Crisis in country birthing
By UTE SCHULENBERG
TREVOR Cheney believes there is no better part of medicine than supporting women through their pregnancies, births and the ongoing care of their babies.
One of only two GP obstetricians in Bellingen, Dr Cheney said while the role takes its toll on self and family, there are also enormous rewards.
"The opportunity to do obstetrics in a country town is wonderful because you develop close relationships with the mothers and can deal with lots of questions," Dr Cheney said.
"Which all helps when it comes to the actual delivery."
"It is not easy to achieve that in the busy, big hospitals."
In light of a recent study published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, Dr Cheney would appear to be more the exception than the rule.
The study found the number of rural obstetricians was dwindling at an alarming rate, with almost half of the 73 per cent who responded, intending to cease obstetric practice within five years.
This has prompted a call by the Rural Doctors Association of Australia (RDAA) for urgent measures.
According to RDAA president, Dr Sue Page, many younger obstetricians are choosing city-based work with its lucrative private work, guaranteed annual leave and minimal after hours duties.
She says improved rosters and locum arrangements for rural obstetricians are needed, as well as a resolution of the financial anomalies between metropolitan and rural practice.
"We are also investigating the possibility of a national rural Specialist Obstetrician Locum Scheme to provide affordable locum support in rural areas," Dr Page said.
Another idea canvassed recently is that of birth centres run entirely by midwives, excluding doctors from the birthing suite altogether.
Dr Cheney describes this as an 'unfortunate concept'.
"There are many romantic concepts about birthing, and mostly it is a beautiful healthy event. But the reality is sometimes the process goes awry.
"Assisting women through birth works best when there is a team, and I treasure working with our fantastic dedicated midwives.
"Having birthing centres separated from team facilities would mean in emergencies, mothers would be dislocated from the opportunity for people with the skills to rescue a stuck baby."
He said the support of the large hospitals, like Coffs Harbour or John Hunter, was absolutely critical to his obstetrics work in Bellingen.
"I am happy at the coalface, focusing on personal care, but I need the big hospitals when a birth is not going normally."
Dr Cheney believes the crisis of birthing in country hospitals has less to do with not enough doctors, and more to do with the insurance debacle and the way the health system is skewed to focus on administration and paper trails, making practitioners its adversaries.
Ultimately though it is all about caring for people and Dr Cheney can only encourage doctors to return to rural obstetrics and enjoy the opportunities it offers.