UBC Reports | Vol. 50 | No. 10 | Nov. 4, 2004

All Alone: Too Many Mothers Give Birth Miles from Home

By Hilary Thomson

For thousands of B.C. women, having a baby has meant leaving home and family, travelling hundreds of kilometres, and sitting in a motel room for days or weeks waiting for labour to start.

This bleak scenario is one that UBC Faculty of Medicine investigators Stefan Grzybowski and Jude Kornelsen will explore through a series of studies that looks at rural maternal care services, funded by a $1.4-million, five-year grant from the Canadian Institutes of Health Research (CIHR).

It is the most comprehensive program of research being undertaken on rural maternity care in Canada.

When women are forced to deliver away from home it can lead to serious health and social costs for mothers and their families as well as strain on the health-care system, says Grzybowski, director of research in the Dept. of Family Practice.

“The needs of rural women are not being met -- it’s just not good enough,” he says.

The program of research will bring together a team of maternal care researchers that includes sociologists and economists as well as physicians and community-based investigators. It will focus on seven key areas including health outcomes of mothers and babies from rural areas and how hospitals receiving these patients manage the additional strain on resources. The team will also compare costs of maternal care within and outside home communities.

Studies in the U.S. have shown that delivery outside the home community is connected to an increase in infant deaths and the need for babies to be placed in special care nurseries.

“Decisions are being made at a policy level without all the necessary information,” says Kornelsen, clinical assistant professor in the Dept. of Family Practice. “Surprisingly, there has been no representation of women’s voices in the literature on this subject.”

The team will draw information from existing data sources as well as interviews with community members. Researchers have visited communities from Merritt in B.C.’s Interior to Telegraph Creek in the province’s far north, working with public health nurses and other care providers.

About 2,000 of B.C.’s annual total of 40,000 babies are born to mothers who live in small rural communities. For a variety of reasons, ranging from centralization of services to difficulties recruiting and retaining maternity care providers, rural services have been gradually eroding in these communities. Since 2000, 13 B.C. communities have stopped offering local maternity care.

For example, women from the northern community of Dease Lake must travel for nine hours (longer in winter) to get to Terrace to have their baby. Because projected due dates are not always accurate, women are advised to leave home weeks in advance of the birth to ensure they will have care when they need it.

Kornelsen says the stress is significant. There is anxiety about being alone in a strange place for an indeterminate period and being treated by an unfamiliar doctor. In addition, there is the financial burden of accommodation, food and long-distance phone bills. There may also be concerns about finding and paying for childcare for children left at home. Some mothers bring their children with them because there is no care for them at home.

Fewer than half the mothers are able to stay with friends or family in the communities they are referred to, estimates Kornelsen.

Although most aboriginal women have costs subsidized by their band, they are often hit hardest by the social disruption, she says.

“These women may be first-time mothers who have never been away from home and rely on strong family and community support. It can be a frightening situation for them.”

For some, moving away to have a baby is just not feasible. They remain in the community until delivery and hope a general practitioner can handle any complications. Some women take the risk of an unassisted home birth.

Part of the problem is the increasing difficulty in finding general practitioners willing to provide maternity services in small communities, says Grzybowski, who is also an investigator at the Children’s & Women’s Health Centre of B.C. There is also a general shortage of obstetricians and gynecologists in Canada and a particular shortage in rural communities that serve as referral centres. The whole system is breaking down, he says.

The problem calls for sustainable solutions, he says, and points to Norway’s system of rural maternity units staffed by midwives as a possibility. He and Kornelsen hope their research will trigger increased awareness of the problems faced by rural women who are soon to give birth.

Children’s & Women’s Health Centre of British Columbia is an agency of the Provincial Health Services Authority, and includes BC Children’s Hospital and Sunny Hill Health Centre for Children, and BC Women’s Hospital & Health Centre.