‘Very distressing’: Rural mothers left in isolation

Since the 1990s there are 41 per cent fewer rural and remote maternity units, leaving some expectant mothers a 560km round trip for ultrasounds and appointments.

A 560km round trip for an ultrasound; three-and-a-half hours travel to the nearest maternity ward; an early morning 297km flight while in labour to reach to the closest hospital - only to be told to go “home” until things progress.

Welcome to pregnancy and childbirth in rural Australia. It’s a reality NSW’s Victoria Bruggy has lived, and the challenges of the “very distressing” experience have left an indelible mark.

“I really struggled after my second, there was just nothing there for me,” Victoria says, describing the post-natal anxiety and depression and post-traumatic stress disorder she suffered.

“I struggled to connect to my son for the first six weeks, I wouldn’t call him by his name.

“It has been very hard, he is 18 months now and I am a lot better.”

Victoria, who lives on a station between Cobar and Tilpa in central west NSW, says care was patchy during her pregnancy. Cobar does not have birthing services, and she says there was no proper process to link her to Dubbo, three and a half hours away, where she was expected to have the baby, with no in-person or telehealth appointments made available to her.

Victoria was flown to Dubbo when she went into labour but, after hospital staff decided she was not far enough progressed to admit, she was sent “home”.

“My partner and kids had driven to Dubbo too, but we had to wait to get into the AirBnB there we had booked into so we had to wander around, with our two year old, with nowhere to go,” she said.

Victoria Bruggy and partner Will Bennett with children Macauley (3) Myles (18 months). Picture: Supplied

A day and a half later, Victoria delivered her son back at the hospital but “after we had him, there was nothing, no support. It was six to eight weeks post-partum before I saw someone in Cobar,” she said.

The experience was in stark contrast to that of Victoria’s first birth while living in far west NSW; there, they travelled 280km each way for every ultrasound and maternity appointment, but she says the after-care was more thorough.

Victoria knows, however, she is just one of many of rural women navigating the pot-luck of rural maternity care.

Care falling short

According to the Rural Doctors Association, maternity health services are failing to adequately provide care for rural families, leading to higher rates of early births and financial and emotional costs to communities.

Nationally there are about 41 per cent fewer rural and remote maternity units than there were in the 1990s.

A study from 2015 - which rural health experts cite as the most comprehensive despite being a decade old - found between 1992 and 2011, the number of women having early births increased by 47 per cent; coinciding with the cut in maternity units in Australia.

Today, not all units are fully operational, which health experts say is a major contributor to poor health and wellbeing of rural people, as well as the migration to coastal cities.

Last week, 12 peak organisations - including the Australian College of Midwives and the Rural Doctors Association of Australia - released a National Consensus Framework for Rural Maternity Services, pushing for more equitable services.

It’s calling for rural people to have better access to birthing services closer to home, and has continuity of care and respect for rural mothers are at the centre of its recommendations.

Immediate past National Rural Health Commissioner Ruth Stewart said the view that maternity care only involved a woman, baby and identified maternity care professionals had driven the “closure of smaller more remote services and the contraction of maternity services into larger, more urban settings”.

“Rural and remote communities have been protesting about this approach. It is important that we listen to them,” she said.

Risks rise as services shut

RDAA chief executive Peta Rutherford said research showed closures of maternity units led to a significant increase in births before due dates, higher risks to mother and child, and “profound” impacts on rural families that were expensive, stressful and “not acceptable”.

Even if units were still in operation, many others, such as the major regional centre of Mount Gambier in South Australia in recent years, were often on bypass, Peta said.

This meant mothers had to travel to another hospital to give birth when staffing levels were inadequate.

In Camperdown in southwest Victoria, expectant mothers have also faced inconsistent services due to staff shortages, after the hospital temporarily reduced services last year.

Women also needed more choice and ability to birth near home, Peta said - a move that would require investment and for health providers to consider if they could do things differently.

For Nyngan, NSW, farmer Sophie Holmes, giving birth to her daughter meant a two-hour drive and week long stay at Dubbo waiting for the baby to arrive, with follow-up care provided at Nyngan.

“I had a positive story, but many people in our area (if they can’t afford to stay in Dubbo) drive there when they are in labour, or go 3.5 hours and stay in Orange ahead of their birth,” she said.

“I know women now locally who are half way through pregnancies and haven’t seen a midwife yet.

“Driving in labour is definitely more risky and there’s an added level of anxiety people in metro areas wouldn’t understand and there’s the risk you could have to deliver on the side of the road.”

Sophie said she would encourage rural mothers to “keep asking questions, persist and find a GP or nurse who you can see face-to-face”.

“Find the support, it might not be where you expect but its not all doom and gloom, you can still have a beautiful experience,” she said.

Back in Cobar, Victoria said better co-ordination of birthing was desperately needed.

“There should be a community midwife available that is accessible and a system where you can always contact a midwife who you know, or can jump on a telehealth call - we can’t just run into the Emergency Department and see someone, they have a lack of knowledge about maternal health services.
“Babies are born every day, but it seemed nobody knew what to do for me.”

Moves underway on services

The NSW state govenment, in its latest budget, has moved to improve women’s birthing experiences.

Last month it announced $44.8m to increase access to midwifery continuity of care models, including 53 full-time midwives in regional NSW, plus enhanced training for clinicians in respectful maternity care.

NSW Health Minister Ryan Park speaks during Question Time in the Legislative Assembly at New South Wales Parliament House in Sydney. Picture: NewsWire/Gaye Gerard

NSW health minister Ryan Park said the government’s “investment in maternity care, regional parenting support services and vaccination programs for pregnant women, will help all babies born in NSW get the very best start to life.”

Meanwhile, a spokesman for the federal Department of Health “acknowledges the challenges that many women in rural, remote and very remote locations face in accessing maternity care and is committed to improving health outcomes for mothers and their babies”.

He said the government recognised the value of the new framework, and while the commonwealth contributed to maternity service costs, states and territories were responsible for public hospital services including where birthing services were available.

“All Australian governments are collaborating closely to develop national maternity workforce solutions,” he said.