Doctors call for urgent birthing fix
QUEENSLAND'S peak doctor body has weighed into the rural maternity crisis for the first time, saying long distances between maternity services are risking babies' lives.
In a submission to the Rural Maternity Task Force, the Australian Medical Association Queensland called for urgent measures to attract and maintain general practitioners with obstetric and anaesthetic skills to the bush.
Their plea coincides with a Health Minister Steven Miles sending an SOS to federal counterpart Greg Hunt for help in building Queensland's rural generalist workforce.
Mr Miles will discuss the problems with health ministers at the upcoming COAG Health Council meeting in Adelaide on Friday.
The Sunday Mail has been campaigning for improved services for pregnant women following an investigation that uncovered the heart-wrenching fallout of the closures of dozens of maternity units.
Shock data from despairing doctors revealed babies born in Queensland country towns, where maternity services have been closed, were dying at a much higher rate than newborns in other rural centres.
The investigation has also revealed mothers are being given DIY birthing kits in case they do not make it to their closest birthing unit - often hundreds of kilometres away.
Despite Mr Miles trying to suggest the DIY kits had not been handed out recently, doctors in the bush have confirmed the kits have been issued by local medical staff as recently as late last year.
Mr Miles set up a taskforce of 18 clinicians, academics and consumers to look into ways to improve services.
Last week the team visited Roma and Theodore and this week they head to Ingham and Mount Isa. Queensland Health says they will add Chinchilla to the itinerary.
The Chinchilla maternity unit had been on bypass to Dalby since December 2017 and reopened in November. But the doors closed again for the Christmas holidays until December 27, and by New Year, the decision was made that services would not be available from January 17.
The recruitment of two midwives is under way to reopen maternity services, Queensland Health says.
But in its submission to the taskforce, AMAQ said the change to a midwifery service model with restricted hours in centres such as Chinchilla and Theodore "is problematic".
"There is ample evidence that perceived low-risk pregnancies often turn out to be high risk," the submission said. "In these situations, the first time a doctor sees the patient should not be when labour is obstructed or a severe complication develops or becomes apparent.
"We strongly caution against the further introduction of midwife-led-only caseload models without medical backup. We have feedback from members which indicates this experiment has been trialled and failed in parts of rural and regional Queensland, particularly given the evidence which indicates a doubling of perinatal mortality under this model."
The AMAQ has instead called for more rural GPs to be given admitting rights to care for their private patients in public hospitals as part of a wider push to keep bush practices alive.
"Admitting rights to public hospitals in rural centres is not available to all GPs," said AMAQ obstetrics spokesman and taskforce member Gino Pecoraro.
"Addressing this issue will go a long way towards recruitment and retention of suitably trained GPs for these areas of need."
The AMAQ's submission said "there is evidence that closing maternity and birthing services can actually result in poorer health outcomes".
"Extended travel time to access maternity services has been shown to lead to increased rates of mortality and adverse outcomes, underscoring the need for local services to deal with obstetric emergencies," it said.
In a letter to Federal Health Minister Greg Hunt, Mr Miles outlined Queensland's bush maternity emergency ahead of this Friday's COAG meeting, where he will push for help in creating more rural training places for doctors and in keeping their skills updated.
"The Queensland population is the most distributed of any Australian state and despite this, we have been able to maintain safe and accessible birthing services for women in rural and remote locations," Mr Miles wrote. "Services are, however, facing increasing pressure, especially in recruiting and retaining doctors and midwives.
"Rural generalism in Queensland is a mature and well-established model.
"The Queensland Rural Generalist Pathway is a well-subscribed medical training pathway providing doctors with the necessary skills for rural and remote medical practice.
"This pathway supplies doctors with an additional skill such as obstetrics and/or anaesthetics that is critical for a rural maternity service."
Mr Miles said that, over their career span, rural generalists needed to periodically upskill.
"To do this a rural generalist needs to leave their place of employment and undertake upskilling and skills maintenance in another location," he said, adding there were significant financial and logistic barriers to supporting this.
"As a result, the rural generalist's additional skills may be lost, and consequently the rural maternity service may be lost.
"Because these doctors provide all the services in rural towns, there is a significant loss of skilled response to all time critical events, from heart attacks, to road trauma and farm accidents."
Dr John Wakefield, chair of the Rural Maternity Taskforce, told The Sunday Mail that last week's visits to rural communities provided an "opportunity for us to listen to experiences of people receiving and delivering maternity services in rural communities".
"The taskforce acknowledges the thoughtful, constructive and solutions-focused dialogue with mothers, community members and clinicians," he said.
"The feedback and ideas we have received from people in the rural towns we have visited have been fantastic.
"They will help us create guidance for health services in partnering with community to get the best possible maternity service for rural families."