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Abstract：
BACKGROUND: Rural and remote Australian women are less able to access locally situated maternity care and birthing facilities, largely due to the gradual closures of rural and remote birthing services. Closures have occurred due to workforce issues, safety and quality issues and economic rationalisation of services to offset rising health system costs. An examination of the published literature to gain a deeper understanding of this phenomenon is warranted.
OBJECTIVE: What are the impacts of rural and remote maternity unit closures in Australia?
METHODS: A systematic integrative review of published literature on Australian maternity unit closures was undertaken using Whittemore and Knafl\'s (2005) framework. A database search was conducted with date limiters of 2010 to 2020 on papers within the search parameters \"maternity unit*\" AND closure* AND women AND (midwife OR midwives) AND Australia, also with \"birth unit\", \"labour ward\" and \"rural\" in varying combinations. This search resulted in 348 papers. After applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process and the Crowe Critical Appraisal Tool (CCAT) and discarding those non-relevant, seven papers remained.
RESULTS: A methodological analysis of seven papers occurred, three qualitative studies, three quantitative studies and one mixed methods study. Two main stakeholders were identified, the woman, and the health service. Women identified risks associated with travel, lack of access to services, costs or financial issues, safety, and emotional burdens. Women explicitly stated that access to local maternity services would negate many of their concerns. Health services indicated closures were due to safety and quality considerations and workforce issues.
CONCLUSIONS: Conflict exists in trying to meet the perceived needs of both stakeholder groups. Published evidence supports midwifery models for low-risk women. National policy also supports woman-centred care; however, local service uptake is minimal due to organisational barriers.
OBJECTIVE: What are the impacts of rural and remote maternity unit closures in Australia?
METHODS: A systematic integrative review of published literature on Australian maternity unit closures was undertaken using Whittemore and Knafl\'s (2005) framework. A database search was conducted with date limiters of 2010 to 2020 on papers within the search parameters \"maternity unit*\" AND closure* AND women AND (midwife OR midwives) AND Australia, also with \"birth unit\", \"labour ward\" and \"rural\" in varying combinations. This search resulted in 348 papers. After applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process and the Crowe Critical Appraisal Tool (CCAT) and discarding those non-relevant, seven papers remained.
RESULTS: A methodological analysis of seven papers occurred, three qualitative studies, three quantitative studies and one mixed methods study. Two main stakeholders were identified, the woman, and the health service. Women identified risks associated with travel, lack of access to services, costs or financial issues, safety, and emotional burdens. Women explicitly stated that access to local maternity services would negate many of their concerns. Health services indicated closures were due to safety and quality considerations and workforce issues.
CONCLUSIONS: Conflict exists in trying to meet the perceived needs of both stakeholder groups. Published evidence supports midwifery models for low-risk women. National policy also supports woman-centred care; however, local service uptake is minimal due to organisational barriers.
摘要：
背景：澳大利亚农村和偏远妇女无法获得当地的产妇护理和分娩设施，主要是由于农村和偏远分娩服务的逐步关闭。由于劳动力问题而发生了关闭，安全和质量问题以及服务的经济合理化，以抵消卫生系统成本的上升。有必要对已发表的文献进行检查，以更深入地了解这种现象。
目的：澳大利亚农村和偏远产科关闭的影响是什么？
方法：使用Whittemore和Knafl\（2005）框架对澳大利亚产科关闭的已发表文献进行了系统的综合审查。进行了数据库搜索，使用2010年至2020年的日期限制器，对搜索参数“产妇单位*”和关闭*以及妇女和（助产士或助产士）和澳大利亚，还有“出生单位”，“劳动病房”和“农村”以不同的组合。这次搜索产生了348篇论文。在应用系统审查和荟萃分析（PRISMA）过程和Crowe关键评估工具（CCAT）的首选报告项目并丢弃那些不相关的项目之后，还有七篇论文。
结果：对7篇论文进行了方法学分析，三项定性研究，三个定量研究和一个混合方法研究。确定了两个主要利益相关者，那个女人,和卫生服务。妇女发现了与旅行相关的风险，缺乏获得服务的机会，成本或财务问题，安全,和情感负担。妇女明确指出，获得当地产妇服务将消除她们的许多关切。卫生服务部门表示，关闭是出于安全和质量考虑以及劳动力问题。
结论：试图满足两个利益相关者群体的感知需求时存在冲突。已发表的证据支持低风险女性的助产模型。国家政策也支持以妇女为中心的护理；然而，由于组织障碍，本地服务的吸收很少。
目的：澳大利亚农村和偏远产科关闭的影响是什么？
方法：使用Whittemore和Knafl\（2005）框架对澳大利亚产科关闭的已发表文献进行了系统的综合审查。进行了数据库搜索，使用2010年至2020年的日期限制器，对搜索参数“产妇单位*”和关闭*以及妇女和（助产士或助产士）和澳大利亚，还有“出生单位”，“劳动病房”和“农村”以不同的组合。这次搜索产生了348篇论文。在应用系统审查和荟萃分析（PRISMA）过程和Crowe关键评估工具（CCAT）的首选报告项目并丢弃那些不相关的项目之后，还有七篇论文。
结果：对7篇论文进行了方法学分析，三项定性研究，三个定量研究和一个混合方法研究。确定了两个主要利益相关者，那个女人,和卫生服务。妇女发现了与旅行相关的风险，缺乏获得服务的机会，成本或财务问题，安全,和情感负担。妇女明确指出，获得当地产妇服务将消除她们的许多关切。卫生服务部门表示，关闭是出于安全和质量考虑以及劳动力问题。
结论：试图满足两个利益相关者群体的感知需求时存在冲突。已发表的证据支持低风险女性的助产模型。国家政策也支持以妇女为中心的护理；然而，由于组织障碍，本地服务的吸收很少。
