Primary Maternity Units in Australia (an international research collaboration)

The Australian government has declared a commitment to improving women’s access to maternity care in rural and remote areas, following the adverse effects of prior maternity service closures. In an international context, Primary Maternity Units (PMUs) provide birthing services in areas geographically separated from ideal obstetrics and neonatal services.

A recent study, “Primary Maternity Units in rural and remote Australia: Results of a national survey,” conducted in part by the Center for Rural Health Research’s Dr. Jude Kornelsen, sought to investigate and describe how PMUs operate throughout rural and remote Australia. The study is intended to inform both policy makers and health care professionals regarding the function and role of PMUs across Australia’s rural and remote regions. The researchers hope to identify what areas will require governmental support to improve rural women’s access to proper maternity care.

Sustaining Rural Maternity and Surgical Care

In a newly published article, “Sustaining rural maternity and surgical care,” Dr. Jude Kornelsen, Dr. Stuart Iglesias, and Dr. Robert Woollard comment on the “Joint Position Paper on Rural Surgery and Operative Delivery” they co-authored in 2015, this time focusing on three main issues: providing rural health service closer to home, the impasse on safety, and operative delivery. They look at how the adoption of health services provided closer to home has impacted three communities in rural BC. Next they present undeniable evidence that rural surgical care has long been facing a service closure crisis, similar to that of maternity care. They recognize the need for action, and follow this up with background information on the relationship between general surgeons and family physicians with enhanced surgical skills (FPESS), and how their professional links impact the international discussion on defining and evaluating “safety.” For the third issue, the authors comment on the importance of local caesarean section services, and argue that unless a link can be fostered with surgical programs, these too will be unsustainable in rural and remote areas. Finally, Drs Kornelsen, Iglesias, and Woollard present and discuss the current need for all health care professionals and partners to align for a system change. They suggest that while interprofessional relationships will require significant attention, such an alignment will enable responsible policy to be implemented and lines of accountability to be maintained in each essential jurisdiction.

Where are the Midwives?

Over the past two decades there has been a slow erosion of maternity services in rural and remote areas in Canada. Many rural residents have been vocal about their opposition to the closures. However, the voices of health care professionals have been missing from the dialogue. In the recently published commentary “The Closure of Rural and Remote Maternity Services: Where are the Midwives?” Dr. Leslie Barclay and Dr. Jude Kornelsen argue that it is the responsibility of professional bodies to advocate for sustaining maternity services in rural and remote areas. The authors defend their belief that it is necessary for midwives to speak out and advocate as a means to effect system changes for both political and strategic reasons. Researchers must continue to develop evidence that can be used as a basis for strong advocacy on behalf of women living in rural and remote areas. System-level changes cannot be done by individuals alone; they require collective effort from professional bodies in all pertinent fields. Those who read this article will gain insight into the current situation facing rural and remote women, and how we all have a role to play in maintaining maternity services.

Reconceptualizing Risk

Maternity services in rural and remote regions of Canada, France, the United States, and comparable jurisdictions are facing closures. Australia has seen a closure of nearly half of their maternity units over the past two decades. Dr. Lesley Barclay (University of Sydney) has carried out fieldwork on how growing rates of maternity unit closures has impacted rural and remote residents in Australia. This research was part of the Australian Rural Birthing Index Project (ARBI), which was developed to assist in planning appropriate levels of maternity services for various rural communities. Dr. Barclay was supported by a team of researchers from Canada and Australia, including CRHR’s very own Dr. Jude Kornelsen.

A full description of the main findings has been made in a 2016 article titled “Reconceptualising risk: perceptions of risk in rural and remote maternity service planning.” The paper reports participants’ perceptions of risk in relation to the closure of rural maternity services, obtained through semi-structured individual and group interviews, focus groups, and group discussions. The analysis covers various clinical, legal, political, financial, cultural, emotional, and operational risks associated with the closure of rural maternity services. Understanding these risks, whether they are perceived or observed, is vital to the planning and improvement of rural and remote health services.

Time for an Alliance between Rural Perinatal Service Providers

Rural maternity and surgical care is facing a crisis. There is a growing recognition of the need and desire to keep rural women closer to home for their maternity care. However, responding to this desire is impeded in British Columbia – and throughout rural and remote areas of Canada – due to increased attrition of rural maternity and surgical services over the past few decades. In their newly released commentary “Rural Perinatal Surgical Services: Time for an Alliance Between Providers,” Dr. Jude Kornelsen, Dr. Stuart Iglesias, and Dr. Robert Woollard discuss how the sustainability of rural maternity care can be preserved through the Family Physicians with Enhanced Surgical Skills (FPESS) program and the creation of a “network of care.” The authors argue that a network model should be adopted in order to build genuine relationships that will lead to the collaborative commitment of servicing rural areas in need of maternity care.

Closing Rural Maternity Services: Is it worth the risk?

Maternity and newborn outcomes and stress levels are significantly worse for women and infants living in rural and remote communities when compared with individuals living in urban environments. While many sociopolitical and economic factors influence these adverse outcomes, they are in part the result of the shortage of local services available in rural areas. At the same time, closures of local maternity services in rural and remote communities throughout Canada have increased in the last five years. In a newly released commentary, “Closing Rural Maternity Services: Is it worth the risk?,” Dr. Stefan Grzybowski, Dr. Jude Kornelsen, and Dr. Lesley Barclay discuss the impacts maternity service cessation has on mothers and newborns, and the implications this has for policy makers. The authors use a rural lens to suggest various alternatives to health service closures in rural and remote communities, in order to promote equitable and sustainable services for these consistently underserved communities.

New Publications, New Research, and More…

A lot has happened at CRHR in the past six months.

We have had eight journal publications come out this year so far, with two more in press. We are working on publishing more of our research findings. At the same time, APRU is wrapping up its fourth systematic literature review on rural patient transport and transfer.

We continue our active research profile, and are developing new research projects on topics including:

  • telehealth and video conferencing for rural maternity care
  • patient decision aids regarding place of birth in communities without access to cesarean section
  • the sustainability of rural hospitals
  • rural surgical networks

Finally, we are very excited to welcome new members to the CRHR office and our research team. Check out their profiles here.

Stay tuned for more details about our projects and publications!