Rural maternity and media discourse analysis: Framing new narratives.

INTRODUCTION: Continued rural maternity closure across Australia has seen impacts on women and families such as financial pressures, quality and safety concerns, and emotional pressure. This review aimed at understanding how media coverage of rural maternity and closure are presented and what impact this may have on maternity service sustainability. OBJECTIVE: This research seeks to examine media discourse and characteristics of online newspaper articles related to rural maternity services. DESIGN: A narrative review was conducted using thematic discourse analysis to examine online newspaper content published in Victoria, Australia from 2010 to June 2021. FINDINGS: Local maternity services were a source of community interest for rural people. Coverage of negative outcomes for mothers and babies was highlighted by rural newspapers; however, increased content over the last 12-month period focused on community support for the sustainability of rural maternity services. Recent community support in newspaper articles coincided with maternity services reviews and retaining some of these rural services. DISCUSSION: Community support in media may provide a protective social pressure, leading rural health services to consider this when reviewing the sustainability or closure of rural maternity services. CONCLUSION: Media attention about sustaining local maternity services by highlighting issues and representing community voices may influence health executive to consider opportunities to remodel and sustain high-quality and safe maternity care in rural settings. Knowing how rural health executives consider media, community pressure, and how it impacts expediency of maternity service closure decisions is unknown and an important gap in knowledge to explore and understand.

Sustainability of rural Victorian maternity services: 'We can work together'.

BACKGROUND: Rural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service's operations and sustainability. AIM: To examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services. METHODS: This was a qualitative study. Interviews were conducted via Zoom™ with 16 rural Victorian hospital board members and executives. Data were thematically analysed. FINDINGS: Severe shortages in the rural maternity workforce, primarily midwives, have contributed to service sustainability decisions. Challenges in offering midwifery workforce incentives cause difficulty in overcoming workforce shortages. A rural maternity workforce strategy harnessing connection with regional services was called for. Innovative models of maternity care were often actioned at the point of service suspension or closure. Participants requested a government policy position and funding for innovative, safe, and sustainable models of care in rural settings. DISCUSSION: There is an opportunity for workforce planning to occur between regional and rural services to ensure the development of sustainable maternity models such as midwifery group practice and incentivise the workforce to address current deficits and sustain service provision. CONCLUSION: Models of care developed with rural communities, in collaboration with regional services, have the potential to strengthen the delivery of safe, sustainable maternity services. Workforce modelling and centralised government policies aimed at arresting workforce deficits are suggested to provide rural health service leaders with strategic and operational directions to support the delivery of safe, sustainable maternity services.

Language used to describe the Australian midwifery workforce: A change opportunity to improve professional identity.

BACKGROUND: Tertiary level midwifery educational pathways to achieve registration as a midwife vary in Australia, with a shift from the hospital to the university sector more than 20 years ago. These pathways are often referred to in the workforce setting to distinguish midwives with different academic backgrounds. AIM: To discuss the genesis of midwifery education in the Australian setting and explore the impact of the language used to describe the educational backgrounds on the professional identity of midwives. DISCUSSION: Strong tertiary and regulatory governance exists to support the robust development of midwifery educational programmes and to ensure a high-quality, woman-centred workforce. Once registered, all midwives have the same skill set to provide care to women and families. However, separatist language is often used to describe midwives according to their educational background which has a propensity to reduce positive midwifery identity and influence continuing workforce attrition rates. CONCLUSION: Positive expression of midwifery identity, using a strength discourse and an inclusive workforce have the ability to strengthen job satisfaction and intention to remain in the profession. Midwifery education can occur through several pathways; however once registered, all midwives are equal.

Australian maternity care, considering risk and supporting safety: A scoping review.

OBJECTIVE: Assessment of women's risk status influences the operationalisation of maternity. Decisions are made at a health service executive level, related to the ongoing level of maternity care provided, and/or sustainability of the maternity service. The aim of this scoping review was to explore how health service executives considered maternity risk when operationalising safe maternity services in Australia. DESIGN: Scoping review methodology was used to examine the breadth and extent of evidence, and to identify potential gaps in the research evidence. RESULTS: Overall, there was little literature on how health service executives understand and interpret risk to providing and operationalising maternity services. Evidence indicated a reduced tolerance for risk in the provision of maternity services. Executive consistency and midwifery leadership were important in operationalisation of maternity service provision. KEY CONCLUSIONS: With rising rates of maternity service closure and reduction of service capability in Australia, women are most impacted, having reduced access to timely and quality care. More needs to be done to understand the health service executive perspective regarding drivers for these decisions and the barriers and enablers for maternity service sustainability. How health service executives perceive maternity care and experience operationalising maternity services, particularly in rural areas is a gap identified. Further research is warranted in this area to address this significant lack of knowledge. IMPLICATIONS FOR PRACTICE: Understanding how health service executive consider maternity care is crucial for ongoing operational safety and maternity care sustainability.

Australian maternity service provision: a comparative analysis of state and territory maternity care frameworks.

Objective Healthcare delivery in Australia is managed at state and territory levels. This paper aims to compare the content and structure of publicly accessible Australian maternity service state and territory frameworks which guide the delivery of maternity care. Methods A scoping review was conducted to identify publicly accessible Australian state and territory maternity service frameworks. A comparative content analysis was undertaken. Results Six of the potential eight states and territories had locatable frameworks. Differences in both structure and content were found between frameworks. Variation exists between standalone maternity service frameworks and comprehensive clinical frameworks. Several jurisdictions align policy and ministerial directives in their frameworks outlining service delivery and guidance relating to maternal and/or neonatal transfer. Language referring to the assessment of maternity services and service risk varied. Conclusion Consistency in structure, language, and a clear communication strategy embedded into each maternity service framework may improve the functioning and consistency of Australian maternity services at each level of the healthcare system.