A decade-long campaign to restore maternity services to a once thriving rural hospital has finally paid off.
Announcements about rural maternity services are not usually cause for celebration - after all, more than half of Australia's small rural maternity units have closed in the past 20 years.*
So when Queensland Health Minister Lawrence Springborg announced at the Rural Doctors Association of Queensland conference in June that Beaudesert Hospital's obstetric services would resume from July 2014, the conference room erupted with applause and cheers.
For some it was cause not just for jubilation, but also for relief. A team of community advocates from the south-east Queensland town had been working tirelessly for close to a decade to draw attention to the loss of maternity services at a hospital that, at its peak, delivered more than 400 babies a year.
"Beaudesert Hospital in the late 1990s and early 2000s was the jewel in the crown of Queensland's country hospitals," says Beaudesert GP Dr Michael Rice. "It had the biggest country birthing unit in Queensland, it was providing hundreds of elective surgical procedures, including dental procedures, as well as quite sophisticated in-patient care for adults, for the elderly, children and neonates."
However, the hospital lacked the critical mass of health professionals to maintain a sustainable 24/7 obstetric service and it took the departure of only one doctor in 2001 for cracks to start to appear. From 2002 to 2004, the hospital's obstetric services limped along, offering mostly only antenatal clinics and elective Caesarean sections, because this enabled staffing to be planned. Other women had to travel 50km to Logan Hospital to deliver their babies.
In mid-2004, the health service district officially stopped trying to restore a full-time obstetric service, although Dr Rice says the labour wards and nursery were not decommissioned until some time later.
But the local community didn't give up. Leading the campaign to restore services was Dr Rice, a GP who formerly practised obstetrics. While Dr Rice initially raised his concerns about the service's closure with local papers, at an RDAQ conference in 2006 he met Health Workforce Queensland's Chris Mitchell, who advised him not to go it alone.
"I realised that there was a strong evidence base for involving the local community on a broader scale and particularly the local council," Dr Rice says. "A doctor can be a lone voice in the wilderness. You can be as right as you like, but it's only one vote, whereas the mayor and the council can really sink the boot in on behalf of the local community - and that's what will bring results."
The then Beaudesert Shire Council, now the Scenic Rim Regional Council, was only too willing to take on the fight and formed a health services taskforce, chaired by then deputy mayor Mr Dave Cockburn.
"The advocacy was a real team effort. Everyone had their role to play," says Mr Cockburn, adding that Dr Rice has been a tireless advocate - from first raising the issue with council to collecting the many facts and figures needed.
Dr Rice says the RDAQ was very supportive too in regularly issuing press releases, and the local newspapers were key in advocating for a restoration of services.
"In small communities, the role of the local media extends beyond reporting local news and goes to supporting advocacy for local community development," Dr Rice says. "A series of editors and journalists [at the Beaudesert Times and Jimboomba Times] have been extremely supportive."
Regional and state media also extensively reported on the issue, ensuring that the demise of maternity services at Beaudesert Hospital remained on the political radar.
Mr Cockburn says that, in addition to keeping the issue in the headlines, it was also essential to keep the community's spirits up. "It had been so long, over a decade, the local community were starting to give up hope," he says. "We needed to let people know this was something that is really worth fighting for and we are going to get these services back - they need to be back."
The loss of maternity services at Beaudesert has had a far greater impact than just requiring women to travel to Logan.
"It goes deeper than that," Mr Cockburn says. "Rural communities are very proud and we have had 3-4 generations who have had family members born at Beaudesert and with the closure we have a generation who didn't have that [opportunity]. It's interesting how those sorts of things affect the community fabric."
So now attention is turning to rebuilding a full-time obstetric service - a task perhaps no less daunting than the lobbying efforts to restore services. While the firm commitment of a July 2014 start date has been welcomed, there is no doubt that it's an ambitious target.
Dr Adam Coltzau, newly elected RDAQ president, says getting the maternity unit up and running again is not going to be an easy task.
"Once maternity services have been lost to a town or an area it is really difficult to get them back and I think that's why previous governments have shied away from it, because it's difficult," he says. "It shows a lot of courage on the part of the new government to agree to this so early in their term."
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From left, Professor Hazel Brittain (Queensland president of the Australian College of Midwives), Mr David Cockburn, Mr Lawrence Springborg and Dr Michael Rice at the RDAQ conference.
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Much needs to be done in the next two years to prepare the hospital to reinstate maternity services. After a visit to the hospital last month, Mr Springborg said in a statement that Metro South Hospital and Health Service and the Greater Brisbane South Medical Local would work together on the project.
He said the hospital's midwifery practice was already growing, with four new midwives to come on board by August, and post-natal inpatient transfers to Beaudesert would soon be available.
"Before the year is out, new mums from the Scenic Rim who have birthed at Logan can move closer to home ... more quickly," Mr Springborg said.
"Starting out with post-natal care is a necessary first step to restoring birthing services and will provide the hospital with the opportunity to trial vital support services," he said.
Dr Rice says he expects the restoration of maternity services to have flow-on effects, enabling the hospital to offer other advanced clinical services. "The number of staff that will be required to fill the roster means that there will be an enormous capacity to provide other advanced skills, which is what happens in other country hospitals in Queensland and Australia."
