Rural maternity units: how will they have a future?

In this issue of the Journal, a description by Scherman and colleagues (page 85) of the first year’s experience at Mareeba District Hospital’s midwifery-led maternity unit provides some interesting and valuable insights into the role of low-intervention birth units for low-risk women in rural areas. 2 Women planning to give birth at Mareeba were screened for risk factors, and low-risk women were selected for maternity care provided by a midwife. Medical back-up was provided through regular case conferences with an obstetrician at the nearby Cairns Base Hospital, who also visited Mareeba once a month, and on-site back-up from local GPs, who were able to perform caesarean section delivery if necessary. Intrapartum transfer was rarely used and largely confined to primiparous women. The authors reported no significant preventable morbidity or mortality in mothers or their babies, and their findings would appear to support the feasibility of this model of care, especially for multiparous women — although they acknowledge that the number of births so far is too low to support any conclusions regarding safety. Intervention rates were significantly below state averages. In 2004, 207 women gave birth at Mareeba District Hospital