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Wonders and hurdles of rural midwifery
Mathilda (Tilley) Wilson, who completed her Bachelor of Midwifery at Charles Darwin University last year, summarises her final placement.
I was incredibly lucky to complete my final midwifery placement at Mansfield Hospital in North East Victoria, where I witnessed the wonders of small community midwifery practice, as well as the hurdles that arise simply because of the distance to the nearest referral hospital.
I spent eight weeks working with the small (and amazing) midwifery team. The Midwifery Group Practice of seven midwives work in collaboration with GP/Obstetricians and other health professionals.
Mansfield is very lucky to be only three hours north of Melbourne, with access to a large hospital just over an hour away, but I was still intrigued by just how different practice is in a small rural hospital with limited resources, be that medical resources or staff available. I was able to gain exposure to antenatal clinics both at Mansfield and a smaller clinic an hour away from the hospital.
I was also lucky enough to meet amazing families and welcome their babies into the world, care for women postnatally and attend domiciliary (home) visits in the most beautiful places. Some of these families are quite isolated from services, but still receive fantastic midwifery care.
One of the most memorable experiences I was involved in was a woman presenting at 35 weeks gestation with back pain. In any of my previous placements, this would have been investigated rapidly, but not with the urgency and thoroughness I witnessed here.
Having spent a lot of my placement time in the past at large metropolitan hospitals, I was well aware that the sheer number of women and possible complications mean that there are designated triage midwives, monitoring units and emergency departments (in tertiary hospitals) to care for these cases. I had no idea how this was managed in a rural setting.
In this case, there was only the midwife, a doctor on call, and the larger hospital to refer to if need be, with an ambulance as the best option if a transfer was necessary. Within 20 minutes, the midwife had called me to ask if I would like to come in… the on-call doctor was on her way. The woman was greeted by first name by a midwife she knew already, a CTG monitor was in place, and a fetal fibronectin test organised. We chatted about her family, other children and plans for the weekend while we waited for the test results and when it was apparent all was well, she went home. If this had not been so smooth, and the woman or her baby needed to be transferred, I was made aware of protocols about PIPER (Paediatric Infant Perinatal Emergency Retrieval), paediatricians at Wangaratta which is the nearest large hospital, how to use the isolette and who to contact in an emergency. Every option was considered and covered.
Whilst a metropolitan tertiary hospital has every specialist and care option at their fingertips, there’s a lot to be said for small communities, where patients know their practitioners and vice versa.
I will never forget the impact that having known midwives in a small community had on the women, and the midwives too. I feel so incredibly lucky to have been able to consolidate three years of learning about woman-centred care by spending time with midwives, doctors, women and families; watching just how wonderful true continuity of care can be. I could have written pages and pages about the wonderful experience I had on my placement, the amazing people I met and how rewarding it was to have the opportunity to learn so much about such a variety of things.
I am incredibly grateful to CRANAplus for the assistance to complete this placement, and navigate small community life, via an Undergraduate Clinical Placement Scholarship, and hope to continue witnessing the wonderful work that CRANAplus does for rural and remote health care professionals, students and communities.