Dr Rice is optimistic that services that have been lost to the town - such as exercise stress testing, fracture clinics, paediatric in-patients and a high-dependency unit - may be regained. "Obstetric services are like the chockstone at the top of the arch - you have to have all these other things in place before you can put in a full-time obstetric service; take it away and everything else collapses," he says.
The Beaudesert model will also be keenly watched by other rural towns that have lost or are struggling to maintain maternity services. In announcing the Beaudesert plan, Mr Springborg said in a statement that it marked a "commencement of a plan to re-open obstetric and procedural services in other regional and rural locations".
It's welcome news to the RDAQ, with Dr Coltzau hopeful the Beaudesert decision will mark a reversal in the trend of rural maternity unit closures in the state. "We are also hopeful that this will mean that some maternity services that have been flagged as being potentially under threat will be able to look at the model of how this was done and hopefully maternity services will stay open," he says.
Chinchilla, in Queenland's Darling Downs region, is one such town. Dr Coltzau says Chinchilla is a growing town, with a nearby coal seam gas boom, and a young population - but with a maternity unit that relies on the services of two GP-obstetricians who are approaching retirement.
Earlier in the year, Chinchilla residents took to Facebook to voice their concerns. Local mother-of-three Danielle Causer says Chinchilla's maternity unit covers a broad surrounding area and, without the service, women would have to travel two hours west to Roma.
"We didn't want to lose this service," she says. "So I thought that we needed to be heard and [setting up a Facebook page] seemed to be a way of pulling people together so we could then speak as a group."
Dr Rice says he hopes Beaudesert can pave the way for towns like Chinchilla. Dr Rice, who last practised obstetrics in 2003, has yet to decide whether he will renew his obstetrics skills by obtaining DRANZCOG (Advanced) certification. However, he says the solution will require more than just upskilling local GPs.
"There are other towns where maternity units thrive on the skills of local GPs and in the past Beaudesert GPs have been criticised or blamed for not working at the hospital ... but the way forward for Beaudesert and many other country hospitals will involve growing a new workforce."
And Queensland is the place to do it, says Dr Rice, adding that the state is leading the way in training doctors for rural practice with the rural generalist pathway.
"Feeding them into places like Beaudesert is going to provide a large part of the answer to solving the rural procedural problem," he says.
Dr Coltzau agrees that a new model is needed. He says a critical mass of health professionals is needed to build safe obstetric services in rural centres. "Gone are the old days when a single doctor could do the anaesthetic, then proceed to do the caesarean section and resuscitate the baby," he says adding that such an approach is outdated both medicolegally and in terms of best standard of care.
The revitalised Beaudesert Hospital will service a very appreciative community. The Scenic Rim Health Taskforce's Mr Cockburn says the township has learnt some valuable lessons over the past 10 years.
"One of the things our community has recognised is that a lot communities take such health provision for granted," Mr Cockburn says. "The [Beaudesert] community has come to a real realisation that we have to stand up and work together to preserve these health services." ·
*http://nrha.ruralhealth.org.au/cms/uploads/factsheets/Fact-Sheet-25-Maternity-Services.pdf
Closures linked to out-of-hospital births
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 THE closure of rural maternity units has been partly blamed for a doubling of unplanned out-of-hospital births in Victoria.
Writing in Midwifery, Monash University researchers found that "births before arrivals" (BBAs) had increased from an annual incidence of 157 in 1991 to 351 in 2006.
Dr Mike Moynihan, pictured, a GP-obstetrician and president of the Rural Doctors Association of Victoria, says this is an extraordinary number for this day and age.
"Delivery in transit attracts considerable risk," he says. "We need to know about the outcomes."
One of the factors identified by the researchers was the closure of rural maternity units in the state.
"The farther a woman has to travel has been shown to increase the incidence of unplanned births before arrivals," the researchers wrote.
"Rising incidence of unplanned BBAs in Victoria also coincides with closure of multiple rural maternity units - 37 since 1997 and 88 since 1983."
Dr Moynihan says it is vital that Victoria develop initiatives to rebuild the rural medical workforce.
He is doubtful the solution found for Beaudesert will easily translate to the southern state. "We can't afford it here," says Dr Moynihan, who notes that Queensland's rural generalists are paid as specialists.
He says there is momentum in Victoria to train more rural generalists, with $2.4 million set aside over four years for such training. But with just 14 rural generalists being trained in Victoria this year, it is too few to make up for the retirement rate of the state's procedural GPs, most of whom are in their 50s.
Dr Moynihan says it's also crucial for hospitals to embrace rural generalists.
"It's not as though everyone is clapping their hands about [training rural generalists]," he says.
"There are some hospitals that just don't really want to be in it, who have actually been moving away from generalists and trying to run smaller hospitals with specialists and it doesn't work because you can't get enough of them.
"Maternity units require 24/7 obstetric and anaesthetic cover and this can only be achieved in a rural setting by rural medical generalists working as both community GPs and hospital doctors. This model has consistently been shown to be safe in many studies."
Midwifery; online 20 June 2012
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