Hi Marilyn and Macha, I can sympathise with the plight of birthing women who live in rural or remote locations. In Canada, we face similar issues. Many rural hospitals do not do obstetrics and women in my region regularly travel 1-2 hours in labour to a larger centre to give birth. Women from the north have been flown to major centres to birth for years. It is very disruptive to families and social networks, not to mention expensive and highly likely that is down right unsafe. Any way I just wanted to comment on Marilyn's comments on having an emergency plan. Yes, I think that is essential to have transport details worked out in advance. One thing though, there seems to be a dearth of literature (if someone knows of any please let me know as we are always looking for it here) on safe distance/time to access emergency services, particularly c-section. The "30 minute rule" Marilyn refers to is in fact an arbitrary number that has made it's way into policy everywhere. There is no evidence to show that "30 minutes from decision to incision" should be the standard. (Of course, this is a heretical statement.) Just as a matter of interest, there is a birthing centre at Rankin Inlet in Nunavet which handles "low risk" births with midwives in attendance. This birth centre is either two or four hours (I can't remember) by air to the nearest hospital centre capable of cesarean. They have fairly recently expanded their criteria to allow first time mothers to birth there, as they have been very successful at keeping women in the community with good results. Anyway, I am fairly certain this is accurate information. You may be able to find more on the web. I do know that there is a site out there but I do not know the URL. Interesting discussion, as this is one of my pet topics. I had been assisting women at rural home births for years before midwifery became regulated here . I have no problem with regulation, but now that we have been bureaucratized into regional health authorities I am beating my head against a brick wall to continue to serve my former clientele in their own communities. It has been heart breaking.
Meaghan At 10:10 PM 2/26/02 -0500, you wrote: >Dear Macha: I liked Wendy's response. It seems that we should be writing >grant/funding proposals for midwifery led care for rural communities >throughout Australia. I was recently up in North Queensland and discovered >that maternity care at the local hospital where I grew up (Tully) was >basically discontinued and that women travelled to Cairns to have their >babies at the base hospital. It is hard to understand why or how women are >accepting this, but maybe they just feel they have no other options. > > One concern might be the plan for transfer to hospital in case of an >emergency. Where I am now (Seattle) if we need an aid car we can usually have >one in 5-10 minutes and then another 5-10 minutes to the hospital which is >within the 30 minutes required to set up for an emergency c/s, however for >women in remote areas it is harder, though we do have emergency ambulance >helicopters. Is such a service available in rural Australia? I would have >thought so, but I don't know. Also while just recently in Australia I saw the >NET helicopter transfer a sick neonate from Bali to Westmead in Sydney, so I >think this is doable. I think it is critical to have a realistic emergency >transfer of care plan and OB's who are oncall who you would be transferring >to in such a situation. > >It is one of my pet peeves that the increasingly high tech nature of >hospitals has made the practice of rural medicine (unfortunately, including >childbirth) almost obsolete. I think it we have ti be creative about this >before it disappears altogether. > >regards marilyn >-- >This mailing list is sponsored by ACE Graphics. >Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
