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Adding maternity emergency care skills to the remote area nurse's toolbox, with midwife Di Evans

7 Dec 2023

Remote area midwife and CRANAplus facilitator Di Evans is passionate about empowering and supporting RANs. Here Di shares what drives her volunteer contribution to CRANAplus’ “something for everybody” Maternity Emergency Care (MEC) course.

Di’s first taste of rur­al and remote mid­wifery was over the Christ­mas peri­od of 2015, when she took long ser­vice leave from her Mid­wifery Unit Man­ag­er role on the Gold Coast to help a friend in the Kather­ine Mater­ni­ty Unit. 

I absolute­ly total­ly loved it. I saw that there was a niche that met my core val­ues in mater­ni­ty care-pro­vid­ing, and gave me the oppor­tu­ni­ty to think out­side the box to deliv­er mater­ni­ty care,” she says. 

Over the past sev­en years, Di’s remote area mid­wifery work has also seen her liv­ing and work­ing along­side RANs in Abo­rig­i­nal com­mu­ni­ties, includ­ing two-and-a-half years that she absolute­ly loved” in Wad­eye, NT deliv­er­ing con­ti­nu­ity of care and mak­ing a difference.

Nowa­days, you will find Di trav­el­ling in her Land­cruis­er 200 series across rur­al and remote Aus­tralia under­tak­ing 12-week con­tracts in com­mu­ni­ties in need of mid­wifery care.

From Wad­eye I went to the Tor­res Strait, to Thurs­day Island, and to Port Hed­land and com­mu­ni­ties in WA and Queens­land,” says Di.

Recent­ly I’ve been doing some rur­al place­ments, Glad­stone, Esper­ance and Carnar­von, with that rur­al and Indige­nous health focus – they’re not as remote, but just to recharge and keep current.”

Di used to run impromp­tu emer­gency birthing cours­es when she met RANs at out­reach cen­tres. She has since trans­ferred this pas­sion to her vol­un­teer role as a CRANAplus facil­i­ta­tor on the Mater­ni­ty Emer­gency Care (MEC) and Mid­wifery Upskilling (MIDUS) cours­es. 16 months in and she has five course facil­i­ta­tions under her belt.

I have huge respect for remote area nurs­es, hav­ing worked with them real­ly close­ly in remote com­mu­ni­ties,” Di says.

How­ev­er, Di believes a fear of mater­ni­ty can at times pose a risk to the pro­vi­sion of evi­dence-based care to moth­ers and babies in remote areas, where birthing ser­vices are not often avail­able locally.

Di says that the MEC course is about expand­ing the mas­sive tool­box of skills” RANs have even fur­ther, in order to alle­vi­ate under­stand­able anx­i­ety about mater­ni­ty care includ­ing emer­gen­cies and equip RANs with the right ques­tions to ask and the aware­ness of whether a woman can be man­aged in Community.

The end result is that they will be able to col­lab­o­rate as effec­tive­ly as pos­si­ble with the mid­wife or dis­trict med­ical offi­cer, and pro­vide as much care as pos­si­ble on Country.

For exam­ple, is it preterm labour or is it just a sim­ple uri­nary tract infec­tion that is giv­ing her con­trac­tions?” Di asks.

If we treat the infec­tion ear­ly, she may not have to go into a ter­tiary unit for weeks pri­or, to await the arrival of her baby.”

Di says that RANs can also play a vital role in shap­ing healthy preg­nan­cies and lim­it­ing the occur­rence of preterm birth; for exam­ple, by screen­ing for STIs and anaemia dur­ing the pre­con­cep­tion period.

A healthy mum grows a healthy baby,” says Di.

A trust­ed, flu­id, cul­tur­al­ly safe and appro­pri­ate health­care ser­vice that strength­ens healthy lit­er­a­cy is key to pre­vent­ing preterm birth and achiev­ing opti­mal mater­nal outcomes.

It’s about being in that yarn­ing space, being trust­ed,” says Di

Trust is the most impor­tant thing… and these RANs are trust­ed, and they’re there all of the time, as unfor­tu­nate­ly, not all ser­vices have access to a mid­wife on the ground.

We just need to empow­er that trust… that goes some way to pre­vent­ing adverse outcomes.”

Di encour­ages any nurse who has an inter­est in rur­al or remote health to attend a MEC course and expand their tool­box further.

Once nurs­es have done a MEC, they have the skills to take back to their indi­vid­ual work­ing envi­ron­ments and pro­vide great imme­di­ate ante­na­tal assess­ment and care,” she says.

We’re not expect­ing RANs to know how to be a mid­wife; we’re just expect­ing them to be able to know what’s nor­mal… and know that it’s okay to not know and to con­sult and refer.”