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Urgent action needed for rural maternity services

FROM: Dr Don Simmers, Deputy Chairman NZMA

DATE: Friday, 8 September 2006

SUBJECT: Urgent action needed for rural maternity services

Maternity services for rural women are at crisis point and urgent action is needed to improve the situation, says the New Zealand Medical Association.

In an editorial (attached) appearing in this week’s New Zealand Medical Journal, published by the New Zealand Medical Association, NZMA Deputy Chair Dr Don Simmers outlines the precarious state of rural obstetrics.

“Of the 55,000 women who give birth annually, nearly a third live in rural areas,” Dr Simmers writes.

- Only 54 general practitioners nationally are still involved in births.

- Many rural GPs have previous experience with obstetric care and are able to help during emergency obstetric situations. However, many are expected to retire within a decade and no-one with this experience is taking their place.

- There is a workforce crisis among New Zealand’s provincial hospitals where there are shortages of obstetricians, anaesthetists and paediatricians.

- There are now many provincial centres, (eg Wanganui, Greymouth, Invercargill, Masterton, Gisborne) where at best specialist cover is less than ideal and at worst is imminently threatening closure of secondary care maternity unit services.

“Are rural women really prepared to accept this previously unthinkable situation, where they may be forced to travel to a larger city to give birth?” Dr Simmers asks.

He cites Queenstown as an example of what can be achieved with some local expertise and what is not achieved when that expertise is absent. In 1990 there were over 100 deliveries performed locally and in 2003 there were 31. Given the continuing population explosion in this area, if the 1990 conditions were rekindled, the annual local birthing rate would be well over 200. Queenstown women now routinely travel to Dunedin and Invercargill to give birth, because of the absence of local medical back-up.

“In other countries with similar problems, the response has been to up-skill generalists in provincial areas giving them sufficient skills to perform instrument assisted deliveries, caesarean sections and neonatal and maternal emergency care,” Dr Simmers says. “However, this has not happened in New Zealand.”

“But of even more urgency is the need for our health system to recognise and reverse the neglect it has shown towards the provision of maternity services in rural and provincial areas compared with other countries. This neglect has resulted in needless disruption to young couples’ lives, unwarranted cascades of intervention and, on rare occasions, the death of a neonate (newborn baby).”

Dr Simmers advocates the development of a new framework that would inspire and encourage doctors in training to pursue a career that includes provision of primary maternity care, the acquisition of more technical skills, and the ability to know when to refer.

The NZMA has long advocated for improved maternity services in New Zealand.


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