Midwifery in rural areas could be challenging and more stringent guidelines were needed for midwives working in areas hours away from hospital care, the Otago District Health Board women's health clinical director says.
Making timely decisions about when a woman should be transferred to Dunedin Hospital to give birth could be difficult as guidelines were not completely clear, Dr Susan Fleming told the hospital advisory committee this week.
"We are struggling to provide oversight, guidance and support to lead maternity carers [midwives] in rural communities about making wise and timely decisions about transfer."
There had been dramatic changes in maternity care during the past 20 years and experienced midwives or GPs were not always on hand to provide guidance to less experienced midwives working in rural areas.
In response to a question from chairman Richard Thomson if there were not explicit, clinically-based national guidelines available, Dr Fleming said there was a lot of grey in current guidelines.
District health boards, the Ministry of Health and midwifery colleges needed to get together to resolve issues facing rural midwives, she said.
New Zealand College of Midwives Otago regional chairwoman Kerry Adams said rural healthcare was challenging for all primary healthcare providers, not just midwives.
"Not a lot of people want to work in rural practices. It is a really challenging area because you have to be quite proficient in secondary care."
While there was always room for improvement, she felt the current guidelines were "pretty clear" and they had been agreed by all colleges and the regulatory authority, the NZ College of Midwives, she said.
