The buck stops here: midwives and maternity care in rural Scotland.
OBJECTIVE
To explore and understand what it means to provide midwifery care in remote and rural Scotland.


METHODS
Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach.


METHODS
Remote and rural areas of Scotland.


METHODS
Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs.


RESULTS
Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence.


CONCLUSIONS
This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations.


CONCLUSIONS
It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be required in considering issues of transfer.
Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4LA, UK. Fiona.Harris@stir.ac.uk
Fiona M
FM
Harris
Edwin
E
van Teijlingen
Vanora
V
Hundley
Jane
J
Farmer
Helen
H
Bryers
Jan
J
Caldow
Jillian
J
Ireland
Alice
A
Kiger
Janet
J
Tucker
D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment / Q000458:organization & administration; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D012606:Scotland