Mapping maternity services in Australia: location, classification and services

Abstract

Objective. To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. Design. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 2–6). Results. A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Conclusion. Maternity service provision varies across the country and is defined predominately by location and annual birth rate. What is known about the topic? In 2007, over 99% of the 289 496 women who gave birth in Australia did so in a hospital. It is estimated that there are more than 300 maternity units in the country, ranging from large tertiary referral centres in major cities to smaller maternity units in rural towns, some of which only provide postnatal care with the woman giving birth at a larger facility. Geographical location, population and ability to attract a maternity workforce determine the number of maternity units within a region, although the means of determining the number of maternity units within a region is often unclear. In recent years, a large number of small maternity units have closed, particularly in rural areas, often due to difficulties securing an adequate workforce, particularly midwives and general practitioner obstetricians. There is a lack of understanding about the nature of maternity service provision in Australia and considerable differences across states and territories. What does this paper add? This paper provides a description of the geographic distribution and level of maternity services, the demand on services, the available obstetric interventions, the level of staffing (paediatric and anaesthetic) and support services available and the private and public mix of maternity units. The paper also provides an exploration of the different interventions and discusses whether these are appropriate, given the level of acuity and access to emergency Caesarean section services. What are the implications for practitioners? This study provides useful information particularly for policy-makers, managers and practitioners. This is at a time when considerable maternity reform is underway and changes at a broader level to the health system are planned. Understanding the nature of maternity services is critical to this debate and ongoing planning decisions.