Where are the Midwives?

Over the past two decades there has been a slow erosion of maternity services in rural and remote areas in Canada. Many rural residents have been vocal about their opposition to the closures. However, the voices of health care professionals have been missing from the dialogue. In the recently published commentary “The Closure of Rural and Remote Maternity Services: Where are the Midwives?” Dr. Leslie Barclay and Dr. Jude Kornelsen argue that it is the responsibility of professional bodies to advocate for sustaining maternity services in rural and remote areas. The authors defend their belief that it is necessary for midwives to speak out and advocate as a means to effect system changes for both political and strategic reasons. Researchers must continue to develop evidence that can be used as a basis for strong advocacy on behalf of women living in rural and remote areas. System-level changes cannot be done by individuals alone; they require collective effort from professional bodies in all pertinent fields. Those who read this article will gain insight into the current situation facing rural and remote women, and how we all have a role to play in maintaining maternity services.

Reconceptualizing Risk

Maternity services in rural and remote regions of Canada, France, the United States, and comparable jurisdictions are facing closures. Australia has seen a closure of nearly half of their maternity units over the past two decades. Dr. Lesley Barclay (University of Sydney) has carried out fieldwork on how growing rates of maternity unit closures has impacted rural and remote residents in Australia. This research was part of the Australian Rural Birthing Index Project (ARBI), which was developed to assist in planning appropriate levels of maternity services for various rural communities. Dr. Barclay was supported by a team of researchers from Canada and Australia, including CRHR’s very own Dr. Jude Kornelsen.

A full description of the main findings has been made in a 2016 article titled “Reconceptualising risk: perceptions of risk in rural and remote maternity service planning.” The paper reports participants’ perceptions of risk in relation to the closure of rural maternity services, obtained through semi-structured individual and group interviews, focus groups, and group discussions. The analysis covers various clinical, legal, political, financial, cultural, emotional, and operational risks associated with the closure of rural maternity services. Understanding these risks, whether they are perceived or observed, is vital to the planning and improvement of rural and remote health services.

Time for an Alliance between Rural Perinatal Service Providers

Rural maternity and surgical care is facing a crisis. There is a growing recognition of the need and desire to keep rural women closer to home for their maternity care. However, responding to this desire is impeded in British Columbia – and throughout rural and remote areas of Canada – due to increased attrition of rural maternity and surgical services over the past few decades. In their newly released commentary “Rural Perinatal Surgical Services: Time for an Alliance Between Providers,” Dr. Jude Kornelsen, Dr. Stuart Iglesias, and Dr. Robert Woollard discuss how the sustainability of rural maternity care can be preserved through the Family Physicians with Enhanced Surgical Skills (FPESS) program and the creation of a “network of care.” The authors argue that a network model should be adopted in order to build genuine relationships that will lead to the collaborative commitment of servicing rural areas in need of maternity care.

Closing Rural Maternity Services: Is it worth the risk?

Maternity and newborn outcomes and stress levels are significantly worse for women and infants living in rural and remote communities when compared with individuals living in urban environments. While many sociopolitical and economic factors influence these adverse outcomes, they are in part the result of the shortage of local services available in rural areas. At the same time, closures of local maternity services in rural and remote communities throughout Canada have increased in the last five years. In a newly released commentary, “Closing Rural Maternity Services: Is it worth the risk?,” Dr. Stefan Grzybowski, Dr. Jude Kornelsen, and Dr. Lesley Barclay discuss the impacts maternity service cessation has on mothers and newborns, and the implications this has for policy makers. The authors use a rural lens to suggest various alternatives to health service closures in rural and remote communities, in order to promote equitable and sustainable services for these consistently underserved communities.

New Publications, New Research, and More…

A lot has happened at CRHR in the past six months.

We have had eight journal publications come out this year so far, with two more in press. We are working on publishing more of our research findings. At the same time, APRU is wrapping up its fourth systematic literature review on rural patient transport and transfer.

We continue our active research profile, and are developing new research projects on topics including:

  • telehealth and video conferencing for rural maternity care
  • patient decision aids regarding place of birth in communities without access to cesarean section
  • the sustainability of rural hospitals
  • rural surgical networks

Finally, we are very excited to welcome new members to the CRHR office and our research team. Check out their profiles here.

Stay tuned for more details about our projects and publications!

CRHR In the Media: Surgical Networks for Improving Rural Health Care

Vancouver Coastal Health Research Institute recently published an article in their newsletter regarding the importance and value of formal, inter-professional networks to support rural surgical services.

VCHRI’s article follows the landmark publication of the Joint position paper on rural surgery and operative delivery,  endorsed and collaboratively developed by the Canadian Association of General Surgeons, the Society of Obstetricians and Gynaecologists of Canada, the College of Family Physicians of Canada, and the Society of Rural Physicians of Canada. Co-author of the new paper, Dr. Jude Kornelsen, offered her commentary to VCHRI.

“That our organizations have all come together to admit this is a problem and come up with a theoretical solution that we’re all on board with is phenomenal. This has been many decades coming.”

Dr. Jude Kornelsen is presenting on this topic in  Banff, Alberta later this month.

APRU Releases New Report: The Safety of Rural Maternity Services Without Local Access to C-Section

APRU3 Front CoverThe Applied Policy Research Unit (APRU) has released its latest report entitled, “The Safety of Rural Maternity Services Without Local Access to C-Section.” This major realist review is the third in a series of reviews on maternity services for rural and remote women here in BC and around the world.

This work offers a uniquely comprehensive examination of evidence on what has been a policy and planning problem for several decades all over the world. For the first time, institutional data, population health evidence, case studies, qualitative studies and thoughtful analysis have been considered across fields of research that historically have been siloed: persistent rural health disadvantages; the psycho-social risk to women of not having local services; the clinical dangers of greater distance to services found in every jurisdiction around the world; the high-quality outcomes of existing or historical primary services led by both physicians and midwives; the challenges and importance of service sustainability; and even the relationship of volume to outcomes for maternity.

“For rural women and their families, the pressing question is not whether a given birthing unit, model or tier of service is safer, but whether that potential improvement in safety out-weighs the increased risk of traveling to care.”

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