CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Health Review   
Australian Health Review
  Journal of the Australian Healthcare & Hospitals Association
blank image Search
blank image blank image
blank image
  Advanced Search

Journal Home
About the Journal
Editorial Structure
For Advertisers
Online Early
Current Issue
Just Accepted
All Issues
Research Fronts
Sample Issue
For Authors
General Information
Author Instructions
Submit Article
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
Call for Reviewers
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates

ANZ Health Policy

Open access content from the Australia and New Zealand Health Policy journal is now available.

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with AHR
blank image

red arrow Connect with AHHA
blank image
facebook TwitterIcon

red arrow Connect with CP
blank image
facebook twitter logo LinkedIn


Open Access Article << Previous     |     Next >>   Contents Vol 38(3)

Identifying maternity services in public hospitals in rural and remote Australia

Jo Longman A F, Jennifer M. Pilcher A, Deborah A. Donoghue A, Margaret Rolfe A, Sue V. Kildea B, Sue Kruske C, Jeremy J. N. Oats D, Geoffrey G. Morgan A E and Lesley M. Barclay A

A University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Email: jpil2286@uni.sydney.edu.au; deborah.donoghue@ucrh.edu.au; margaret.rolfe@ucrh.edu.au; geoff.morgan@ucrh.edu.au; lesley.barclay@sydney.edu.au
B Women’s Health and Newborn Services (Maternity) Mater Health Services, Australian Catholic University and Mater Medical Research Institute, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia. Email: sue.kildea@acu.edu.au
C Queensland Centre for Mothers & Babies, The University of Queensland, Brisbane, Qld 4072, Australia.
D Melbourne School of Population and Global Health, University of Melbourne, PO Box 5266, Burnley, Victoria 3121, Australia. Email: jeremy.oats@thewomens.org.au
E North Coast Public Health Unit, PO Box 498, Lismore, NSW 2480, Australia.
F Corresponding author. Email: jo.longman@ucrh.edu.au

Australian Health Review 38(3) 337-344 http://dx.doi.org/10.1071/AH13188
Submitted: 3 October 2013  Accepted: 25 February 2014   Published: 2 June 2014

 Full Text
 PDF (669 KB)
 Export Citation

Objective This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25 000 people across Australia, and presents the findings of this process.

Methods Health departments and the national government’s websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives.

Results In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure.

Conclusions The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised.

What is known about the topic? Australian birthing services have previously been identified for hospitals with 50 or more births a year. Less is known about public hospitals with fewer than 50 births a year or those with only antenatal and postnatal services, particularly in rural and remote locations, or how maternity services information may be identified from publicly available sources.

What does this paper add? This paper describes the process and challenges of identifying maternity services in rural and remote public hospitals serving towns of between 1000 and 25 000, and presents the findings of this process.

What are the implications for practitioners? Nationally accessible, reliable and comparable information is important for health planners, policy makers and health practitioners. This paper provides useful information on the variations in the capability and location of maternity services across Australia. Opportunities exist for consistent collection, collation and reporting of maternity services across rural and remote Australia. This will ensure quality and safety of services, contribute to policy review, support the development and maintenance of service networks, and assist in planning services and expenditure, as well as in the identification of problems. It is therefore key to providing equitable services across the country.


[1]  Homer CSE, Biggs J, Vaughan G, Sullivan EA. Mapping maternity services in Australia: location, classification and services. Aust Health Rev 2011; 35: 222–9.
CrossRef |

[2]  Australian Health Ministers Advisory Council. National maternity services plan. Canberra: Commonwealth of Australia; 2011.

[3]  Goodwin N, 6 P, Peck E, Freeman T, Posaner R. Managing across diverse networks of care: lessons from other sectors. Report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D. London: National Co-ordinating Centre for Service Delivery and Organisation; 2004.

[4]  Duckett S, Wilcox S. The Australian health care system. 4th ed. Melbourne: Oxford University Press; 2011.

[5]  Eagar K, Garrett P, Vivian L. Health planning: Australian perspectives. Crows Nest, NSW: Allen & Unwin; 2001.

