Maternity Care for Rural Women–A Thing of the Past

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From the ATLANTIC CENTRE OF EXCELLENCE FOR WOMEN'S HEALTH

Canadian women in rural communities are finding it harder and harder to get good maternity care—or any maternity care at all, according to a new study authored by Jude Kornelsen and Stefan Grzybowski, and funded by the Status of Women Canada’s Policy Research Fund.

Speaking at the ACEWH-sponsored Canadian Association of Midwifery’s annual conference in Halifax, Kornelsen says, “Decisions are being made to close rural services in the absence of a strong evidence base. Our research has shown that this has devastating consequences to rural women, their families and communities.”

The new study, entitled, Rural Women’s Experiences of Maternity Care: Implications for Policy and Practice, looks at women’s experiences in four British Columbia communities. But the findings are not restricted to that province, says Dr. Christine Saulnier, Senior Research Officer with the Atlantic Centre of Excellence for Women’s Health. “This study has particular relevance in Atlantic Canada because of our strong rural population base and many remote communities.”

As one rural Atlantic Canada woman told Dr. Saulnier, “the birthing rooms had been closed down since my second delivery. Due to a lack of finances for a second anesthesiologist, who was required to fulfill the demand for freezing prior to delivery, my options were an hour and a quarter to an hour and a half drive to the nearest hospital that would deliver my baby,” she noted. “When my contractions started, the last place I wanted to be was in a car or an ambulance, which I would have had to cover the costs of.”

Kornelsen and Grzybowski’s study increases understanding about the social and psychological effects of limiting local access to maternity services, and how these changes might affect the birth experience. Many concerns have been raised in terms of physical health outcomes alone. Evidence suggests that a lack of local access can be associated with increased perinatal mortality and increased rates of premature birth.

“In some of the communities we studied,” says Kornelsen, who is also a member of the Department of Family Practice at the University of British Columbia, “women are forced to travel to access basic birthing support for the first time in recorded history. This is especially poignant for Aboriginal communities where records of local occupation go back 10,000 years.”

Among the issues raised by the study participants was the financial cost of leaving the home community. Other problems include physical and emotional stress due to weather conditions, the care needs of children left at home, and the loneliness of being separated from family at the birth and in the days or weeks before it.

The report also makes recommendations on how to increase access to maternity services for rural women. One of the key ingredients for this move is the integration of regulated and funded midwifery services. By working with regulatory and training bodies (CPS, CMBC and SOGC), the contribution midwives can make to rural maternity care can be actualized. Kornelsen and Grzybowski advocate new models of collaborative practice that remove barriers to inter-professional clinical care (e.g., restrictions on shared care between midwives and GPs). Such interdisciplinary collaboration would work at a variety of levels, including innovative models of prenatal education, interdisciplinary professional development for local caregivers, and recognizing the contribution of the informal labour support provided by doulas.

For the full report, Rural Women’s Experiences of Maternity Care: Implications for Policy and Practice by Jude Kornelsen and Stefan Grzybowski with Michael Anhorn, Elizabeth Cooper, Lindsey Galvin, Ann Pederson and Lana Sullivan, visit:

www.swc-cfc.gc.ca/pubs/pubspr/0662407997/index_e.html
or call: 613-995-7835.