Developing rural based maternity services benefits women and their local communities. The key to success will be in making these services and positions attractive for the skilled clinicians they require.
I WAS RECENTLY invited by the Rural Doctors Association of Australia (RDAA), and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to discuss the future of rural maternity services at Parliament House. The AMA, RDAA, and the two rural generalist training colleges (RACGP and ACRRM) have long seen eye to eye on the need to develop Rural Generalist Medicine in Australia.
The local health system is, and will remain, the basis on which vibrant rural communities are built. It is absolutely essential that these systems are built by rural doctors for the benefit of their communities. In larger rural communities, the appeal of locally based maternity services is clear. When a maternity service is lost from a rural town, this has catastrophic consequences, not only for mothers and babies, but also for our communities at large.
The loss of a maternity service means that women must travel long distances to access care. This may be for something as simple as an antenatal appointment. It will almost certainly be required for delivery. It is difficult for many who live in the city to imagine uprooting your entire family at 34-36 weeks gestation to move to a larger centre to deliver your baby safely. This is a particular travesty in our First Nations communities who have gradually had their rights to birth on country removed from them as services are wound back.
Not only are there direct consequences for women, but communities as a whole benefit from a functional maternity service. Maternity Services attract broadly skilled rural doctors (Rural General Practitioners, Rural Generalists, and Specialists) with the capacity to work in both primary and hospital care. They also require an operating theatre to be available in the event of a crisis during labour. The running of these services requires a critical mass of skilled doctors, nurses and midwives. This is an incredibly valuable resource that can be called upon whenever difficult situations arise in a rural town.
In their zeal to overcentralise services, governments of all stripes have suggested that rural birthing is “unsafe” and can only be performed in larger metropolitan and regional centres. This has been disproven by data time and time again. Rural clinicians are regularly ignored in the planning of local services in favour of centralised opinion and edict from our cities. It is an egregious example of geographic narcissism that has real consequences for our communities and our patients.
Governments claim they cannot recruit doctors, nurses, and midwives. These skilled clinicians do exist. We will be seeing more of them as the National Rural Generalist Pathway (NRGP) gains steam. We must focus on making these services and these positions attractive for the skilled clinicians they require.
To have a baby is a human right. To have quality healthcare in rural Australia is a human right. Childbirth does not respect geography, but it is time our governments do.
About the author
Dr Marco Giuseppin is chair of AMA Council of Rural Doctors (CRD) and a member of AMA Queensland Council. He is a practising Rural Generalist based in Queensland and a retrieval doctor with the the Royal Flying Doctors Service.