Literature

Rural obstetrics in NSW. Wollard LA, Hays RB. Australian and New Zealand Journal of Obstetrics and Gynecology 1993; 33 (3): 240-242

The safety of obstetrics in rural areas has been, and remains, a controversial issue.

In this paper Wollard and Hays compared 5950 deliveries conducted by rural GPs in New South Wales, Australia, during 1990-1991, to the nearly 90 000 deliveries conducted in NSW as a whole during the same period. The authors found that the outcomes of both groups were comparable. They stated: "No evidence that obstetrical care in accredited rural GP obstetric units is of less than acceptable standards, could be found." Noting that these units are a rich source of experience for GPs in training, they went on to state: "There is scope to increase the use of rural obstetric units for the training of future rural GP obstetricians."

This recent evidence adds support to the belief that rural women can demand that their obstetric care be provided close to their own communities and that they can expect this care to be safe and of a high standard.

Management of labour in an isolated rural maternity hospital. Baird AG, Jewell D, Walker JJ. British Medical Journal 1996; 312: 223-226

In a recent UK retrospective study of a rural maternity unit 120 km from the nearest consultant maternity unit, 997 consecutive deliveries managed by midwives and GPs were audited. Mode of delivery, complications, medical interventions and transfers were quantified.

Fifty-three percent of the women (530) were classified as low risk and were booked for elective delivery at the rural unit. In spite of this attempted screening, 12.8% subsequently had an unplanned transfer, and 3.8% required a cesarean section. Among the 462 women who remained for delivery in the low-risk unit, 5% required the application of forceps, and 7% had significant postpartum complications.

This study demonstrates that at a relatively isolated unit, in spite of an attempt to limit deliveries to those in a low-risk category, nearly one-third of the deliveries required intervention (either by the GPs in the unit or at the consulting unit 120 km away) for an unanticipated difficulty. Although this study did not assess outcomes in a comparative way, it suggested that "a team approach to obstetric management" be emphasized so that complications can be dealt with appropriately and in the appropriate setting.

Procedural medicine: Is your number up? Jackson WD, Diamond MR. Australian Family Physician 1993; 22 (9): 1633-1639

Maintenance of competence is a current preoccupation of regulators and educators at the local, provincial and national levels. In their review of the literature pertaining to procedural competence, Jackson and Diamond recognized one of the basic features of rural practice: namely, its requirement for procedural skills that may only be practised infrequently.

The authors reviewed the literature relating to psychomotor-skill preservation and argued that "there is little or no evidence to justify the judging of competency by numbers of procedures performed." They noted that numerous studies on three continents have documented the safety of obstetrical practice in rural hospitals with low delivery numbers, and they suggested that "the extent of initial training is more important than the frequency of continuing practice." This conclusion should resonate among those who organize the training of physicians headed for rural practice.


Table of contents: Can J Rural Med 1 (1)
Copyright 1996, Canadian Medical Association