With International Day of the Midwife (IDM) on Wednesday 5 May, Lecturer and Midwifery Discipline Lead in the Charles Sturt University School of Nursing, Paramedicine and Healthcare Sciences, Ms Jeannine Bradow (pictured, inset), says it presents opportunity to reflect on the fact many women in rural Australia have limited access to maternity care.

The lack of maternity services for women in rural Australia is not a new issue – it’s been a persistent issue within our health system for two decades.

It has forced women in these areas to travel – often hundreds of kilometres – just so they can give birth. For some women, the distance has proved too far, and they’ve had no other option but to give birth on the side of the road, without care.

The theme for this year’s International Day of the Midwife on Wednesday 5 May is: ‘Follow the data: Invest in midwives’. The IDM is advocating the need for quality midwifery care for all women around the world.

On the same day, the World Health Organisation (WHO) will launch the 2021 State of the World’s Midwifery report (SoWMy) which will speak to the impact midwives have on maternal and neonatal outcomes.

Women deserve the right to choose safe and quality midwifery care in their local community, and the research supports this. For the last 30 years the evidence has supported midwifery-led care and continuity of care as the gold standard for all women.

However, in Australia, not all women are given the option of midwifery care in pregnancy or one-to-one care in labour, and some rural women have no access to maternity care at all.

Since 1996, 130 Australian maternity units have closed with local health services diverting maternity care to centralised maternity hubs operating out of larger regional centres.

Maternal and infant safety has been cited as one of the main reasons for diverting care to a larger centre where emergency facilities may be available ‘just in case’.

However, these closures pose ongoing issues and inconvenience for women in rural communities, as services close and women are required to travel to access maternity care, placing themselves at risk of intervention if they haven’t laboured by a certain date.

In 1989 the ‘Maternity Services in NSW Final Report of the Ministerial Taskforce on Obstetric Services’ (the Shearman report) was released. The Shearman report was tasked to explore issues in maternity care, namely, the increase in medicalisation, and make recommendations for future maternity service provision.

This report made 105 recommendations for improving maternity services, with four guiding principles: equity of access to quality care for all women; supporting women’s informed choice in choosing care providers and decision making in pregnancy; promotion of multidisciplinary collaboration to improve care; and improving health outcomes for women at risk, disadvantaged or isolated.

Although the Shearman report may have made some valuable recommendations for change, and some of these changes have been implemented, they have not been universally adopted and medical intervention rates continue to rise; Australia’s caesarean birth rate is currently at 35 per cent.

Of particular interest, the Shearman report identified rural maternity services and the need for women to access safe maternity care by suitably qualified staff within their communities.

To achieve equitable access the Shearman report’s recommendations included the implementation of antenatal care, provision of midwifery services, expansion of medical specialties, and support for the recruitment and retention of GPs, obstetricians and midwives in the rural areas to keep women local.

However, women in rural areas are still experiencing difficulties accessing maternity care locally.

The Shearman report is 30 years old and there have been 16 further documents making recommendations for maternity care since.

All the while the rate of intervention increases and the caesarean rate soars. The evidence shows midwifery-led care, caseload midwifery or continuity of care is the gold standard.

It is convenient, affordable and women experiencing this care have better outcomes, are more likely to have a vaginal birth, use less analgesia in labour, less likely to have intervention, less incidence of postnatal depression (PND), and better breastfeeding rates.

So why not provide these services to rural women, in order to prevent women from being dislocated from home and family and the subsequent impact it places on women and families?

So, let’s see what the WHO have in mind for supporting women in Australia; women and midwives want change, but who is going to take notice?

It’s time for action, it’s time to reduce the intervention and birth trauma that women are experiencing, and it’s time to reduce the caesarean rate. It’s time to bring birth back to the bush.