Less than a month after Kapuskasing’s Sensenbrenner Hospital announced that its obstetrics program is at immediate risk of closing, a new report from the Northern Policy Institute is calling for action on the shortage of labour and birthing care in the rural north.
Only nine rural hospital sites are currently providing labour and delivery services to the 50,000 rural northern Ontarians of childbearing age, according to the report, titled Delivering Solutions: An Action Plan for Sustaining Rural Birthing in Northern Ontario.
That’s down from 20 hospital sites around 20 years ago.
And the number could be further reduced to eight if Sensenbrenner’s program closes.
Every year, approximately 1,200 northern Ontarians travel an average of more than 1.5 hours for basic labour and delivery services, the report says.
‘Distance is danger’
During the 2021-2022 fiscal year, more than 200 people had to travel more than four hours.
“Distance is danger,” said Dr. Eliseo Orrantia, the report’s author.
“When pregnant people have to travel to access services, that’s when they encounter risk.”
Studies have shown that longer travel times to access care are linked to increased risks of stillbirths and preterm births, according to the report.
Even infants whose parents travel between one and two hours to give birth often require significantly longer stays in the neonatal ICU (NICU) compared to those living closer to labour and delivery services, it said.
What’s more, parents residing in rural areas experience a twofold increase in the risk of life-threatening conditions such as eclampsia, amniotic embolism and uterine dehiscence or rupture compared to their urban counterparts.
Forcing parents to travel long distances for labour and birthing care flies in the face of the province’s stated objectives of providing faster access to care and providing “the right care in the right place,” the report argues.
It also represents a failure to meet the Truth and Reconciliation Commission’s calls to action #18 and #19, which call for addressing health care inequities between Indigenous and non-Indigenous people.
In order to address the closures of northern obstetrics programs, Orrantia sought first to understand why they happened, he said, and that led to a series of recommendations for how to prevent any more of them.
And expanded role for midwives?
The first is to improve education and training in obstetrics for rural family physicians.
“We need to get professionals ready for the practice of obstetrics. And in Australia, they’ve done that by changing the curriculum,” Orrantia said.
“So they’ve really emphasised obstetrical rotations, and they get folks out learning in rural communities.”
The government also needs to provide funding for continuing medical education for rural physicians to learn and upgrade their obstetrics skills, he said.
The second recommendation is to specifically recruit healthcare professionals who are skilled in labour and delivery care.
Orrantia acknowledged that rural northern communities have struggled to attract any healthcare professionals, let alone those with special skills such as obstetrics, but he said a change in provincial funding for midwives has the potential to provide some relief.
“Where before, midwives could never work in a small community because they need to essentially deliver 40 people in a year to be getting a full salary, now they’ve come out with a new funding model,” he said.
“It’s not based on numbers of deliveries, and it encourages midwives to work in a broader scope of practice.”
Need for expanded supports
After trying and failing to recruit a third physician to do obstetrics in Marathon, where Orrantia works as a rural generalist physician, his team hired a midwife, who supports labour and delivery and does baby care and immunizations, he explained.
The report’s third recommendation is to improve support for obstetric care.
By way of example, Orrantia pointed to systems in place for emergency room physicians that allow them to quickly contact more experienced doctors or specialists when dealing with cases they aren’t sure how to manage.
“In [obstetrics], if I have a critical case … I have to do what I did 30 years ago,” he said.
“Get on the phone call … wait for them to connect to my regional centre and try to find the obstetrician. And if they’re in surgery, I’m stuck.”
Orrantia’s report concludes by calling on the province to appoint an organization to produce a strategic plan to address the issue.
He estimates that the work will cost approximately $350,000 and calls on the province to provide the funds.
Asked if it would, a spokesperson for the Minister of Health did not directly answer the question but instead said that the province has added 100,000 new nurses and 15,000 new doctors to the healthcare workforce since 2018 and has launched the largest medical school expansion in 15 years. That includes 44 new undergraduate seats and 63 new residency positions at Northern Ontario School of Medicine University, where Orrantia is a professor.
The government is also spending more than $15 million to connect more people to high-quality midwife care closer to home, Hannah Jensen said.
The chief of staff at Kapuskasing’s Sensenbrenner Hospital said she welcomed Orrantia’s report and was enthusiastic about its recommendations for improved residency training and funding for continuing education.
It also makes sense to have a central organization coordinate the response to the shortage of obstetric care, Dr. Jessica Kwapis said.
“If we can all work together on something, as opposed to individual sites trying to come up with their own individual solutions, I think we’ll have a better chance of solving the issue,” she said.
For now, Kwapis said Kapuskasing’s obstetric’s program remains open while the province considers a funding proposal aimed at sustaining it long-term.
