Midwives' competence: is it affected by working in a rural location?

Abstract

Introduction – Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method – This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results – The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p=0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p