Human Resource and the Environment of Birth in Canada: On the Brink of a 'New Normal'
Sutherns, Rebecca, Women & Environments International Magazine
In Canada, the environment in which women give birth today is changing so rapidly that a woman may need to do new research with each pregnancy to find a care provider and where to obtain care. This is especially true in rural or remote locations, as well as for women who may require or desire care outside of the mainstream. Women can no longer assume their family doctor will deliver their baby in their local hospital.
While births once took place at or close to home, and involved relatively few interventions, now the majority of births are highly medicalized events, attended by obstetricians in urban, tertiary hospitals, with increasing interventions. This change in birth environments has largely been driven by human resource challenges, rather than clinical or womenfocused imperatives.
As with all environments, sustaining a positive, healthy environment for birth has far-reaching consequences. These changes to the birth environment affect that experience, both in terms of outcomes and satisfaction.
By international standards, Canada ranks among the best in the world in maternal, and child health. It has the infrastructure, and expertise, to deal with health catastrophes as well as an internationally-recognized health system. However, there are some alarming trends: Canada has slipped from 6th to 21st in terms of infant mortality, 12fh to 14th in perinatal mortality, and 2nd to 1 1th in maternal mortality. Canada also has one of the highest rates of preterm births in the OECD. (Health Canada; Changing Fertility Patterns: Trends and Implications. Health Policy Research Bulletin. May 2005) Interventions in births are rising at the same time as outcomes are falling.
What Mothers Want
Despite individual differences, there is substantial consistency at the root of what women want from childbirth: they want to have a healthy baby, to be familiar with the people helping with the birthing process, to be able to cope with the pain of childbirth, and to feel positive about their experience.
Given good care, the vast majority of women can labour, and give birth, without intervention. Patients under the care of physicians who support birth as a natural process report high satisfaction, and betterthan-average outcomes. Midwifery clients are reporting consistently higher levels of satisfaction than other mothers. These women describe satisfaction with care that is relational, informed, local and empowering, characterized by one-on-one support and few medical interventions, and is embedded within an effective referral network. (Health Canada, Changing Fertility Patterns: Trends and Implications, Health Policy Research Bulletin, May 2005.) These characteristics should guide the development of a women-centred maternity care system.
Human Resources: Who's in the Game
Due to challenges with matching supply and demand, it is difficult for Canada's obstetric system to reflect these priorities; however, the dramatic shift in the mix of care providers attending births may force us to reshape our vision of maternity care.
While there have been few contingency plans in place to address labour shortages in health care, decision makers are starting to take notice. Addressing shortages in health human resources was identified as a priority in the First Ministers' Accord of 2003. It is the number one strategic priority of the Canadian Association of Midwives, and is high on the agenda of the Society of Obstetricians and Gynecologists of Canada. The Health Council of Canada has referred to health human resources as the most pressing challenge facing our health care system.
There is an overall shortage of family doctors in Canada, particularly in rural, remote and northern communities. Family doctors are leaving obstetrics in droves, citing factors such as interference with lifestyle, remuneration concerns, burnout due to limited back up, and fear of litigation. …