REGIONAL communities are hoping to stem the tide of reduced rural maternity services, after the closure of more than 260 units nationally in the past 30 years.
Representatives from the Rural Doctors Association of Australia met with politicians in Canberra late last week, calling on the federal government to put pressure on and provide support to state governments - which are responsible for healthcare services - to protect and reinstate maternity services.
RDAA president and obstetrician John Hall said state governments had been "mischievously" closing rural maternity services claiming safety reasons, but in reality, "it's about cost-cutting and rationalising services back to the city".
"They're saying that it's not safe to deliver these specialist services in rural Australia, but we have got long-term data that shows it is safe," he said. "In many of our functional rural maternity (units) the perinatal mortality - the death rates for babies - is actually lower."
In SA, less than 20 maternity units are still operating in regional areas, with Tanunda the latest to officially close in 2018.
Kapunda and Waikerie are also closed temporarily - Kapunda until July for hospital upgrades and Waikerie for a three-month period since January, due to "an unplanned shortage of nursing and midwifery staff".
The concern is, once you close a birthing unit, it is very hard to reopen.
- PETER RISCHBIETH
Rural Doctors' Association of SA president Peter Rischbieth was among those at the Canberra delegation and said there were concerns about the potential for more closures in SA, such as at Waikerie, Kangaroo Island and Ceduna.
Ceduna birthing services resumed in May 2020 after it managed to recruit the required skilled staff.
Dr Rischbieth said access to staffing was a major reason for closures.
"The concern is, once you close a birthing unit, it is very hard to reopen," he said.
Dr Hall said maternity services could be the "canary in the coal mine" for regional services.
"What happens when you lose a maternity service in a country town is often the operating theatre closes and a lot of the skilled staff leave," he said. "So those hospitals get downgraded and those communities then have a lower level of service."
Dr Rischbieth said this skill shortage could flow on as people might be reluctant to move to a town with reduced health services.
While the closure of services often was permanent, it did not have to be the case, with the RDAA pointing to six being re-opened in Qld during the past five years.
"More state governments need to show this commitment, rather than finding every excuse under the sun to shut rural maternity services down, and the federal government needs to ensure they are doing all they can to support this," Dr Hall said.
District Council of Loxton-Waikerie councillor and Waikerie resident Clive Matthews said while the closure of maternity services at the local hospital was temporary, it was a "fear for everyone in the local area" it might not return.
"It is a very good hospital, with excellent staff, but we just can't find midwives," he said. "The fear is, once we lose one thing, it might start a chain of events, and we want to avoid that."
He said since January, expectant mothers within Waikerie's catchment had been required to drive further - to Loxton, Berri or even east to Clare or the Barossa - to give birth.
When questioned if the closure, due to finish at the end of this month, would continue, SA Health said birthing services at Waikerie Health Service remained temporarily suspended.
"The fear is, once we lose one thing, it might start a chain of events, and we want to avoid that."
- CLIVE MATTHEWS
The SA Health spokesperson said there had been no further loss of service at Tanunda after the closure of the birthing services, which happened after consultation with local GPs and clinical advice to adopt a continued GP shared care model for maternity and obstetric care.
"Women can continue to access community midwifery support in the Barossa, including antenatal and postnatal care, with birthing available at Gawler or Kapunda Hospital," they said.
"All other services remain available at Tanunda Hospital, including accident and emergency, community health and general medical care for the community."
The spokesperson said works were continuing on the Central Sterile Services Department and fire compliance upgrades at Kapunda Hospital, with maternity services temporarily relocated to Gawler Health Service.
"The upgrades are expected to be complete by mid-2021, with maternity services returning at Kapunda once works are complete," they said.
SA Health said the six regional Local Health Networks were striving to maximise the opportunity for women in their regions to give birth at a facility with the staff and resources required to provide the highest level of care.
"Birthing services require a number of GPs with obstetric and anaesthetic skills, a 24-7 roster of midwives and operating theatre staff, and there are circumstances where there is not sufficient demand for regional birthing services and for these staff to maintain their specialised skills," the spokesperson said.
Dr Rischbieth said accessing enough patients to maintain skills could be an ongoing challenge for a number of regional staff, but refresher training and upskilling could assist.
He said RDASA had plans to meet with Health Minister Stephen Wade within weeks to discuss the issue. While there was progress on the development of the Rural Health Workforce Strategy, he said it was critical obstretics and midwifery were among the highlighted skills, with positions in training hospitals earmarked for those heading to regional areas and funds for further training at country LHNs.
Regional Health Minister Mark Coulton has expressed some support for the RDAA push, saying expectant mothers in his own electorate were often required to drive hundreds of kilometres to access services.
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