Title: Rural "Obstetrics"!!!!!!!!!
Dear All
Thought you might like to see some more media on the continuing rural saga. I was a little misrepresented I said 70 not 80 and he got the MC representation thing wrong, but perhaps you may like to e-mail Peter at ABC Health report
Or better write to Tony Abbott re the Obstetric locum crap! I really have heard it all now.
Mr Tony Abbott
Minister for Health and Ageing
Parliament House
CANBERRA ACT 2600
JC
xx
Obstetric crisis in the bush
by Peter Lavelle
Published 24/02/2005
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If you want to have a baby, don't live in the bush.
That's effectively the message for pregnant mums in regional and rural Australia, suffering the gradual closure of obstetric services in country hospitals. And things will probably get worse, not better.
Obstetrics is the hard yard of medical practice - the hours are long, and there's a lot of after-hours work (babies come at a time of their own choosing). Insurance premiums are high and the fear of litigation is a constant factor.
Many obstetricians - especially young doctors - are leaving the field for the safer and easier areas such as infertility, family planning and gynaecology. Those obstetricians who are left are mainly older men in their fifties and sixties, for whom retirement is not far off.
In regional areas, GPs have traditionally done much of the obstetric work done by specialists in the cities. But for the same reasons, GPs too are now abandoning obstetrics - it's just too hard. In New South Wales, for example, the number of GP obstetricians has slumped from nearly 250 in 1996 to 125 last year, according to the Rural Doctors Association of Australia.
Women in country areas are increasingly having to travel long distances, often hundreds of miles, to have their babies delivered in metropolitan centres. Dr Andrew Flutzkin, vice president of the Rural Doctors Association of Australia, says that in some instances, women are having their children in cars or by the side of the road. Or they are electing to stay home to have their babies and if something goes wrong, present to the local hospital, which doesn't have obstetrics services and isn't set up to handle emergencies. Under these circumstances the chances of the mother or baby dying are much higher.
What makes the problem worse is that in the country, most mothers are admitted as public patients, rather than as private patients. But the trend is towards private obstetrics, thanks to measures like the health insurance rebate and the new Medicare Safety Net legislation (which caps the amount a person has to pay for expensive procedures like childbirth) - measures that make it more attractive for an obstetrician to work in the cities, says Flutzkin.
More responsibilities for midwives?
How to get obstetric services back to the bush is a question that's concentrating the minds of health bureaucrats at the state and federal levels. But the solutions aren't simple.
One idea that's gaining currency at the state government level is to let midwives take over more of the responsibilities that have traditionally been the domain of doctors.
Ms Justine Caines is President of a group called the Maternity Coalition, which represents midwives and childbirth educators. She says that in New Zealand about 80 per cent of births are managed by midwives. In Australia it's less than one per cent. She says that midwives are trained to deliver babies with the same expertise as obstetricians and that includes handling emergencies.
She's an advocate for the concept of midwives units, in which midwives are responsible for the antenatal care, the delivery, and post natal care. If there's an emergency, women are transferred to a larger hospital by air or road. So far there is one in New South Wales, in the Sydney suburb of Ryde. The unit is just one year old. Two others are planned - for Belmont (in Lake Macquarie) and Camden in Sydney's west. The Victorian Government is also committed to the idea, Ms Caines says. She believes it's the logical solution to the obstetrics crisis in rural and regional Australia. However the concept is facing stiff resistance from sections of the medical profession who resent the threatened loss of income from someone else doing obstetrics services, she argues.
Oh for a holiday
Increased responsibility for midwives isn't the whole solution, argues Andrew Flutzkin. He believes that when there's an complication in a delivery, specialist services need to be available - with surgeons, obstetricians and anaesthetists on hand at the hospital. He'd prefer to see increased funding and incentives for more obstetricians to train and practice in the bush.
In the meantime, obstetricians want a break. Last week, a group met with Federal Health Minister Tony Abbott to ask for funds to cover the cost of obstetric locums (including the costs of the locums' insurance premiums), to give them a holiday and a chance to recuperate from their workload. The Minister is said to be considering the idea.
And country women? If they're pregnant they better keep that travel kit packed. When they go into labour, chances are they'll have a long journey ahead.
More info
* Midwives pick up where GPs left off - Rural Health Conference 2003
* The Maternity Coalition
* The Rural Doctors Association of Australia
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