title: The development of a caseload midwifery service in rural Australia.
abstract: OBJECTIVE
  The past two decades have seen progressive decline in the number of rural birthing services across Australia.
  
  
  BACKGROUND
  Despite health system pressures on small birthing units to close there have been examples of resistance and survival.
  
  
  OBJECTIVE
  This descriptive study explored the evolution of a rural birthing service in a small town to offer insight into the process of transition which may be helpful to other small healthcare services in rural Australia.
  
  
  METHODS
  Quantitative data derived from birth registers on number and types of birth from 1993-2011 were analysed. Interviews were conducted between January and August 2012 with nine participants (GP obstetricians, midwives, a health service manager and a consumer representative).
  
  
  RESULTS
  This rural maternity service developed gradually from a GP obstetrician-led service to a collaborative care team approach with midwifery leadership. This development was in response to a changing rural medical workforce, midwifery capacity and the needs and wants of women in the local community. Four major themes were developed from interview data: (1) development of the service (2) drivers of change (3) outcomes and (4) collaborative care and inter-professional practice.
  
  
  CONCLUSIONS
  The success of this transition was reported to rest on strategic planning and implementation and respectful inter-professional practice and alignment of birth philosophy across the team. This team created a unified, progressive community-focused birthing service.
  
  
  CONCLUSIONS
  The development of collaborative care models that embrace and build on established inter-professional relationships can maximise existing rural workforce potential and create a sustainable rural service into the future.
authors.affiliation: Faculty of Medicine, University of Sydney, City Rd Darlington, NSW 2006, Australia.
authors.forename: Tara
authors.initials: T
authors.lastname: Tran
authors.affiliation: School of Public Health, University Centre for Rural Health - North Coast, University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia. Electronic address: Jo.longman@ucrh.edu.au.
authors.forename: Jo
authors.initials: J
authors.lastname: Longman
authors.affiliation: Centre for Rural Health Research, University of British Columbia, 530-1501 West Broadway, Vancouver, BC V6J 4Z6, Canada.
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
authors.affiliation: School of Public Health, University Centre for Rural Health - North Coast, University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D008880:Midwifery / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011247:Pregnancy; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012424:Rural Population
keywords: Birthing centres; Caseload; Home childbirth; Midwifery; Rural health services