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Restoring rural birthing services in Australia

Watch Hazel Brittain talk about reopening the maternity unit of a rural Australian hospital using midwifery continuity of care as a foundation.
When you’re looking at establishing continuity of care models be that a brand new model or an existing model that you revamping, then you know there’s certain things that I’ve found have worked and certain things that I look back now and think, oh, I wouldn’t do that again. So using Beaudesert– reopening by Beaudesert services as an example, I’d really say that the key things that you need to achieve are getting the community onside. So that’s one of the absolute key things that you need to do. But you also need to have some personal characteristics, as well. So you have to be committed. You have to think this is the right thing to do.
You also have to have a certain amount of resilience and persistence, because when you think about change, any sort of change, there is always a certain amount of resistance to what you want to do. There are people who benefit from the status quo. So they’re not going to be all that keen to let it go, the status quo that is. And then those people who will benefit from the new world order can’t quite see it. They can’t quite picture how they will benefit or how it will work.
So as a leader when you are doing this big change, you need to be able to make it clear to people exactly what you are trying to achieve, and what it will look like, and what it will feel like in the new system. And you also have to be careful of people’s sensitivities as well, because remember that a lot of people invested a lot of time, and energy, and effort into the status quo. So if you then come along and you say, although, oh, all rubbish now and we have to do it a different way, then you’re not exactly going to get a lot of buy-in. And that’s what you’re looking for.
You’re looking for a buy-in from the people who are working in the existing system, people who might want to work in a new system, and then those people who are actually using the system as in the consumers and any other interested parties. So certainly when I went around the community at Beaudesert– I mean, it’s a fairly discrete community so it’s very easy to do it. And you know, I was fairly well-known in the local area. I went everywhere. So I went to local schools. I went to childbirth classes, people who are running those. I went to the childcare centres, any playgroups, breastfeeding mothers groups. You name it, I went there.
And then the– so that’s– the obviously the childbearing women’s group. But then I also looked at the grandmas group if you like and the granddad’s groups, because you’re talking about whole family not just women who are actually having the babies. That really then stirred up some community support for what we’re trying to do. And that was way back in 2008, 2009 when we were first looking at the feasibility of reopening birthing services at Beaudesert hospital. Because I suppose the essential thing to do was to work out, well, is this something that the community actually want?
I mean, if they don’t want it and they’re quite happy trotting up the road an hour up the road and having their babies up at the other hospital, then we’d be wasting our time really in trying to achieve this and putting a lot of time and energy into it. So after doing all that work with the local community, it was very, very clear that the local community wanted it. So you know, everywhere I went, nobody turned around and said, no, this is a bad idea. They all said, this is a great idea, and we want to see this happening. And that also then led me to the Rural Doctors Association.
So I went alone and had a chat to them as well, and the local GPs, and also the local council who were– they were absolutely on board right from the word go. So the local mayor, the local councillor for the area that, you know, covers Beaudesert. And they then brought in their surrounding people. So the local councils for the surrounding areas have also thought, well, women from my area could also go to Beaudesert. And it wasn’t that we were proposing anything crazy like doing really high-risk births at Beaudesert. We were just saying, let’s do rural birth by Beaudesert, which is within the remit of the rural midwives and the rural generalist doctors.
So there were a lot of people involved, it wasn’t just me. You know, I was a person just doing the running around. But really I think that the community stood up and said, we want our services reopened. Because what they had seen was, when their birthing services closed 10 years previously, then there had been a trickle down effect, where the work wasn’t quite so interesting for the doctors. So those doctors who could do birthing could do anaesthetics, and then they didn’t want to work there anymore. So then they couldn’t cover the operating theatre. So then the operating theatre closed. So that meant that people who were having simple surgery at the hospital no longer could have simple surgery done there.
So it’s not just a case of thinking about birthing in isolation. It’s about how it impacts upon the whole community and how it impacts upon the services that are provided within that community. Midwives are never a service on their own. They always interact and collaborate with other services and other care providers in order to provide the best service for women and their families. So it’s the same deal. What we do in clinical practise is the same deal that we need to do to– same sort of process that we need to adopt in setting up a service and sustaining a service. So certainly, again, the Beaudesert experience really brought that home.
The rural doctors particularly were part of the key to getting this to happen. So working alongside the rural doctors, midwives working alongside the rural doctors was a fantastic experience. They were a great bunch who had access to resources that I would never have had access to myself. So they almost had a hotline to the minister’s office, for example. So you know, if something wasn’t going quite so well, we were getting a few road blocks, then you know they helped to smooth the way. And without them, without the Rural Doctors Association, I would say that we would not have had such a successful reopening of Beaudesert hospital.
Really, you need to make the best use of that that you can by developing relationships and by collaborating with other people to get the outcomes that we’re all after. So it’s about the common ground, about what we all want. So the rural doctors are just the same as the midwives. They want rural services in good rural services, safe rural services in rural towns. And obviously, they like the midwives, believe that it’s doable and that it can be successful. And I think that’s what’s been really proved with the reopening of Beaudesert.

Hazel Brittain is currently the Director of Midwifery Services at the Gold Coast University Hospital in Queensland, Australia. Previously, she was the Director of Nursing and Midwifery at Beaudesert Hospital – the hospital she talks about in this video. She’s a UK-trained midwife with a wide variety of experience, and she’s passionate about women having access to quality free midwifery services through the public health system.

In this video, Hazel talks about the positive aspects – and some of the challenges – of reopening her local hospital’s maternity unit using midwifery continuity of care as the foundation, alongside upskilling rural doctors, and with a nearby large hospital for referral when needed. Although there was some initial resistance to reopening the service without 24-hour on-call obstetric support, the alternative was women needing to travel sometimes hours away from home to get to a maternity unit – and that is potentially unsafe in itself. Without local services available, some women were choosing to induce their babies early or even have an elective caesarean section to avoid either having to drive hours in labour, or staying close to the maternity service with perhaps weeks of accommodation to pay for.

You can hear in this video Hazel talking about how midwifery services sit within the larger maternity care system: midwives collaborate with others in order to provide the best service for women and families. This is the Integrality Framework in action. Alongside the rural doctors, allied health and other specialists they can refer to when needed, the midwifery group practice (MGP) at Beaudesert Hospital provides maternity care for women and families. The community is elated to have relationship-based midwifery care available in their local area.

Over to you

Many rural hospitals globally have had their maternity units closed down because of obstetric shortages and the inability of the hospital to provide 24-hour caesarean services. Yet Beaudesert Hospital, along with others such as Mareeba in North Queensland, Australia, managed to re-open with a redesigned birth service focused on midwifery continuity of care.

How did they manage it? Can we emulate it? What did Hazel do to make change happen that could be useful in maternity services in your area?

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Maternity Care: Building Relationships Really Does Save Lives

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