Erin Dummermuth wishes her children's births had been different.
The mother of three said she experienced a range of issues giving birth at the Esperance Hospital, 700 kilometres east of Perth on Western Australia's south coast.
But she is still coming to terms with delivering her third child by elective caesarean, despite wanting to give birth vaginally.
"I'm grieving over the birth that I didn't get," she said.
Ms Dummermuth said she was told the Esperance Hospital did not accommodate vaginal births after caesareans (VBACs).
Her friend and fellow Esperance mum, Taylor Desmond, recently experienced a stillbirth and delivered by caesarean.
Ms Desmond said that would impact where she can give birth in the future.
"If I'm wanting a VBAC, I'm having to travel to Perth to have one," she said.
"I've got three kids who are in school. How am I going to stop them from going to school just to go to Perth, weeks before your due date?"
VBACs 'safe in right context'
John Hall, a past president of the Rural Doctors Association of Australia, said there was a range of opinions around the safety of VBACs.
"For instance, there are some jurisdictions where VBACs are done in the community as home births by community midwives," Dr Hall said.
"Ranging through to places where they would refuse to do them even in a hospital where they have access to an emergency caesarean section."
He said his organisation believed VBACs were appropriate in many rural settings.
"In the right context they can be very, very safe and the research certainly confirms that," Dr Hall said.
He said when assessing whether a public hospital could perform VBACs, the state health department would likely look at whether it had access to an emergency caesarean service.
Dr Hall said it would also depend on the attitudes and skill set of staff.
"On a lot of rural sites they do take into account the comfort and willingness of clinicians," he said.
"Because they are at the end of the day taking responsibility for the outcomes."
'We will not compromise on patient safety'
WA Country Health Service (WACHS) Goldfields spokesperson Donna Hindmarsh said the health service would meet with staff to discuss the current situation.
"Though we want to provide consumers with as many options as possible, we will not compromise on patient safety," she said.
"While consumer feedback is extremely important to us, any change in scope of care must be balanced against clinical risk and service sustainability."
She said the Esperance Health Campus has supported more than 120 families to give birth in the past year.
'You don't know anyone'
Ms Desmond said the Esperance Hospital should bring in a continuity-of-care model.
The continuity-of-care model involves a woman seeing the same midwife or medical personnel throughout pregnancy and birth to develop a meaningful relationship.
Ms Desmond said when she experienced a stillbirth, she needed a familiar face in the room.
"It's more just going into hospital with that news and you don't know anyone," she said.
"That is why I would love the continuity of care."
Ms Dummermuth said she struggled after the birth of her first baby.
She said she was sent straight home and, aside from a health nurse who checked on the baby after one week, she did not see another medical professional until six weeks later.
"I was just an anxiety-ridden mum," she said.
"I didn't know anything, I didn't know how to breastfeed."
She said when her next child had complications, her concerns initially went unheeded.
She said her child was eventually diagnosed with a rare neurological disorder.
"It was very traumatic, and I wasn't listened to," she said.
When she fell pregnant for the third time, she said she was exhausted by the system.
"I was so mad," she said.
"I didn't want to go through this whole system again because I knew the lack of care."
'Put the woman at the centre of the care'
Australian College of Midwives vice president Zoe Bradfield said midwifery continuity of care was associated with improved outcomes for both mother and child.
Dr Bradfield said it was also 20 per cent cheaper than standard public fragmented care.
"It's evidence-based, it's cheaper … why would we not implement this model of care?" she said.
But Dr Bradfield said the world was facing a global midwife shortage, which was being felt acutely in regional areas, and called for extra investment in resourcing and workforce retention.
She also said evidence showed, for most women, VBACs were not only an option but "an ideal way for them to give birth", if that was what they wanted.
"When we all listen to the woman, put the woman at the centre of the care, that's when we can begin to improve outcomes," Dr Bradfield said.
Move away from regional maternity services
Peter Maguire, senior medical officer at Narrogin Hospital, said there was an underlying tension in regional maternity care between having extremely safe birthing services and the wishes of the mother.
Dr Maguire said over the past few decades the push for safety and lowering risk had generally won, with maternity services contracting away from smaller towns and into larger centres.
But that often meant less choice for country mums.
"That's the trade-off we've made," he said.
"I suppose it's a debate the community needs to have around what sort of maternity care we want in the future."
Dr Hall said about 120 state-based birthing services had closed nationally over the past 20 years, but there had been a resurgence more recently with a number reopening.
"We staunchly support continuing to provide birthing services in rural and regional Australia," he said.
"It's very, very safe."
