title: A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009-2011.
abstract: BACKGROUND
  A widely held view in maternity services in rural Australia is they require 24-h on-site surgical and anaesthetic capability to be considered safe. This study aimed to provide a detailed description of three years of activity (2009-2011) of a rural maternity unit approximately 1h from the nearest surgical service. We describe the reasons for transfer to and from the unit, transfer times and the clinical health outcomes of all women (all risk status) and their babies.
  
  
  METHODS
  This retrospective study utilised contemporaneously, purposefully collected audit data, routinely collected data and medical chart review. Data were analysed based on the model of care that women were allocated to at the time of booking.
  
  
  RESULTS
  The PMU provided care to twice as many young women (13.3% MDH vs. 5.1% QLD) and almost five times as many Aboriginal and/or Torres Strait Islander women (27.5% MDH vs. 5.7% QLD). A total of 506 women booked to receive care through a midwifery group practice (MGP), and 377 (74.5%) gave birth at the local facility as planned. Clinical outcomes for women and babies birthing both at the PMU and those transferred were comparable or better than other published data.
  
  
  CONCLUSIONS
  The results challenge the notion that birthing services can only be offered in rural areas with onsite surgical capability. More PMUs should be made available in rural areas, in line with national and state policy and international evidence.
authors.affiliation: School of Nursing and Midwifery, The University of Queensland, Australia. Electronic address: s.kruske@uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: Institute for Social Science Research, University of Queensland, Australia. Electronic address: t.schultz1@uq.edu.au.
authors.forename: Tracy
authors.initials: T
authors.lastname: Schultz
authors.affiliation: Mareeba District Hospital, Australia. Electronic address: sandra.eales@health.qld.gov.au.
authors.forename: Sandra
authors.initials: S
authors.lastname: Eales
authors.affiliation: Mater Research Institute and School of Nursing and Midwifery University of Queensland, Australia. Electronic address: sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
mesh_terms: D000328:Adult; D001315:Australia; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility; D006303:Health Services, Indigenous; D006801:Humans; D007223:Infant; D008427:Maternal Health Services / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011247:Pregnancy; D011787:Quality of Health Care / Q000458:organization & administration; D011793:Queensland; D012189:Retrospective Studies; D019035:Rural Health Services; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Continuity of care; Midwifery; Midwifery group practice; Rural maternity care; Transfer