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Obstetrics

The availability of maternity units is highly significant for the rural population of Victoria.

The Victorian rural population is isolated and requires maternity units within reach of expecting mothers. Traveling in labour is dangerous and the more that do it the greater the number of adverse outcomes. ½ hr traveling time is optimum but no longer achievable because of unit closure. 1 hour travel distance should be feasible for the State to keep babies 'born before arrival' to a minimum.

Repeated studies have shown rural obstetrics in accredited units with GP obstetricians to be safe no matter how small the unit. GP Obstetricians work in all sizes of rural towns including the larger where they supplement to work of specialists. There are strong indications that rural specialist obstetricians are diminishing in numbers.

Eight training positions are funded by the State through the Regional training programs and more are becoming available. They are open to any selected doctor available for the one year period, but also by negotiation can be spread over a longer period of time in conjunction with registrar training. Doctors with adequate overseas experience can have their capabilities checked and work without formal Australian qualification.

The Diploma of Obstetrics is a qualification aimed at antenatal care only. Rural Obstetricians currently obtain an advanced diploma, which includes some Gynaecological surgery The Joint consultative Committee (ACRRM, RACGP and RANZCOG) operates a system of certification.

Rural GP obstetricians throughout Australia are credentialed to perform instrumental delivery and Caesarean section. In Gippsland the training program has been significantly successful in recent years thanks to the dedication of one or two individuals. GP obstetricians for the most part work in collaborative teams with Midwives. The aim is safe working hours which additionally allow the GP to fulfil community needs for medical practice.

Whilst the GP may conduct private deliveries by maternal choice, normal deliveries are conducted by midwives. GP obstetricians should maintain skills in normal delivery. In larger units with good on-call back up and good midwife skills, GPs do not always physically attend every delivery but should be on hand for all higher risk deliveries including primiparae.

Closures of units continue to occur and are expected to do so for some years. Maps are available from several RDAV submissions including that to the 2008 Maternity Services Review. The RDAV is highly concerned to protect the remaining network of rural units. Any doctor wishing to obtain assistance with studying or practicing rural obstetrics may contact the RDAV to help facilitate training or placement. There are scholarships available from the Commonwealth which are currently available by application to RANZCOG.

Where decisions counterproductive to proper operation of maternity units are being made, it may also assist to contact RDAV early. Because of the unpredictability of obstetric emergencies the RDAV does not support stand-alone midwifery units without available obstetrician back-up. Death of a baby can be devastating to the midwife. Likewise, because of risk the RDAV is opposed to independent home-birthing and views with alarm instances of out of town, breech and twin deliveries.