Obstetric Training for Rural General Practice
Authors: Hays Richard 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication because it discusses an important issue not only for rural general practitioner obstetricians and their patients, but for the officers of the Royal Australian Colleges of Obstetricians and Gynaecologists, and General Practitioners who negotiate with hospitals who have accredited training posts for general practitioners seeking to obtain the Diploma in Obstetrics. The problem is real and wilt persist; many rural communities do not have a resident or available specialist obstetrician, and country dwellers usually consider that safe confinement in their local hospital is to be expected. Moreover, patients realise that there is more to obstetric practice than the mechanics of confinement, and consider that the advantages of being cared for by their local practitioner and nursing staff far outweigh the advantages of travel to the regional major hospital for delivery.

Unfortunately, morbidity statistics, which would provide an important method of assessment of the quality of obstetrics care, for mother and baby, are not available. However, mortality rates for rural practice are available and they indicate that results are excellent. For example in 1988 the perinatal mortality rate in Victoria was 10.9 per 1,000 births whereas that for the 35 Bush Nursing Hospitals in the State for the 1988–1989 year was 1.8 per 1,000 (4 in 2,182 births). These figures include all mothers (35) and babies (24) transferred from country to city hospitals but exclude patients who, perhaps because of past obstetric problems or known medical disease, were delivered in a city hospital without being admitted to the local hospital (i e. home to city hospital referrals are excluded). These Bush Nursing Hospitals and State figures should be corrected for fetal birth‐weight and major malformations for proper comparison of results in low risk patients.

Transfer of mothers in premature labour and with other complicated obstetric problems means that these patients are provided with intensive care facilities at the larger hospitals when these are required.

There is no simple solution to the problem of providing procedural training for doctors in solo practices in rural areas. It seems to the editor that the Colleges will not seek a solution because they are unlikely to endorse a crash course in surgical obstetrics no matter where performed. It is up to the major obstetric institutions and their specialist staff to create positions where a general practitioner committed to solo practice in remote areas can receive training in manipulative obstetrics and techniques of epidural or caudal analgesia ‐ it is then up to the rural practitioner to be temperate when exercising his/her newfound skills!

In the current debate on the problems faced by rural doctors, lack of training in procedural disciplines such as obstetrics has emerged as a priority issue. With specialist obstetric services concentrated in metropolitan and major provincial cities, general practitioners will continue to provide rural communities with obstetric care. Postgraduate obstetric training programmes for general practitioners must provide procedural skills training for intending rural practitioners or risk being regarded as irrelevant to the needs of rural communities.