Queens­land's rise in baby deaths af­ter ob­stet­ric unit clo­sures sparks ur­gent re­think

The Guardian Australia - - Headlines - Melissa Davey

Woe­ful ac­cess to ma­ter­nity ser­vices in ru­ral and re­mote Queens­land has prompted the state’s health min­is­ter to sum­mon Aus­tralia’s top med­i­cal ex­perts to take part in a sum­mit ex­am­in­ing the is­sue.

It comes af­ter the Sun­day Mail re­vealed 23.3 ba­bies in ev­ery 1,000 were dy­ing in some ru­ral Queens­land towns where no birthing ser­vices are avail­able, com­pared with 6.1 ba­bies in ru­ral ar­eas with ob­stet­rics. Ru­ral doc­tors told the Sun­day Mail that the clo­sure of 40 ru­ral and re­gional ob­stet­ric units had con­trib­uted to the higher death rate in those ar­eas, with women forced to de­liver their ba­bies at home or on the road­side try­ing to get to a hos­pi­tal.

Queens­land’s health min­is­ter, Steven Miles, said the death of even one mother or baby in child­birth was a “tragedy”.

“I’ve asked the De­part­ment of Health to es­tab­lish a sum­mit, in­clud­ing re­con­ven­ing an ex­pert panel formed in 2014 to look at these is­sues,” he said. “Doc­tors and med­i­cal prac­ti­tion­ers are the right peo­ple to make these de­ci­sions based on pa­tient safety.”

How­ever, he said over­all data showed Queens­land was one of the safest places to give birth.

Queens­land Health’s deputy di­rec­tor gen­eral, Dr John Wake­field, said he un­der­stood “ev­ery­one would like ev­ery fa­cil­ity or ser­vice right there in their own com­mu­nity”. How­ever, he said there needed to be enough women and births in ru­ral ar­eas to jus­tify ap­point­ing teams of doc­tors and open­ing ma­ter­nity ser­vices there.

“This de­ci­sion is never made lightly and in­volves care­ful and hon­est con­sid­er­a­tion of the risks and con­se­quences by health ser­vices and their com­mu­ni­ties,” he said. “Each sit­u­a­tion is unique.”

But a pro­fes­sor of mid­wifery at the Western Syd­ney Univer­sity, Hannah Dahlen, said “you don’t need a ma­ter­nity ser­vice in ev­ery sin­gle tiny town”.

“What you can do, how­ever, is re­think your models of care so you at least have mid­wives who are able to pro­vide an­te­na­tal care, and mid­wife-run units for low-risk women who can triage women and send those with more risk fac­tors to a more med­i­cally man­aged unit,” she said.

“The prob­lem is we treat ev­ery preg­nant woman as the same. We need a more fi­nessed ap­proach. Not ev­ery woman needs a doc­tor but ev­ery woman needs a mid­wife. So why don’t we de­sign ma­ter­nity ser­vices to meet that re­al­ity?”

She added that Queens­land did not have a pub­licly funded home­birth pro­gram, which was ex­ac­er­bat­ing the is­sue.

The Ru­ral Doc­tors As­so­ci­a­tion of Queens­land vice-pres­i­dent, Dr John Hall, agreed that ex­pec­tant moth­ers were be­ing backed into a cor­ner.

“Women are left with very poor choices – leave your life and kids be­hind for a cou­ple of weeks or take the chance of do­ing it alone,’’ he said.

Pho­to­graph: Jen­nifer Polixenni Brankin/Getty Images

Ru­ral doc­tors in Queens­land say the clo­sure of 40 ru­ral and re­gional ob­stet­ric units con­trib­uted to the higher death rate in those ar­eas.

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