title: Primary Maternity Units in rural and remote Australia: Results of a national survey.
abstract: BACKGROUND
  Primary Maternity Units (PMUs) offer less expensive and potentially more sustainable maternity care, with comparable or better perinatal outcomes for normal pregnancy and birth than higherlevel units. However, little is known about how these maternity services operate in rural and remote Australia, in regards to location, models of care, service structure, support mechanisms or sustainability. This study aimed to confirm and describe how they operate.
  
  
  METHODS
  a descriptive, cross-sectional study was undertaken, utilising a 35-item survey to explore current provision of maternity care in rural and remote PMUs across Australia. Data were subjected to simple descriptive statistics and thematic analysis for free text answers.
  
  
  METHODS
  Only 17 PMUs were identified in rural and remote areas of Australia. All 17 completed the survey.
  
  
  RESULTS
  the PMUs were, on average, 56km or 49minutes from their referral service and provided care to an average of 59 birthing women per year. Periodic closures or downgrading of services was common. Low-risk eligibility criteria were universally used, but with some variability. Medically-led care was the most widely available model of care. In most PMUs midwives worked shift work involving both nursing and midwifery duties, with minimal uptake of recent midwifery workforce innovations. Perceived enablers of, and threats to, sustainability were reported.
  
  
  CONCLUSIONS
  a small number of PMUs operate in rural Australia, and none in remote areas. Continuing overreliance on local medical support, and under-utilisation of the midwifery workforce constrain the restoration of maternity services to rural and remote Australia.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Queensland, Level 3, Chamberlain Building, Brisbane, Queensland 4072, Australia; Institute for Urban Indigenous Health, PO Box 5638, West End, Queensland 4101, Australia. Electronic address: sue.kruske@uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Queensland, Level 3, Chamberlain Building, Brisbane, Queensland 4072, Australia; Mater Research Institute, University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia. Electronic address: sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Queensland, Level 3, Chamberlain Building, Brisbane, Queensland 4072, Australia; Mater Research Institute, University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia. Electronic address: rebecca.jenkinson@mater.uq.edu.au.
authors.forename: Bec
authors.initials: B
authors.lastname: Jenkinson
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: jpil2286@uni.sydney.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pilcher
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: sarah.robin@ucrh.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Robin
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: margaret.rolfe@ucrh.edu.au.
authors.forename: Margaret
authors.initials: M
authors.lastname: Rolfe
authors.affiliation: Centre for Rural Health Research, University of British Columbia, 3rd floor David Strangway Building, 5950 University Boulevard, Vancouver, Canada V6T 1Z3. Electronic address: jude.kornelsen@familymed.ubc.ca.
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
authors.affiliation: University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: lesley.barclay@sydney.edu.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
mesh_terms: D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000191:economics* / Q000458:organization & administration / Q000592:standards*; D008880:Midwifery / Q000379:methods* / Q000706:statistics & numerical data; D009774:Obstetrics / Q000191:economics / Q000379:methods; D011247:Pregnancy; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Maternity hospitals; Midwifery models of care; Primary Maternity Units; Rural health services