Maternity units cut despite baby rush | The AustralianAUSTRALIA is delivering record numbers of babies, despite losing a sixth of its public hospital maternity wards over the past decade.
Despite rising fertility rates and population growth, the number of obstetric and maternity services offered by state-run acute-care hospitals has plummeted from 298 in 2000-01 to 248 in 2007-08.
Neonatal intensive care and specialist pediatric services have also become scarcer in the public sector at a time when most other specialist units grew in number.
The Australian Institute of Health and Welfare data shows the bush suffered the steepest decline in maternity services, with medical workforce shortages and low volumes of births speeding closures.
Australian Medical Association president Andrew Pesce, an obstetrician, acknowledged that many women were travelling away from home, sometimes several hundred kilometres, to give birth to their child.
"There's real difficulty delivering maternity services outside the metropolitan areas" and it was difficult to attract people with skills to some areas, he said.
Governments should make the best use possible of local facilities, but could not be expected to provide every maternity service in all places, for safety reasons, Dr Pesce said.
"Often they're small units doing a small number of deliveries, and they don't have the nursing, the midwifery or medical expertise available to provide a safe, co-ordinated service," he said.
Justine Caines, a member of the Maternity Coalition executive, said state health services had been too quick to use obstetrician shortages as an excuse to abandon local maternity units, arguing midwives could provide substitute services if current rules were relaxed.
She said so many expectant mothers were being referred to larger regional or city hospitals that those services, too, were struggling to cope.
Even in the biggest hospitals, some birthing units were so overwhelmed they required mothers to register within weeks of conception or, in one case, used a lottery system to decide who they could take, Ms Caines said.
"Why has this been allowed to happen when the midwifery workforce has been there forever, willing and able and yet prevented from practice by funding arrangements?" she said.
The reduction in services has coincided with a multi-year baby boom that has taken demographers by surprise.
Australia is expected to register almost 300,000 births in 2008, surpassing the previous record of 287,000 in 2007.
In recent years it has reversed a falling birth rate to reach its highest total fertility rate in more than a quarter of a century.
Queensland cut the deepest into its maternity services this decade, slashing 22 obstetric units and 16 specialist pediatric services, at a time when its population was booming.
Victoria lost 11 obstetrics and two neonatal intensive care units, while NSW closed down nine maternity units.
Only South Australia bucked the trend, retaining the same number of services for mother and child as it did at the start of the decade.
Women's & Children's Hospitals Australasia chief executive Elizabeth Chatham yesterday acknowledged planners had failed to pick the baby boom, but said hospitals had demand management strategies in place.
The federal government's $120 million budget package for maternity services, which boosted the role of midwives, would allow more creative ways of returning services closer to women's homes, she said.
"I think the policy to direct closures has relied on thinking of traditional models -- models provided by hospitals only -- when now we may be able to look at hospital services working together with community ones," Ms Chatham said.
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