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Wonders and hurdles of rural midwifery

1 Jun 2021

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.