A rural generalist-led model of birthing services has been reinstated in Cooktown, a remote coastal town in Queensland.
For the first time in more than four years, women in Cooktown no longer have to travel to access maternity care, with the region’s birthing services resuming yesterday.
But experts say gaps remain.
Government strategy combined with shortages of local health professionals and chronic underinvestment in rural and remote maternity services have forced the closure of more than 150 rural maternity units across Australia over the past two decades.
Dr John Hall, a rural generalist obstetrician and past president of the Rural Doctors Association of Australia (RDAA), is now a medical director of maternity services for the Cape York region. He helped reopen Weipa’s birthing services in 2024, before playing a key role in restoring Cooktown’s this year.
Dr Hall now calls the coastal town his “forever place”, where he resides and is sole director of Melaleuca Medical, the town’s GP practice.
The state government’s strategy of centralising services in large regional centres, under what Dr Hall described as the “guise” of safety, was, in fact, economic rationalism, resulting in the downgrading of hospitals, increased perinatal mortality and roadside births.
When hospitals lose their maternity services, they often lose their operating theatre, taking with it midwives, doctors with acute care skills, anaesthetists and obstetricians, Dr Hall told The Medical Republic.
Where elective maternity services continued, Dr Hall said they achieved better key performance indicators than their metropolitan counterparts, thanks to continuity of care and “one-on-one attention” from senior doctors and midwives.
He pointed to a 20-year combined localised analysis of obstetric outcomes at Atherton Hospital between 1981 and 2000, which tracked 5880 total deliveries attended by rural non-specialist doctors.
The study recorded no maternal deaths over the two decades and a crude perinatal mortality rate that remained steady, from 5.2 per 1000 births between 1981 and 1990 to 5.3 per 1000 births between 1991 and 2000.
“That’s one of many studies that’s been able to show that the outcomes in rural maternity services that are run well are really good,” he said.
“It’s been nice to close the loop on advocacy,” he told TMR.
He also attributed the reopening of Cooktown’s birthing services to Eastern Medical Services’ Torres and Cape Hospital director, rural generalist Dr Natasha Coventry, and to director of midwifery Michelle O’Connor.
Dr Hall said they “provided exceptional leadership, working with the local team to build the workforce, clinical capability, and systems needed to restore a safe and sustainable service.”
With no access to local birthing services, women in the region were often sent to Cairns four weeks before their due date, where they were required to find accommodation away from their support systems and then reintegrate into their community, he said.
Cairns Hospital is roughly 326km from Cooktown – a four hour drive under normal conditions.
Cooktown has a large First Nations community, but it also served the adjacent communities of Hope Vale and Wujal Wujal. Weipa served the Napranum, Mapoon, and Aurukun communities, Dr Hall told TMR.
“The importance of birthing close to country or on country for these women can’t be overstated,” he said.
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Associate Professor Gino Pecoraro, a Brisbane-based obstetrician and gynaecologist, said the closure of birthing services made it harder to attract and retain GPs and ACRRM trainees and disrupted families, especially when fathers were FIFO workers or other children needed care.
“Mothers are the glue that keep families together so we need to look after them,” he said.
While he was “really, really happy” about the service reopening, he said many more like it were needed.
Biloela Hospital, located in a medium-sized rural town in central Queensland, also saw its birthing services resume yesterday after a four-year closure. However, Professor Pecoraro expressed concern that the hospital could provide only level two services – low-risk, uncomplicated pregnancies – down from level three at the time of its closure.
“They don’t have access to obstetrically trained doctors, and if something goes wrong, it’s hours away from the nearest site that can provide GP obstetricians, specialist obstetricians, anaesthetists, and operating theatres,” he said.
“We know that even in low-risk situations, up to 50% of women deemed low risk and cared for by midwives will need the services of an obstetrically trained doctor to deliver the baby.”
“It’s just too scary to think that in a situation where something does change, [women are] hours away from help. That’s just too long,” he told TMR.
Roughly four in every 1000 births are born before arrival – what Professor Pecoraro called “the worst possible outcome”.
ACRRM president Dr Rod Martin said the “important and exciting milestone” for Cooktown would also enhance rural hospital capabilities well beyond maternity care.
“Rural Generalists work across general practice, emergency, and hospital care, and bring advanced skills in areas including obstetrics, anaesthetics, and paediatrics,” he said.
“When that capability is built locally, it strengthens the entire health service and increases the care that can safely be provided close to home.”
Rural communities should not have to travel hundreds of kilometres for care that could be provided locally, he said.
Rural generalist and RDAA president Professor Sarah Chalmers said the reopening was “absolutely fantastic” and cause for celebration, but stressed the need for ongoing commitment to prevent rural and remote communities from continuing to lose their birthing services.
As a mother who had both her children in remote, RG-led maternity services, she told TMR local services had “whole system benefits”.
“They can attract more staff because they have opportunities for people to work across the health continuum,” she said.
“Being able to birth at home means [women] don’t have to travel; they don’t have that stress during the pregnancy of trying to work out what that’s going to look like,” she said.
High levels of maternity-related stress are linked to a greater risk of hypertension, immune suppression, and labour complications in mothers, and neurodevelopmental and behavioural issues in children.
