Finding Out About Birth Options In Rural Canada is Harder Than You Might Think

Text Size: Normal / Medium / Large
Printer-friendly versionPrinter-friendly version



Rural mothers need better access to information about childbirth services and parenting resources, especially as those services and resources become increasingly scarce. This was the key message to emerge from a recent pilot study comparing women’s experiences of rural maternity care in Ontario and Alberta. The study found that women living in rural areas often experience difficulties accessing both health information and services—sometimes, for unexpected reasons.

Mothers in the pilot study spoke of the importance of having access to various kinds of information. Even experienced mothers expressed the need for updated information about the location and availability of childbirth services, since these are constantly shifting in the rural areas of both provinces. Specifically, women noted that consistent availability of health care providers who deliver babies, provide anesthesia, Caesarean sections and even emergency services cannot be taken for granted in rural areas. Beyond basic medical services, women are also seeking opportunities to have their parenting questions answered and to obtain reassurances from health care practitioners as they adjust to motherhood.

Physicians were identified as the primary source for such information, often acting as the first point of contact for women trying to link up with other resources in their community. Women without a physician, therefore, lack access not only to primary health care, but to vital parenting information as well. Although family members, friends and public health staff members are also important sources of support, in the absence of rural physicians, there is currently no clear mechanism for systematic information sharing with mothers.

Even when the information about resources and services was available to rural women, they identified a number of barriers that make it difficult to make use of those resources. One barrier is the physical setting itself, where driving distances and winter weather often discourage new mothers from getting to the services that are available. Social barriers were also seen as important, especially in small communities where “everybody knows everybody.” In such cases, lack of anonymity and the importance of social reputations heavily influence whether women feel comfortable attending playgroups or other community services. This is particularly true for teen mothers, who described being so isolated and stigmatized that they could not comfortably access local services.

The study further notes three important considerations, which pose particular challenges to those interested in improving rural women’s access to appropriate health care. Firstly, the study calls into question the idea that those lacking financial and social resources are especially disadvantaged in terms of accessing services. While it is true that women lacking resources such as money, transportation, education and social contacts are at particular risk of being marginalized, the experiences of the women in the study suggest that even those with considerable privilege are struggling to fit the various pieces of the health services puzzle together. The availability of services in general is declining. Changes are rapid, largely uncoordinated and are poorly communicated to those most affected. All women in rural areas are therefore vulnerable.

Secondly, the study reveals the extent to which this poverty of information creates a double burden for rural women. In most rural places, it is rare for basic maternity health services to be consistently available in one place at one time. Surgical services, for example, may only be available at certain hospitals at certain times, and those may not correspond with the availability of anesthetics or lactation consulting or midwifery care. This uncertainty creates great anxiety for rural mothers as they anticipate the conditions under which they might give birth. Their anxiety is compounded by a lack of clear access to information and/or the ability to act on that information. This additional burden means that rural mothers are forced either to take the initiative to research what is available to them, or to do without.

Finally, the pilot project noted, paradoxically, that the availability of traditional medical services may lead to less informed health decision-making by rural women. Where family doctors were readily available, women frequently did not look beyond the maternity care options those doctors presented. This was true whether the doctors were themselves attending births, or were referring their patients to other practitioners. In contrast, in communities where local physician services were not available, women were compelled to look elsewhere for health information and services. In having to research alternatives, women often considered a wider range of options than they otherwise would have. In Ontario, for example, women who were not originally considering a midwife-attended birth found themselves investigating that possibility because they had to make deliberate choices about their care, and often there were few options from which to choose.

The pilot project findings generally emphasize the need not only to address the social and structural barriers to maternity health care information and options, but also to do so in ways that are strategically tailored to the realities of living in rural Canada.

For further information on the comparative rural maternity care study, contact Rebecca Sutherns (Ontario data) at sutherns@sprint.ca or Ivy Lynn Bourgeault (Alberta data) bourgea@mcmaster.ca Both can be reached c/o the Health Studies Programme at McMaster University, (905) 525-9140 ext. 27961.