National Rural Health Commissioner- Professor Ruth Stewart.
Recently appointed National Rural Health Commissioner Professor Stewart (pictured) was in Canberra last week making a case for reversing the trend of closing down rural maternity services.
Professor Stewart addressed the National Press Club but was first interviewed on ABC Radio along with Yass mother and member of the New Yass Hospital with Maternity working group, Rebecca Duncan.
Professor Stewart was appointed Rural Health Commissioner by the Federal Government in July 2020 and brings to the role nearly 30 years of experience working as a Rural Generalist doctor with the advanced skills of a GP obstetrician and twenty years of experience in rural medical education.
Speaking to the ABC (Sabra Lane) marking World Prematurity Day (18 November) ahead of her address to the National Rural Press Club, Professor Stewart said the facts speak really strongly.
“At present, in rural and remote communities, pregnant women have nearly twice the risk of giving birth prematurely compared to their sisters in the city.
13.5% of rural and remote women will have a premature birth compared to 6.5% in the city.
“It’s about access to care. We have really strong evidence that where there is a rural maternity service, it provides good quality care.”
Professor Stewart said myths and money drove closures.
“There here has been an urban myth about rural maternity for a very long time that it is not safe. That myth has driven the closure of a lot of rural maternity services. Between 1995 and 2005 over 130 rural maternity services were closed. They used both safety arguments, and they also used finance, it’s too expensive to do this. But the reality is when you close rural maternity services that’s when mothers and babies are much more at risk of serious poor outcome and even death.”
The Rural Health Commissioner said evidenced-based safety is what should count.
“It’s about safety. At present, the rate of premature birth in rural and remote communities is nearly twice as high. And there is an increasing number of rural babies born before arrival (BBA) in the larger hospitals when their mothers are driven to the hospital. We know that if women have a local maternity service where there is continuity of care, they are less likely to have a premature birth, the babies are more likely to be born at a normal birth weight and particularly for Aboriginal and Torres Strait Islander women, their baby can be born on-country and within a culturally safe service.”
Professor Stewart discussed her investigations.
“At the start of my thesis, I looked at clinical audits looking at how safe rural maternity was. Of the 40 clinical audits, there were two that suggested it was not as safe and 38 that said yes, rural maternity services are safe and, in some cases, maybe even safer. Since that study, there have been a number of really large studies that have come out to show that if you’re in a rural maternity service, you’re less likely to have intervention, you’re more likely to have a natural birth and the safety is very good.”
Yass mother Rebecca Duncan (pictured) said the New Yass Hospital with maternity working group is encouraged by the Commissioner’s calls to restore rural maternity this week.
“We continue to lobby for maternity services in Yass under the exact model the Professor is calling for. That is, having local GP’s with obstetric training working alongside a team of midwives providing continuity of care.
“This is the model in many rural towns our size, and it is also supported by the Royal Australian and NZ College of Obstetricians and Gynaecologists (RANZCOG), Rural Doctors Association of Australia, Australian Council of Midwives.
NSW Health Minister Brad Hazzard welcomed steps to move to such a model for Parkes in state parliament last year but publicly denounced a similar plan as “dangerous for Yass mothers” presented by the local working group.
Mrs Duncan declared there is overwhelming evidence and weight of expert opinion to warrant change.
“The ball is firmly in the Government’s court to start returning maternity units to rural hospitals, and there is no better place to start than Yass.
“We are not just a group of local mothers who want the convenience of birthing locally. We have the experts with us, and the Government needs to start listening to them.”
With the assistance of Masters student and experienced midwife Jannette Jakab, a business plan to restore birthing services was designed and presented to NSW Health Minister Brad Hazzard and opposition members of parliament.
Both Federal and State Labor pledged 4.7 million dollars in previous election cycles to restore local birthing but were unsuccessful in forming government.
Mrs Duncan also stated health professionals have contacted the group expressing their wishes to be a part of a restored service based in Yass.
“We already have qualified health professionals contacting us, wanting to move to Yass, and many already live in the area.”
A recent review of maternity health services by Southern NSW Local Health District led to a decision in July to upgrade the part-time midwife position to full time as part of a 12-month trial.
The review and maternity plan, finally released to the public last month, revealed reinstating birthing was not supported by the Local Health District.
Members of the working group gave the review scathing feedback stating it raised more questions than it answered as to health outcomes of Yass Valley’s birthing women with no clinical outcomes gathered for the majority who birthed in ACT hospitals.
The review also lacked credibility stating Yass Valley would reach its current ABS estimated population in 2041.