Every year in Australia, 26,000 babies are born prematurely. The experience, often unexpected, can hit parents hard.
- New National Rural Health Commissioner argues premature birth rates in rural and remote areas can be halved
- Ruth Stewart has helped oversee programs in areas such as Thursday Island where no babies were born premature this year
- She wants more rural GPs trained to perform a wide range of services, including obstetrics
While medical advances have significantly improved outcomes, babies who survive premature birth can face a lifetime of complications such as cerebral palsy, learning difficulties, visual, hearing and behavioural problems and increased risk of diabetes, cardiovascular and renal disease.
There is a long way to go, particularly in rural and remote areas, according to Ruth Stewart, the Federal Government’s second National Rural Health Commissioner.
“Remote women are nearly twice as likely to give birth prematurely,” she will tell a National Rural Press Club event today to acknowledge World Prematurity Day.
Adjunct Professor Stewart is on a mission to change that, and she has been making headway from her remote home on Thursday Island in the Torres Strait.
For five years she has lived there with her husband and held roles such as associate professor of rural medicine and director of clinical training at James Cook University, and more recently president of the Australian College of Rural and Remote Medicine.
‘This is wrong’: Fighting for better services
As National Rural Health Commissioner, Adjunct Professor Stewart is the conduit between the rural medical community and its patients and the Federal Minister for Regional Health, Mark Coulton.
Her role is to provide advice and feedback on how to improve the state of rural health services.
With 30 years’ experience as a general practitioner with obstetric skills, one of her passions is rural maternity services — and she has first-hand experience of premature birth.
Her sister was born more than two months premature in Tatura in north-east Victoria. Two years later, Adjunct Professor Stewart herself arrived much earlier than expected.
“I was a bit of a non-event after my sister arrived so early, but I knew from early on that birth did not always go in a straight-forward way.”
While studying obstetrics in Glasgow, she was alarmed that women from Scotland’s remote outer islands had no choice but to spend the last month of their pregnancies in the city.
“Looking at those women cut off from family just so they could access adequate care, I thought, ‘this is just wrong, this is so wrong’,” she said.
She went on to have three children of her own in rural south-west Victoria where she and her husband ran a GP clinic.
“I experienced the benefits of birth close to home with known people in a small community.”
But at that time, she got wind of a push in the Melbourne medical community for rural birthing services to be closed and centralised.
“I knew I should stand up for my mob, which is what I did.”
She attended a meeting in Melbourne where she presented academic literature showing that “once you close rural birthing services, that’s when disaster occurs”.
From that moment, her advocacy for better maternity and health services in the bush had begun.
Halving premature birth rates
In today’s address, Adjunct Professor Stewart will explain that in 2018, 8.4 per cent of births in major cities were premature compared with 13.5 per cent in rural, remote and very remote Australia.
“Those averaged figures hide pockets of greater complexity. In east Arnhem Land communities, 22 per cent of babies are born prematurely,” she will say.
But she will argue it is an “urban myth” that the quality of rural maternity care and services is to blame. Rather, she will point to an ongoing decline in available services, clinics and skilled operators.
One solution she will present is the model of care developed through the Midwifery Group Practice on Thursday Island.
That program has halved premature birth rates across the Torres Strait and Australia’s northern peninsula since 2015.
Crucially, all women have access to continuity of care, or the same midwife throughout the pregnancy, and those midwives are supported by Indigenous health practitioners and rural generalists (GPs with a broad range of skills such as obstetrics).
Gemma McMillan, the program’s director of midwifery, said Adjunct Professor Stewart’s knowledge and “genuine, lived experience” of rural and remote maternity and health services had “helped enormously” to achieve success.
“Aboriginal and Torres Strait Islander women had not liked the model of care previously because there was such a high turnover of staff,” she said.
“They were fed up telling their story to multiple care providers in one pregnancy.”
Indigenous health practitioners such as Auntie Margaret Kiwat have worked for the program since its inception to ensure women feel “culturally safe”.
“We communicate between our girls and the midwives — the language and culture — to make the midwives understand what our girls want and the services they need,” Auntie Margie said.
“Before, we had so many midwives come and go and they had different ways of talking, different ways of breastfeeding, and those girls did not understand.”
Each year, the program takes on the care of 300 pregnant women; half of these women give birth in Cairns or Townsville due to complex and high-risk needs.
But of the 150 babies born on Thursday Island this year, not one was premature.
Calls for continuous care everywhere
Even when women live relatively close to maternity services, the outcomes can still be traumatic and have life-long implications.
Kate Pianto is from a property 70 kilometres outside Griffith in the New South Wales Riverina, and she unexpectedly went into labour at 28 weeks.
“I started experiencing contractions and went to the hospital and they said, ‘oh good, if you’d waited until the morning, you would’ve had this baby,’ and they administered medication there which stopped the labour,” she said.
“But because our hospital’s not equipped to deal with premature birth, I was still flown to Canberra to be monitored for a few days.”
Ms Pianto said a continuous model of care would have reduced her anxiety during pregnancy, considering she had to drive more than an hour to attend perinatal appointments.
Ms Pianto believed better perinatal services would be advantageous to rural communities and reduce rates of prematurity and stillbirth, as well as post-natal depression.
“The headspace out here is just, ‘I guess that’s how it is,’ — you know, we can kick and scream all we want but it really doesn’t get us anywhere.”
Rural generalists key to improving services
Adjunct Professor Stewart said experiences like Ms Pianto’s would be less common if more rural GPs were able to deliver a broader range of medical services.
As commissioner, she will implement the work of her predecessor, Emeritus Professor Paul Worley, who recommended training pathways for rural generalists.
“If you can only have one doctor in your town, you want that doctor to have a very broad set of skills, including emergency skills,” she said.
And she hopes that foundation will help reduce premature birth rates and improve rural health services overall.