Nurses and midwives are the largest group of health providers in Australia (60%), and with increasing remoteness, this proportion increases substantially.1 The recruitment and retention of nurses, and more specifically midwives in rural health services, is at crisis point. Sustainable birthing services will be reliant on a stable, regenerative workforce. Key to this goal is the education of nurses, midwives and doctors, all of whom have stringent pre-service professional placement quotas in order to meet required competencies to practice. The rural workforce crisis in maternity care has been a driving force in health care reform.2 Rural innovation has involved negotiating the space between increased medical risk and the need for a healthy pregnant woman to have the option of staying within her local community to have her baby.3,4 Rural nurses and midwives together with rural doctors agree that continuity of care, irrespective of how it is achieved, is associated with the best outcomes for women and their families in rural locations.4–6 Continuity of care can be achieved using a shared-care medical model involving obstetricians and general practitioners, or midwifery-led primary maternity care services. In the process of securing maternity services that provide continuity of care, the influence of specialist obstetricians, a limited resource in rural locations, has been moderated, and unique solutions to local problems have resulted in the formation of collaborative relationships involving rural nurses, midwives and general practitioners. This polemic makes an argument for a review of the current regulatory requirements for both the education of undergraduate rural nurses and midwives, and the continuing registration of rural midwives who work predominantly in nursing roles. In doing so, the authors provide an overview of the dilemmas facing policymakers, educators, health services managers and clinicians in the provision of sustainable maternity services in rural and remote Australia.
This chapter provides a brief snapshot of children and adolescents in varying contexts of practice in rural environments. Common childhood conditions and aspects of adolescent health will be presented in conjunction with case studies and reflective questions to facilitate practical application,