Babies born before arrival to hospital and maternity unit closures in Queensland and Australia

Kildea, Sue; McGhie, Alexandra; Gao, Yu; Rumbold, Alice; Rolfe, Margaret

doi:10.1016/j.wombi.2015.03.003

Cited by 50 publications

(82 citation statements)

References 38 publications

(61 reference statements)

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“…Despite this, few such services operate in Australia (3 urban/regional; 17 rural; 0 remote), 46 reflecting a centralisation of services, a lack of medical support in some cases, safety and sustainability concerns in others 44 , 47 . In fact, Australia has seen a 41% decline in maternity services over the 20 years from 1992 to 2011, especially in rural areas, correlating with a 47% increase in unplanned out‐of‐hospital births (22 814 births) 48 . There is an unequivocal relationship between distance to maternity services and poorer clinical 49 and psychosocial outcomes 50 , 51 .…”

Section: Birthing On Country In Remote and Very Remote Australiamentioning

confidence: 99%

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Kildea

Tracy

Sherwood

et al. 2016

Medical Journal of Australia

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The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

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Section: Birthing On Country In Remote and Very Remote Australiamentioning

confidence: 99%

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Kildea

Tracy

Sherwood

et al. 2016

Medical Journal of Australia

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“…The tendency towards centralising health services in many developed nations, including Australia, has resulted in rural and remote maternity unit closures. In Queensland, from 1992 to 2011 there was a net reduction of 36 maternity units (28%), effectively increasing the distance to birthing units for rural families . Closures were linked to issues of rurality, medical and midwifery workforce shortages, safety and quality concerns, perceived higher costs and disconnected localised planning and reactionary decision‐making .…”

Section: Introductionmentioning

confidence: 99%

“…In Queensland, from 1992 to 2011 there was a net reduction of 36 maternity units (28%), effectively increasing the distance to birthing units for rural | 43 TENNETT ET al. families. 2 Closures were linked to issues of rurality, medical and midwifery workforce shortages, safety and quality concerns, perceived higher costs 2 and disconnected localised planning and reactionary decision-making. 3 This trend has been met with local community protest and concern.…”

Section: Introductionmentioning

confidence: 99%

“…5 During the 20-year maternity unit closure period in Queensland, the rate of babies born before arrival (BBA) doubled, reaching 429 births by 2011, and was highest in inner and outer regional areas. 2 These findings are consistent with international research, and a large population study in British Columbia between 2000 and 2004 found that the odds of having an unplanned out of hospital birth is 6.41 (95% CI 3.69, 11.28) for women 1-2 hours away from services with statistically significant increases in perinatal mortality for newborns whose mothers reside more than 4 hours from services, as well as induction rates for logistical reasons highest for women located 2-4 hours from services. 6 Distance from a maternity unit not only impacts on delivery plans but also increases distress for those having to travel large distances 7 and for those labouring en route.…”

Section: Introductionmentioning

confidence: 99%

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Access and outcomes of general practitioner obstetrician (rural generalist)‐supported birthing units in Queensland

Tennett

Kearney

2020

Australian J Rural Health

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Objective To describe characteristics and outcomes of women birthing within GP‐obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland. Design Retrospective descriptive study. Setting 21 GP‐obstetrician supported birthing units in Queensland. Participants Women (n = 3111) birthing from January 2017 to December 2017. Main outcome measures Patient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data. Results Women birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001). Conclusion GP‐obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety.

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“…1 The closure of small maternity services in rural and remote Australia 2 and internationally has occurred over the past two decades. 5 In 2016, 69 women gave birth in 31 Queensland Health facilities without maternity services 6 ; approximately 90% of these births occurred in rural and remote settings. It is inevitable that some women will present in established labour to health facilities without midwives or other appropriately qualified staff.…”

Section: Introductionmentioning

confidence: 99%

Imminent birth education for rural and remote settings: An evaluation study

Connell

Kelly

Nagle

2019

Australian J Rural Health

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Objective: To describe the development and evaluation of an educational resource that aimed to provide the non-midwifery workforce in rural and remote health facilities with basic knowledge and skills to assist women who present when birth is imminent. Design: Descriptive methods using surveys were employed to evaluate the resource named the Imminent Birth Education Program. Participants: Health professionals employed in Queensland Health rural and remote non-birthing facilities. Intervention: An evidence-based, blended educational program comprising an online component, a face-to-face workshop and an education package for midwives to facilitate the workshop in their health service. Results: More than 600 participants completed the online course component, and the majority of these participants were employed in non-birthing facilities. Throughout the project, two project officers facilitated face-to-face workshops, training participants to facilitate the workshop in their own health services. The reach of the Imminent Birth Education Program was statewide with clinical staff from all 16Hospital and Health Services participating. Conclusion: The uptake of the Imminent Birth Education Program has been widespread across the state and positively evaluated by the rural and remote non-midwifery workforce in non-birthing facilities. This evidence-based program is an effective way to provide the knowledge, skills and confidence to assist health professionals to care for women who present to these facilities when birth is imminent. K E Y W O R D Sevidence-based, maternity care, professional development 406 |

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Babies born before arrival to hospital and maternity unit closures in Queensland and Australia

Cited by 50 publications

References 38 publications

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Access and outcomes of general practitioner obstetrician (rural generalist)‐supported birthing units in Queensland

Imminent birth education for rural and remote settings: An evaluation study

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