title: Babies born before arrival to hospital and maternity unit closures in Queensland and Australia.
abstract: BACKGROUND
  Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA).
  
  
  OBJECTIVE
  To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives.
  
  
  METHODS
  A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time.
  
  
  RESULTS
  During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, p<0.001 and Queensland, r=0.917, n=20 years, p<0.001 and this was negatively correlated with the number of maternity units in Australia, r=-0.804, n=19 years, p<0.001 and Queensland, r=-0.906, n=19 years, p<0.001.
  
  
  CONCLUSIONS
  The closure of maternity units over a 20-year period across Australia and Queensland is significantly associated with increased BBA rates. The distribution is not limited to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes associated with BBA, it is time to revisit the closure of units.
authors.affiliation: Midwifery Research Unit, Mater Research Institute, The University of Queensland, Mater Health Services, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia; School of Nursing and Midwifery, The University of Queensland, Qld 4101, Australia. Electronic address: sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
authors.affiliation: Midwifery Research Unit, Mater Research Institute, Australian Catholic University, 1100 Nudgee Road, Banyo, Qld 4014, Australia.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: McGhie
authors.affiliation: Midwifery Research Unit, Mater Research Institute, The University of Queensland, Mater Health Services, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia; School of Nursing and Midwifery, The University of Queensland, Qld 4101, Australia.
authors.forename: Yu
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Robinson Institute, The University of Adelaide, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Rumbold
authors.affiliation: University Centre for Rural Health, The University of Sydney, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Rolfe
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000639:trends*; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007223:Infant; D008427:Maternal Health Services / Q000600:supply & distribution*; D008507:Medically Underserved Area; D009775:Obstetrics and Gynecology Department, Hospital / Q000600:supply & distribution*; D011247:Pregnancy; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Birth before arrival; Born before arrival; Maternity services; Maternity unit closures; Rural