The extremes of Midwifery

Ms Heather Cudmore1

1RFDS Western Operations, Broome, Australia

Three vignettes from personal practice will highlight the importance of being able to provide quality maternity and neonatal emergency and retrieval care as a flight nurse/midwife within the remote Kimberley region of Western Australia: a one-day old baby presenting with early neonatal sepsis in a remote indigenous community, an unplanned term breech birth in an isolated bush hospital without ‘birthing rights’, and an advanced extreme premature labour in another very remote Indigenous community. These vignettes will illustrate various challenges to be overcome in the delivery of care to labouring women and/or their neonates retrieved from such remote settings; and it will be evident that in such contexts, the provision of care cannot be solely reliant upon being launched from a tertiary location. In an era of diminishing rural and remote maternity services¹, where indigenous maternal and infant health outcomes are known to worsen with increasing remoteness²; coupled with the push for a reduction in flight nursing qualifications to non-mandatory midwifery³ ⁴, it is imperative that flight nurse/midwives working within such contexts are supported to maintain their maternity and neonatal knowledge and skills. It has been ten years since data was gathered from a group of flight nurse/midwives regarding how this could best be achieved⁵, but it can be asserted that the same challenges are still faced. Greater availability of on-line education materials, regular multi-disciplinary team simulation exercises, employer-supported placement opportunities for professional upskilling; as well as ‘standard’ courses may provide ways to move forward. Because of the high risk nature of this patient group, and the specialist care required; retrieval organisations that offer midwifery scholarships to RN’s should consider requiring them to undertake a consolidating graduate year prior to commencing work with the organisation.

¹Dietsch, E., Shackleton, P., Daview, C., Alston, M. & McLeod, M. 2008, ‘Luckily we had a torch’: contemporary birthing experiences of women living in rural and remote NSW. Wagga Wagga: Charles Sturt University, bahsl.com.au > _literature_159616, accessed 8th April 2019.

²Kildea, S., Kruske, S., Barclay, L. & Tracy, S. 2010, ‘Closing the Gap’: how maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal annd Torres Strait Islander women, Rural Remote Health, 10 (3): 1-18. downloaded from rrh.org.au/journal/article/1383 on 9th April 2019.

³CareFlight, 2019, careflight.org/our-work/training-education/doctor-nurse-training-accreditation/, accessed 8th April 2019.

⁴LifeFlight, 2019, lifeflight.org.au/index.php?action=view&view=244983, accessed 8th April 2019.

⁵Brideson, G., Glover, P. & Button, D. 2012, Flight nurses in Australia: Maintaining their midwifery competence – a case study,  Contemporary Nurse, 43 (1): 121-130. doi: 10.5172/conu.2012.43.1.121


Biography:

Heather started her graduate nursing career in 1998 in Emergency nursing, and enjoyed it so much she stayed for the next 17 years! Along the way she completed her honours degree in 2001, some short-term stints in ICU nursing and had three children. More recently she completed her Grad Dip Mid with the help of a scholarship from RFDS Western Operations, before moving from Tasmania to the Kimberley to commence as a Flight Nurse at the newly opening Broome Base; a position she is still passionate about now. When not flying, she enjoys walking Cable Beach, camping and family time.