Birthing in rural S outh A ustralia: The changing landscape over 20 years

Background:In Australia, a significant proportion of women live rurally and deliver their babies in services supported by general practitioner obstetricians (GPOs).While GPOs are known to be an important backbone in the provision of maternity care in Australia, little attention has been paid to their models of care. Aims:To describe the models of maternity care provided by GPOs across Western Australia. Materials and Methods:This was a multi-phase mixed-methods cross-sectional exploratory study. We invited rural GPOs in Western Australia to complete an online survey about their models of care and a sub-group of GPOs agreed to an interview to further explore their responses.Results: Thirty-five GPOs completed the survey and 12 completed an interview.We found that GPOs work in a variety of models, dependent on local community needs, resources and geography. Key attributes of GPO models are continuity of care, safety, generalism, accessibility and affordability. GPO care involves continuity of care beyond the time limits of pregnancy.Conclusions: GPOs' models of care make up an essential part of rural maternity services and have evolved to meet the needs of the communities they serve. This work informs rural generalist trainees of career pathways and policymakers about rural service provision. K E Y W O R D S rural health, maternal health services, workforce, rural generalismThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

General practitioner obstetricians’ models of care in rural Western Australia

Wazir

Roxburgh

Moore

2022

“…16,17 Reduced availability of these services is likely to among the major discrepancies for women in rural areas. 6,7,12,[18][19][20] Increasing access to specialist care is not a simple task or a solution that will likely be achieved in the short-term. [20][21][22] In the meantime, investment in initiatives such as telehealth appears to be one avenue for improved outcomes.…”

Section: Previous Work Bymentioning

confidence: 99%

Obstetric and perinatal outcomes for women with pre‐existing diabetes in rural compared to metropolitan settings in Victoria, Australia

Williamson

McCarthy

Oats

et al. 2021

Background: Pre-existing diabetes in pregnancy is associated with an increased risk of complications. Likewise, living in rural, regional and remote Victoria, Australia, is also associated with poorer health outcomes. There is a gap in the literature with regard to whether Victorian women with pre-existing diabetes experience a greater risk of adverse pregnancy outcomes compared to their metropolitan counterparts.Aim: Our objective is to compare obstetric and perinatal outcomes for women with pre-existing diabetes delivering in rural vs metropolitan hospitals in Victoria, Australia. Materials and Methods: Retrospective population-based study using routinely collected state-based data of singleton births to women with type 1 and type 2 diabetes who delivered in metropolitan (n = 3233) and rural hospitals (n = 693) in Victoria, Australia, between 2006-2015. Pearson's χ 2 test, Fisher's exact test and MannWhitney U-test were used to compare obstetric and perinatal outcomes between metropolitan and rural locations.Results: Delivery in a rural hospital was associated with higher rates of stillbirth (2.3% vs 1.1%, P = 0.027), macrosomia (25.9% vs 16.9%, P < 0.001), shoulder dystocia (8.4% vs 3.5%, P < 0.001) and admission to the neonatal intensive care unit/ special care nursery (73.2% vs 59.3%, P < 0.001). Smoking (18.0% vs 8.9%, P < 0.001), overweight/obesity (P = 0.047) and socioeconomic disadvantage (P < 0.001) were more common in rural women. Conclusions:Women with pre-existing diabetes who deliver in rural hospitals experience a greater risk of adverse perinatal outcomes and present with increased maternal risk factors. These results suggest a need to improve care for women with pre-existing diabetes in rural Victoria.

“…International goals and rigorous audit remain relevant to maternity units of all sizes, including small rural units . While modern transport and communications go some way to bringing health care to rural and remote Australia, disparate health outcomes still exist in maternal and infant health …”

Section: Background and Rationale For Reviewmentioning

confidence: 99%

Pregnancy outcomes for women with pre‐pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review

McCarthy

Williamson

Shub

2018

Background Historically, pre‐pregnancy diabetes (PPDM) is a recognised risk factor for poor pregnancy outcome. Co‐existing pathology and adverse social determinants including rural‐metropolitan inequities in health and healthcare access may confer additional risks. Multidisciplinary care before, during and after pregnancy can improve outcomes for women with PPDM and their infants. The extent to which rural Australian women and their families share in improved outcomes is unknown. We aimed to summarise maternal characteristics and pregnancy outcomes for women with PPDM, including women in rural settings and examine applications of existing clinical guidelines to rural Australian practice. Methods We sought English language population and cohort studies about PPDM using Medline, Embase, PubMed, Australian epidemiological and international clinical practice guidelines. Results Women with PPDM are changing: older, more obese, of lower parity, less likely to smoke, more likely to have type 2 rather than type 1 diabetes and shorter duration of PPDM. Women with PPDM continue to experience excess adverse pregnancy outcomes, including maternal morbidity, complicated birth, perinatal loss, congenital anomalies and mother‐infant separation. On face value, clinical guidelines appear relevant to women living in rural settings but there are only a few, conflicting outcome studies for rural women with PPDM. Conclusions PPDM is changing. A significant minority live in rural locations, and although perinatal mortality/morbidity seems to be improving, it is unclear if this is also true for rural women due to a lack of recent Australian studies. Further research is necessary to achieve excellence everywhere for women with PPDM and their babies.