises that will be required.

One big problem is that because the GPs attend the births, the midwives have lost some clinical skills and therefore lack confidence (and perhaps competence). Up-skilling the current midwives, or attracting midwives from elsewhere who are able to practise autonomously will be important if case loading is to work.

The project is about half way through its two year term. It is to be hoped that their plans for re-vamping the system will be completed and in place with enough time to evaluate and report on the outcomes. It could be a very useful model for other small rural units, who are often under threat of closure.

Posted by andrea at April 29, 2006 08:32 AM