Dr Jean Patterson
Pregnancy and childbirth can be a fraught enough experience as it is, without the added concern that the nearest hospital is a four-hour flight away.
This is the situation in parts of Canada and Australia, where the question of how to provide quality maternity care in rural and remote locations has long troubled health providers and women alike. In 2009, Jean Patterson, a midwifery lecturer with a special interest in rural maternity care was invited to an international symposium to explain "how we do it in New Zealand".
"We have a reputation for providing equitable maternity services for women in rural areas whereas Australia and Canada struggle to provide and maintain local maternity services in the remote areas, particularly for their indigenous populations."
New Zealand's model for maternity services differs signifi cantly from the rest of the world, explains Patterson. Midwives work autonomously; women can choose a midwife as their lead carer throughout their pregnancy and birth and refer to specialists when required. While independent midwifery is a much-used option in urban settings in New Zealand, Patterson points out that for rural women it's indispensable. "Rural midwives tend to live permanently in their regions, service quite large areas and provide a vital link between community and hospital-based care."
New Zealand's model for maternity services differs signifi cantly from the rest of the world. By contrast, most women in Canada and Australia are under the care of local GPs with varying degrees of obstetric support and skills, "many of whom provide excellent and comprehensive care", says Patterson. However, both countries fi nd retaining rural doctors an ongoing headache. And while there are autonomous midwifery services in Australia and Canada, these are not widespread and tend to operate somewhat independently from the medical system. These midwifery services may be home and community based with nurses caring for women who birth in hospital.
Patterson's presentation explored the strengths of the New Zealand system which is free for all women, with agreed guidelines for referral and consultation. She also revealed some of the challenges in rural areas such as the need to staff and maintain the smaller rural facilities and provide leave for midwives for holidays or professional development.
She also acknowledged that distances can be a challenge when transfer is required, but these are "of a more manageable scale in New Zealand, compared to the distances women need to travel in Canada and Australia for specialist care".
The delegates at the symposium were intrigued by New Zealand's model, and there was considerable interest expressed by the midwives. "There still seems to be some scepticism about the underlying philosophy of independent midwifery. But at a practical level, they could certainly see its advantages; particularly for the rural and remote rural areas