A Time of Travelling Hopefully: a Mixed Methods Study of Decision Making by Women and Midwives about Maternity Transfers in Rural Aotearoa, New Zealand

Making decisions about the reasons for, and the timing of transfer to specialist care from rural maternity care were examined in this study. This is a time when women and midwives 'travel hopefully' through labour and birth aware of their rural context. A Mixed Methods Research (MMR) approach was used to gather data from a national survey of rural maternity units together with individual and small group interviews of women and of midwives. A modified Concurrent Mixed Model Design was used to structure the research process with each data strand collated and discussed consistent with its paradigmatic roots. The findings were then drawn together in a metainference. A 17% rate of transfer during labour and up to 6 hours postpartum was found for the two year period examined. Slow progress in labour was the most common reason for transfer. Interviews with rural women and midwives revealed a similar range of decision making styles. The strategy of 'thinking ahead' emerged as a common theme which allowed for the distance and time involved in the transfer and in anticipation of critique from the secondary care system and local community.This thesis makes a significant contribution to the national and international understanding of the experience of maternity transfer in rural areas and finds that within a regionalised perinatal system, midwives make cautious and timely decisions about transfer in labour and birth. Further, that a rural birthing service contributes to the health and well being of the community and ought to be appropriately resourced to provide the optimal environment for safe decisions about transfer