In the context of maternity care, ‘collaboration’ is defined as a shared partnership between a birthing woman, midwives, doctors and other members of a multidisciplinary team (National Health & Medical Research Council, 2010). Collaborative practice is based on the philosophy that multidisciplinary teams can deliver care superior to that which could be provided by any one profession alone (National Health & Medical Research Council, 2010). Indeed, there is evidence to suggest that collaborative maternity practice does improve outcomes for women, including both clinical outcomes and consumer satisfaction with care (Hastie & Fahy, 2011). Collaborative practice is particularly important in Australian rural and remote maternity settings, which are characterised by fragmented, discontinuous care provision (Downe et al., 2010). As such, both the Code of Ethics for Midwives in Australia (for midwives and obstetric nurses) and the Collaborative Maternity Care Statement (for obstetricians and other doctors) require that a collaborative model of care be adopted in Australian maternity settings. However, inconsistencies between and among midwives and doctors about the definition of ‘collaboration’, and subsequent ineffective collaborative practice, remain key causes of adverse outcomes in maternity settings in Australia (Hastie & Fahy, 2011; Heatley & Kruske, 2011). This paper provides a critical analysis of collaborative practice in Australian rural and remote maternity settings.
It is estimated that one-third of birthing women in Australia live outside of major metropolitan centres â€“ defined for the purpose of this paper as ‘rural and remote regions’ (National Health & Medical Research Council, 2010). However, the number of facilities offering maternity care to women in these regions is just 156 and declining (2007 estimate) (Australian Government Department of Health, 2011). Australian research suggests that the decreasing number of rural and remote maternity services is resulting in more women having high-risk, unplanned and unassisted births outside of medicalised maternity services (Francis et al., 2012; McLelland et al., 2013); indeed, one recent study drew a direct correlation between these two factors (Kildea et al., 2015). Additionally, statistics suggest that both maternal and neonatal perinatal mortality rates in Australia are highest in rural and remote regions (Australian Government Department of Health, 2011). High perinatal mortality rates and lack of services in rural and remote communities mean that many rural and remote women are transferred to metropolitan centres, often mandatorily, for birth (Josif et al., 2014). This system has resulted in fragmented, discontinuous care for many rural and remote women â€“ which is itself a poor outcome (National Health & Medical Research Council, 2010; Sandall et al., 2015). Many women find such models of care to be significantly disempowering, which again may result in poorer outcomes (Josif et al., 2014). Indeed, many women, and particularly Aboriginal women, may resist engaging with medicalised maternity services to avoid being transferred ‘off-country’ for birth (Josif et al., 2014). Furthermore, those women who are transferred ‘off-country’ for birth bear a significant financial, social and cultural burden (Dunbar, 2011; Evans et al., 2011; Hoang & Le,
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