Australia's new rural health commissioner does not believe big is necessarily better when it comes to maternity services in the bush.
Adjunct Professor Ruth Stewart rejected as an "urban myth" the argument rural maternity services are less safe than larger units - drawing on numerous international and Australian studies to show they are at least as safe, and potentially safer.
The new National Rural Health Commissioner has supported the critical role of rural integrated multidisciplinary maternity services and their healthcare teams, in providing safe and quality care for rural women and babies and decreasing the likelihood of premature birth and its complications.
More than 130 small rural maternity units have been closed in Australia since 1995, as various state and territory governments have moved to centralise maternity care to larger regional centres and the cities.
Commissioner Stewart branded this as a simple 'cost and risk shifting exercise', where the cost and risk of birthing is shifted squarely to rural women and their babies - some of the most vulnerable in society.
She argued that, given the higher incidence of prematurity in rural communities, there is a critical need to retain rural maternity services in order to ensure the best outcomes for mothers and babies.
She also cited an Australian study in an Aboriginal Community Controlled Health Organisation showing that providing a culturally safe and responsive service together with continuity of care by a known midwife throughout a pregnancy and birth, halves the incidence of premature birth - an outcome now replicated in a maternity program implemented in the Torres Straits, where Commissioner Stewart lives.
"We greatly welcome Commissioner Stewart's support for rural maternity services and an expansion of the rural health workforce - including building the number of Rural Generalist doctors in Australia via the new National Rural Generalist Pathway," Rural Doctors Association of Australia president Dr John Hall, said.
"Commissioner Stewart has worked for 30 years as a Rural Generalist doctor, and birthed and cared for generations of rural babies and their mothers, so she adds enormous credibility to what all rural doctors know - that rural maternity units are very safe places for low-risk births, and that they play a critical role in reducing complications when rural babies are born prematurely.
"We also welcome Commissioner Stewart's support of the need to build sustainable local healthcare teams in rural communities - teams that comprise Rural Generalist doctors with an extended scope of practice (including in obstetrics) working alongside highly trained nurses, midwives and others.
"As Commissioner Stewart has warned, the closure of rural maternity services often leads to a loss of doctors and other health professionals from rural communities.
"By closing a maternity unit, governments don't just do local women and babies a disservice - they can also sound the death-knell for the local Emergency Department, local surgical services, outreach services from visiting specialists, and other crucial health services that the whole rural community deserves and expects.
"Downgrading hospitals and closing health services in rural towns can also lead local residents to leave these communities, often for larger centres - this is particularly so in the case of young adults who anticipate needing a local maternity service in future years.
"The loss of local residents due to health service closures can impact significantly on the economy and viability of rural communities.
"It is critical we do all we can to ensure rural maternity services across Australia are saved from closure.
"In part, this means keeping up efforts to increase the number of Rural Generalist doctors being trained and recruited to country communities, as well as building up the wider rural healthcare team.
"But it also needs a commitment from state governments to not just take the easy option and shut down a rural maternity unit. When you invest in rural hospitals and modernise their maternity units, you can reverse declining birth numbers in a rural community, boost other health services in the hospital and community, keep more people and businesses in the community, and underpin the health of the local economy.
"Delivering better local access to healthcare for all rural Australians is not only good for their health - it's also good for the long-term viability of rural Australia and good for the wider economy."
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