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Women Birth. 2015 Mar;28(1):30-9. doi: 10.1016/j.wombi.2014.10.006. Epub 2014 Nov 22.

A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009-2011.

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School of Nursing and Midwifery, The University of Queensland, Australia. Electronic address:
Institute for Social Science Research, University of Queensland, Australia. Electronic address:
Mareeba District Hospital, Australia. Electronic address:
Mater Research Institute and School of Nursing and Midwifery University of Queensland, Australia. Electronic address:



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.


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.


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.


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.


Continuity of care; Midwifery; Midwifery group practice; Rural maternity care; Transfer

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