It takes a village to raise a child, but it also takes a village to birth one safely.
The number of rural and remote maternity units in Australia has almost halved since 1992. A new framework aims to put community co-design at the centre of a rebuilding effort.
Almost 20 years after the first edition was released, Australia has a new National Consensus Framework for Rural Maternity Services.
The framework, which covers seven points, was put together over two years by a panel of 12 midwifery, clinician, rural and consumer peak groups and released this week.
With the rural medical workforce still in dire shortage, a birth trauma inquiry in NSW and a number of rural maternity units in Queensland having faced closure, the last two years have brought the issue to a head.
The closure of a rural maternity unit is seen as something of a canary in the coalmine for a regional health service.
“It’s been 25 years of slow and sure death for lots of rural maternity units,” ACRRM president and GP obstetrician Dr Rod Martin told The Medical Republic.
“The problem when you close a maternity unit is that the experienced midwives, who are often very experienced nurses, leave [town] because they still want to go and be delivering babies.
“If there’s no maternity unit, then there’s often no reason to have anaesthetics on the ground.
“All of that senior nursing and … more experienced procedural medical [workforce] disappear as well.”
One of the longer-term flow-on effects, Dr Martin said, is that these towns then become less desirable for young families who do not want to be compelled to travel to a coastal city to deliver.
The new framework stresses the importance of community involvement in designing contextually and culturally appropriate models of care.
It’s laid out under seven principles:
- culture, leadership and wellbeing
- safety and quality
- access
- models of care
- infrastructure
- workforce, and
- funding.
Strategies listed under “funding” include bundled maternity funding which would be tiered for rurality and remoteness. The bundled funding would also include midwifery and GP obstetrician models of care in all settings.
Related
It also recommends that penalties be applied to services where maternity care is withdrawn without community engagement.
Rural Doctors Association of Australia president Dr RT Lewandowski told TMR the framework had come at a “critical” time and that he hoped it would enable or support strategies that will increase rural birthing “back to where it should be”.
Under the safety and quality banner, strategies include that when a woman requests a referral to a certain healthcare professional, it must be facilitated.
The new framework also states that women must have access to culturally safe and appropriate maternity care close to where they live.
Dr Martin said that the “logical step”, if mothers were going to deliver closer to home, would be for states to stop closing down maternity units; but there are caveats.
The new framework, he said, emphasised that multiple professions needed to be represented on a multidisciplinary team.
“[Maternity units] need to have someone who is obstetrically trained – a doctor – and some very clear planning to be able to carry out emergency caesar within 30 to 60 minutes,” Dr Martin said.
“The challenging thing is that midwives are probably very happy with a model where it’s a midwifery-led model, and that’s okay – but it can’t be midwifery only.”
National Association of Specialist Obstetricians and Gynaecologists president Associate Professor Gino Pecoraro said obstetrically trained doctors wanted “proper” team-based care where every woman in every pregnancy is seen by all members of the treating team.
“If [we are] just called in the middle of the night and it’s the first time you meet the patient, it’s not satisfactory for the woman, it’s not satisfactory for the care provider and it makes them feel that they’re only there for their insurance policy,” he told TMR.
