The development of a caseload midwifery service in rural Australia

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Journal Article
Women and Birth, 2017, 30 (4), pp. 291 - 297
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© 2016 Australian College of Midwives Problem The past two decades have seen progressive decline in the number of rural birthing services across Australia. Background Despite health system pressures on small birthing units to close there have been examples of resistance and survival. Aim This descriptive study explored the evolution of a rural birthing service in a small town to offer insight into the process of transition which may be helpful to other small healthcare services in rural Australia. Methods Quantitative data derived from birth registers on number and types of birth from 1993–2011 were analysed. Interviews were conducted between January and August 2012 with nine participants (GP obstetricians, midwives, a health service manager and a consumer representative). Findings This rural maternity service developed gradually from a GP obstetrician-led service to a collaborative care team approach with midwifery leadership. This development was in response to a changing rural medical workforce, midwifery capacity and the needs and wants of women in the local community. Four major themes were developed from interview data: (1) development of the service (2) drivers of change (3) outcomes and (4) collaborative care and inter-professional practice. Discussion The success of this transition was reported to rest on strategic planning and implementation and respectful inter-professional practice and alignment of birth philosophy across the team. This team created a unified, progressive community-focused birthing service. Conclusion The development of collaborative care models that embrace and build on established inter-professional relationships can maximise existing rural workforce potential and create a sustainable rural service into the future.
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