A century ago very few women gave birth in a hospital, and the ones that did usually lived in a major city. Rural areas had " midwives " who attended when birth was imminent, and the local doctor was used to being called out in the wee small hours to provide medical services. That had been the practice ever since we humans first evolved on this planet.
Today, the arrival into this world of a new baby has morphed into a major medical event that requires a fully equipped birthing centre with advanced equipment - including a range of specialist doctors and backing by clinical services. As a result, we have seen seventy percent of country birthing units close in the past two decades and this has vastly increased the chance that when the baby is ready to arrive, it may be another " roadside delivery " - with no one to help other than an untrained and very agitated Dad.
The birthing centre of Bourke hospital is closed and expectant mothers are faced with a 412 kilometre road journey to Dubbo, which has the nearest facilities. They are usually advised to spend the final two weeks prior to birth in Dubbo as a precaution and if they lack friends or family connections, that can impose some hefty Motel charges.
Childbirth mortality is now rare and we are able to save " preenies " that would have been impossible a few short years ago, but this concentration of facilities huge distances apart seems a departure from the practices that apply to most other medical services. We have a fine distribution of small country hospitals and when someone in a rural community has a heart attack that is where the ambulance takes them. They received first response care and - if necessary - an air ambulance transports them to a major centre where heart surgery and full services are available.
It would seem to be a safer alternative for a woman to give birth at one of these country hospitals - where at least trained medical people are available to give care - than take the risk of a last minute dash to a distant hospital. That same air ambulance is available to intercede if the country hospital believes that there are complications beyond it's range of skills and equipment.
This constant contracting of birthing services to a very small number of widely spaced base hospitals seems to be increasing rather than decreasing risk. It may not be financially possible for many women to transfer to a hospital centre pre birth and even in major cities, the number of babies delivered at the roadside by the police or complete strangers is tending to increase. Are we opting for the impractical - and treating childbirth as a major medical emergency when it is after all a very natural function that women have been performing for centuries ?
It seems to be a case of official thinking demanding an unattainable standard be applied to all births, both in the interests of care and costs - and driving those who live a distance from birthing facilities to consider the option of a " home birth " - assisted by lesser trained people.
A " re-think " of how best the existing rural hospital system may plug the gap would be a safer option !
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