Outcomes in rural obstetrics, Atherton Hospital 1981-1990

Analysis of annual obstetric audit data collected over the decade 1981-1990 from the Atherton Hospital in far north Queensland provides evidence of safe obstetric practice provided by a group of non-specialist doctors in a rural community. During that period, there were 2883 deliveries with an overall perinatal mortality of 5.2/1000. There were 1974 public confinements (perinatal mortality 5.1/1000) and 909 private confinements (perinatal mortality 5.5/1000). By including those perinatal deaths that occurred in public patients who were transferred because of intrapartum complications, such as premature labour or neonatal problems, the corrected perinatal mortality rate for the public patients was 9.6/1000, which compares favourably with rates for Queensland and the Far North Statistical Division in 1987 of 13.5/1000 and 16.9/1000, respectively. This was achieved with low intervention, as indicated by an overall Caesarean section rate of 13.0% (public 10.6%, private 18.3%) and an antenatal referral rate of less than 2% of patients from the hospital public clinic for delivery under specialist care.