Comment: Government needs new attitude on midwives

Based on more than 30 years of practice as a newborn-care specialist and family physician attending births and my research and the research of others, I have great concern that women in B.C. and throughout Canada have insufficient numbers of appropriate care providers. This maternity gap is growing.

Increasingly, women and their families have to travel sometimes hundreds of kilometres to obtain quality maternity care. This puts tremendous strain on expectant mothers, their families and their communities, particularly in rural and First Nations communities, where the shortage of maternity care is experienced most acutely.

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When women have to leave their communities to receive essential maternity care, they are under increased stress and health risks. Adverse outcomes increase for both the mother and baby, even when excellent care is finally provided in distant locations, leading as well to increased costs to families and the provincial health-care system.

 While these are the most extreme examples of a maternity system under stress, even women living in large urban centres are finding it increasingly difficult to find a maternity provider to attend them for their pregnancy and delivery.

 Why do we have a growing gap in maternity care? The answer involves multiple factors.

 First, the number of family physicians practising obstetrics in our province and nationally has greatly declined in recent years.

 Further, more than 20 rural maternity services have closed in B.C. since 2000.

 The reality is fewer family physicians are incorporating maternity care into their practices, while the average age of an obstetrician is almost 58, both contributing to the looming maternity care gap.

This gap is even more troubling when you take into consideration that the number of births in our province is projected to increase to more than 50,000 by 2020.

At the same time, while recent increases in the number of posts for midwife trainees has increased, we are still not training enough midwives. Wait lists at most midwifery practices are far outstripping demand.

The point is not to produce just any another care provider, but the type of care provided by midwives and many family physicians is exactly the type of care needed by the population — care specifically addressing the needs of the majority of the low-risk population.

The approach employed by these professionals will reduce unnecessary caesarean sections and other procedures, while improving outcomes for mothers and babies at lower costs to the system.

Sadly, the gap in maternity care is not unique to British Columbia. Rural and overall maternity care is facing serious challenges across Canada. We are facing a maternity-care crisis in Canada. Unless action is taken, the maternity-care system will collapse within the next 10 years.

 I have been voicing my concerns on this issue for some time. While I am a family physician who strongly supports family-practice maternity care, I have also been an advocate for midwifery as being part of the solution.

 I had thought for a time the B.C. government was beginning to recognize the vital role midwives play in the maternity care system.

However, based on the current situation, where midwives have finally felt it necessary to withdraw clinical education services at the University of B.C., expressed by terminating their contact with the government, it is clear the government fails to understand or value the role of midwifery.

 If our government truly understood that midwives provide a high level of care, with far fewer interventions, resulting in overall savings for our health-care system, it would not have allowed events reach this point.

Public-policy decisions regarding health care, especially maternity care, need to be based, not on the vagaries of a year-to-year budget, but on the needs of women and their families, supported by sound evidence and analysis.

 I have spent most of my professional life as a family physician and pediatrician conducting research on maternity care in rural and urban settings. I am convinced that midwives, working in innovative and collaborative models of care with other maternity-care providers, are a significant part of the answer to a system under increasing stress.

Midwives can increase access to maternity care in urban and rural and underserved communities and help to improve health outcomes for mothers and newborns, which is why most of us involved in maternity went into this profession in the first place.

 I hope the provincial government will soon adopt the same view.

Dr. Michael Klein is professor emeritus of family practice and pediatrics at UBC, and the former head of the department of family practice at B.C. Children’s and Women’s Hospital.

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