The health of our rural and remote children starts with high quality maternity care before, during and after birth. This care should focus on the needs of rural and remote women and their families and ideally be provided within their own community.
Unfortunately, we have seen widespread closure of rural and remote maternity services over the past 25 years. Many of these closures have occurred under the guise of concerns about quality and safety. However, there is ample evidence that rural birthing centres can be as safe as their urban counterparts.
In fact, the loss of maternity services can diminish the overall quality of local health services and significantly lower quality and safety outcomes for both mother and child. Women are far more likely to seek regular ante and post-natal care within their own community and where it is culturally appropriate and delivered by a local care team. This in turn, transfers to better health outcomes for both mother and baby.
It may be safer for many rural and remote women to give birth in their local communities and with the support of trained staff and appropriate facilities, rather than being forced to travel to a larger regional centre, with the associated economic imposts and lack of support from family and community.
Maternity services close to home also minimise unplanned births and obstetric emergencies. These situations present a much greater risk to the mother and baby where the facility has been downgraded and staff de-skilled. All rural and remote hospitals should be prepared and equipped to cope with obstetric emergencies and unplanned births, both through the provision and maintenance of equipment and infrastructure and staff upskilling and training.
High quality maternity services can be provided by Rural Generalist doctors who often have procedural skills in obstetrics and anaesthetics, working closely with midwives and other health professionals as part of a maternity care team. This arrangement provides ongoing continuity of care for mother and baby and lays the foundation for a healthier childhood. This is the ideal to which we must aspire.
Achieving this ideal will need a strong commitment from all levels of government to: training and supporting the rural maternity workforce; maintaining and upgrading rural maternity and birthing facilities; and a recognition of the importance of providing access to care which is based on the needs of mothers and babies, as determined by them.
Rural and remote maternity service have been a state and Federal policy focus for the past 18 months, with ongoing work to develop a National Strategic Framework for Maternity Services and a number of state-based reviews and projects. Hopefully, through these processes, we will get some recognition of the importance of providing as much maternity care as close to a woman’s home as possible.