Providing rural and remote rural midwifery care: an 'expensive hobby'.

Background: Providing midwifery care in rural and remote rural regions can be challenging in many ways. This includes financial arrangements for midwives in New Zealand. This paper draws from a larger study exploring the lived experience of rural and remote rural families, midwives, general practitioners (GPs) and ambulance crews. Aim: The focus of this paper is on the financial lived experiences of the rural midwife participants in this study. Method: A qualitative study using hermeneutic phenomenology was used to explore the experiences of six rural midwives. Participants were from two regions in the South Island and two regions in the North Island and interviewed following ethical approval. Interviews were interpretively analysed. Findings: Several tensions surfaced in the study. Across these tensions it was evident that the current funding for rural and remote rural midwifery is not working well. The participants revealed the challenges and financial hardships which they as rural midwives experience in maintaining a local midwifery service and how these challenges adversely affect their wellbeing and safety. The themes, 'cost of distance?, 'spirit of generosity exploited?, 'being treated unfairly' and 'working rurally can be an expensive hobby', are uncovered through stories of rural and remote rural midwives. Conclusion: The current financial system does not serve these midwifery practitioners working in rural and remote areas. Without more financial support reflecting local needs, midwifery services in some of these rural regions are not sustainable and recruitment and retention will continue to be a challenge. There are Lead Maternity Carer (LMC) midwives working in rural, and in particular, remote rural regions who are concerned about the inequality and unfairness of remuneration. This may result in increasing the vulnerability of the maternity service for these regions. Rural and remote rural midwives' need for improved financial support is urgent and requires immediate attention at national level