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Like having your baby at Nana’s house, but with drugs: a love letter to rural maternity units

There are plenty of drawbacks to living in the back of beyond, but for expectant mothers, at least, there’s one big plus: rural maternity units. Southlander Victoria Crockford explains why giving birth in one is a ‘privilege and a pleasure’ – and why their continued existence is under threat.

I’m going to have my second baby in February and I’m looking forward to the birth. Truly, I am. I wish I could say it’s because I’m some zen mother who can just breathe small humans out of her birth canal like flowers. No.

I am the woman who threw up every ten minutes during established labour. I am the woman who literally tried to climb the walls of our truck cab while moaning like a wounded hippo to be “let out right now” for two kilometres before we reached the hospital. I am the woman who was (gently) admonished for “yelling more than you’re pushing”.

I probably wouldn’t be considered a gentle birther.

Still, I look forward to the whole gut-spilling, sweaty, tearful enterprise this time around. Of course, I can’t wait to look into the slime-covered face of my newborn child. Of course. More than that, I’m looking forward to it because I’m planning on birthing in a rural maternity unit in Southland.

I want you all to know, people of the world where the nearest hospital with drugs and an obstetrician is not over two hours away, that the option of birthing in a rural maternity unit is a privilege and a pleasure. This is a love letter to them all.

First of all, a confession: I used to be a complete urbanite. If you had previously told me that I would be popping out sprogs in the middle-of-nowhere-Southland and looking forward to the experience, l would have spluttered my almond milk macchiato all over your Farmlands flannel shirt. Then I went and fell in love with a genetically excellent specimen of the Southern Man variety, who made the prospect of breeding quite attractive.

So, I have unexpectedly had the chance to compare different models of maternity care and have come away as a firm advocate of rural units.

The birthing room. Practically a day spa. Credit: Lumsden Maternity Centre

The birthing room. Practically a day spa. Credit: Lumsden Maternity Centre

Imagine a world where you turn up to have your baby at a cosy facility, perhaps showing its age a little bit, but warm and well-equipped with a lovely garden – it reminds you of your Nana’s. The staff there are uniformly welcoming, reassuringly bracing and have an obvious connection to each other and their community. The sunlit birthing room has an in-built pool – lined with red candles, no less – and feels intimate and private. It also has gas and pethidine and emergency equipment, don’t worry (“But the drugs!”, I hear you say, “the drugs!”). Once you have had your baby, you can recover in a double bed with an ensuite bathroom and a window that opens onto said lovely garden. The meals you receive are home-cooked right on site, with some of the ingredients sourced locally. Not only that, you get proper I-just-pushed-out-a-screaming-lump-the-size-of-a-watermelon portions, with ice-cream for after.

Sounds impossible? I swear, such a place exists. It’s where I’m planning on having my second baby. It’s where I laboured and recovered with my first. No disrespect to the excellent, attentive care we received at the regional hospital, but you just can’t beat a huge helping of homemade mac ‘n’ cheese and ice-cream with chocolate sauce. Or being able to hold hands in bed with your partner when you’ve both just been battered by the realities of the ‘business end’ of new life.

Faced with the decision between the hospital and the rural unit this time around, it really was a no-brainer (thankfully, because sleep deprivation and constant morning sickness seem to have compromised my brain function).

I know I’m extremely fortunate. I’m unlikely to have complications based on my first birth, which didn’t require medical intervention. Of course, if anything goes awry, I will be in the first ambulance to the hospital and bloody grateful for it. Until confronted with that, I just can’t get past the double bed and the mac ‘n’ cheese.

Recovery room. Double bed and real sunlight included. Credit: Lumsden Maternity Centre
RECOVERY ROOM. DOUBLE BED AND REAL SUNLIGHT INCLUDED. CREDIT: LUMSDEN MATERNITY CENTRE

But, sometimes love just ain’t enough.

As I write, rural maternity units are under threat by the usual suspects – declining populations and the correlated centralisation of medical resources. Read: they are considered financially unsustainable. While many units are adapting by employing mixed funding models and employing staff as contractors or part-timers, their long-term viability remains uncertain.

Tuatapere Maternity is a recent example (you know Tuatapere, I’m sure?…It’s in western Southland). The nature of maternity services there has been under review since Southland District Health Board’s contract expired in May this year. Community protests in 2012 against a proposed closure of the unit kept it open then, but with births there dropping from 23 in 2012 to eight in 2015, it closed its doors on October 31 this year – seemingly for good.

The limited research that is out there suggests that these financial tensions amplify the already-difficult ‘cost of distance’ for the Lead Maternity Carers at the rural maternity units (usually midwives). One respondent in a research paper went so far as to describe rural midwifery as an ‘expensive hobby’.

This comment dismayed me, though I can personally attest to the ‘cost of distance’. My midwife turned up to unlock the unit for me at about 5.30 AM. Our daughter wasn’t delivered until just before midnight and our midwife remained with us for most of that time, with just one other midwife on standby to relieve her while we were at the unit. There was a total of 2.5 hours driving in between for all of us back and forth from the regional hospital. It is a huge job and I believe, like so much care-based work, grossly underpaid.

I keep thinking about the scenario in which rural maternity units go the same way as Westpac’s rural bank branches and close for good – eradicated by urbanisation and well-intentioned rationalisations. If they do, there will be a gaping hole left in the middle ground between home birth and hours of travel to the regional hospital for parents living in rural areas.

More than the practicalities of travel, the quality of postnatal care I experienced at the rural unit was so integral to my confidence as a new parent and my postnatal mental health. The model has so much to offer beyond the balance sheet – it’s ultimately about well-being. I mean, there was actual sunlight in our room. Oh, and did I mention the ice-cream and chocolate sauce?

So, what can we do to ensure that these places stay open?

In the big picture, I believe we need to start paying care-workers, including lead maternity carers, commensurate with their societal value – there aren’t many who can maintain an ‘expensive hobby’ in place of cold, hard cash for very long.

I also think we need to actively facilitate professional jobs in the regions. A ‘thriving New Zealand’ shouldn’t just be applicable to Auckland, Wellington and Christchurch (something Xero CEO Rod Drury points out in his announcement that Xero will open an office in Hawke’s Bay early next year). It should be about a New Zealand where its citizens have genuine choice about how and where they live. And how and where they give birth.

That’s all good and well, but what about right now? Use these units. Use them as much as possible. If you have the opportunity to birth at a rural maternity unit, please seriously consider it. Every time parents choose a rural unit, they are bringing their taxpayer funded dollars with them and sending a signal that there is value here. Of course, parents have natural concerns about safety and access to specialists (we did), but I encourage you to take the time to talk through your options and understand the capabilities of your nearest unit.

I don’t know if increased numbers will be enough to stave off closures forever – no-one I have talked about the issue does. What I do know is that by using the units you are showing your support for a model that has community at its heart. I think bringing a baby into a world that values that most of all is pretty good start.

Victoria Crockford is an Arrowtown-based researcher, writer and analyst. She lives with her partner, daughter and a sheep dog that is probably smarter than her. Find her tweeting @VicLeeCrockford and online at Coronet Wordsmith.

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