[6]  Grzybowski S, Kornelsen J, Schuurman N. Planning the optimal level of local maternity service for small rural communities: a systems study in British Columbia. Health Policy 2009; 92: 149–57.
CrossRef | PubMed |

[7]  Health SA. Standards for maternal and neonatal services in South Australia. Adelaide: South Australia Health; 2010.

[8]  NSW Department of Health. Guide to the role delineation of health services. 3rd ed. North Sydney: NSW Department of Health; 2002.

[9]  Government of Western Australia. WA Health clinical services framework 2010–2020. Perth: Department of Health; 2009.

[10]  Victorian State Government Department of Health. Capability framework for Victorian maternity and newborn services. Melbourne: Victorian State Government Department of Health; 2010. Available at http://docs.health.vic.gov.au/docs/doc/Capability-framework-for-Victorian-maternity-and-newborn-services [verified 17 September 2013].

[11]  Queensland Government. Clinical services capability framework for public and licensed private health facilities v3.0. Brisbane: Queensland Government Department of Health; 2010.

[12]  Australian Health Ministers Advisory Council. National maternity services capability framework. Canberra: Commonwealth of Australia; 2012.

[13]  National Rural Health Alliance Inc. Fact sheet 25: rural maternity services: investing in the future. Deakin West, ACT: National Rural Health Alliance; 2012. Available at http://nrha.ruralhealth.org.au/cms/uploads/factsheets/Fact-Sheet-25-Maternity-Services.pdf [verified 17 September 2013].

[14]  Dietsch E, Davies C, Shackleton P, Alston M, McLeod M. ‘Luckily we had a torch’: contemporary birthing experiences of women living in rural and remote NSW. Wagga Wagga: Charles Sturt University; 2008; Available at http://bahsl.com.au/old/pdf/birthing-in-rural-remote-NSW.pdf [verified 17 September 2013].

[15]  Dietsch E, Shackleton P, Davies C, Alston M, McLeod M. ‘Mind you, there’s no anaesthetist on the road’: women’s experiences of labouring en route. Rural Remote Health 2010; 10: 1371
| PubMed |

[16]  Kornelsen J, Moola S, Grzybowski S. Does distance matter? Increased induction rates for rural women who have to travel for intrapartum care. J Obstet Gynaecol Can 2009; 31: 21–7.
| PubMed |

[17]  Kildea S, Kruske S, Barclay L, Tracy S. ‘Closing the gap’: how maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural Remote Health 2010; 10: 1383
| CAS | PubMed |

[18]  Kildea S, Stratigos S. Rural birth index for Australia? Aust J Rural Health 2010; 18: 85–6.
CrossRef | PubMed |

[19]  Hirst C. Re-birthing, Report of the review of maternity services in Queensland. Brisbane: Queensland Health; 2005.

[20]  Ireland S, Wulili Narjic C, Belton S, Kildea S. ‘Niyith nniyith watmam’ (the quiet story): exploring the experiences of Aboriginal women who give birth in their remote community. Midwifery 2011; 27: 634–41.
CrossRef | PubMed |

[21]  Kildea S. Risky business: contested knowledge over safe birthing services for Aboriginal women. Health Sociol Rev 2006; 15: 387–96.
CrossRef |

[22]  James AM. Closing rural hospitals in Saskatchewan: on the road to wellness? Soc Sci Med 1999; 49: 1021–34.
CrossRef | CAS | PubMed |

[23]  Kornelsen J, Grzybowski S, Iglesias S. Is rural maternity care sustainable without general practitioner surgeons? Can J Rural Med 2006; 11: 218–20.
| PubMed |

[24]  van Teijlingen ER, Pitchforth E. Rural maternity care: can we learn from Wal-Mart? Health Place 2010; 16: 359–64.
CrossRef | CAS | PubMed |

[25]  Dooley J, Kelly L, St Pierre-Hanson N, Antone I, Guilfoyle J, O’Driscoll T. Rural and remote obstetric care close to home: program description, evaluation and discussion of Sioux Lookout Meno Ya Win Health Centre Obstetrics. Can J Rural Med 2009; 14: 75–9.
| CAS | PubMed |

[26]  Bronstein JM, Morrisey MA. Determinants of rural travel distance for obstetrics care. Med Care 1990; 28: 853–66.
CrossRef | CAS | PubMed |

[27]  Barnett R, Barnett P. ‘If you want to sit on your butts you’ll get nothing!’ Community activism in response to threats of rural hospital closure in southern New Zealand. Health Place 2003; 9: 59–71.
CrossRef | PubMed |

[28]  Imison C. Reconfiguring hospital services [briefing paper]. London: King’s Fund; 2011.

[29]  National Health Performance Authority. MyHospitals . Sydney: Commonwealth of Australia; 2012. Available at http://www.myhospitals.gov.au/ [verified 14 October 2012].

[30]  Australian Institute of Health and Welfare (AIHW). AIHW 2009/10 Table A2.3: public hospitals included in the National Hospital Morbidity Database. Canberra: AIHW; 2012. Available at http://www.aihw.gov.au/publication-detail/?id=10737418863 [verified 15 May 2014].

[31]  Australian Bureau of Statistics (ABS). Australian standard geographical classification (ASGC) Remoteness Area classification (RA) digital boundaries, Australia, 2006. Canberra: ABS; 2006.

[32]  Schuurman N, Randall E, Berube M. A spatial decision support tool for estimating population catchments to aid rural and remote health service allocation planning. Health Informatics J 2011; 17: 277–93.
CrossRef | PubMed |

[33]  Australian Bureau of Statistics. Statistical geography volume 1: Australian standard geographical classification (ASGC). 2006. Available at http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/3E15ACB95DA01A65CA2571AA0018369F/$File/12160_2006.pdf [verified 13 February 2013].

[34]  Australasian Maternity Outcomes Surveillance System (AMOSS). AMOSS Newsletter. Sydney: University of NSW; 2012. Available at http://www.amoss.com.au/ [verified 31 August 2012].

[35]  Australian Institute of Health and Welfare (AIHW). Public hospital establishments NMDS 2010–2011. Canberra: AIHW; 2012. Available at http://meteor.aihw.gov.au/content/index.phtml/itemId/270150 [verified 29 July 2013].

[36]  McGrail MR, Humphreys JS. The index of rural access: an innovative integrated approach for measuring primary care access. BMC Health Serv Res 2009; 9: 124
CrossRef | PubMed |

[37]  Li Z, McNally L, Hilder L, Sullivan E. Australia’s mothers and babies 2009. Sydney: Australian Institute of Health and Welfare, National Perinatal Epidemiology and Statistics Unit; 2011.

[38]  Centre for Epidemiology and Research. NSW Mothers and Babies 2009. Sydney: NSW Ministry of Health; 2011.

[39]  Steenkamp M, Johnstone K, Bar-Zeev S. Can we count? Enumerating births in two remote Aboriginal communities in the Northern Territory. Aust N Z J Public Health 2012; 36: 281–4.
CrossRef | PubMed |

[40]  Birthplace in England Collaborative Group Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011; 343: 7400

[41]  Hartz D, Foureur M, Tracy S. Australian caseload midwifery: the exception or the rule. Women Birth 2012; 25: 39–46.
CrossRef | PubMed |

[42]  Tracy SK, Hartz DL, Tracy MB, Allen J, Forti A, Hall B, White J, Lainchbury A, Stapleton H, Beckmann M, Bisits A, Homer C, Foureur M, Welsh A, Kildea S. Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. Lancet 2013; 382: 1723–32.
CrossRef | PubMed |

[43]  Evans R, Veitch C, Hays R, Clark M, Larkins S. Rural maternity care and health policy: parents’ experiences. Aust J Rural Health 2011; 19: 306–11.
CrossRef | PubMed |

[44]  NSW Ministry of Health. Maternity: towards normal birth in NSW. Sydney: NSW Ministry of Health; 2010. Available at http://www0.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_045.pdf [verified 21 June 2013].


Legal & Privacy | Contact Us | Help


© CSIRO 1996-2016