Maternity care for people in rural northern Ontario drying up, new study finds

Fewer and fewer doctors are providing obstetrical care in rural communities, according to a recent study published in the Canadian Journal of Rural Medicine.

The issue has helped create what is referred to as a maternity desert. And large parts of rural northern Ontario have become vulnerable to the troubling trend. 

As a result, pregnant people are travelling farther and farther for emergency maternity care like caesarian sections. 

Dr. Peter Hutten-Czapski, who authored the study and is a professor at NOSM University, said the trend poses dangerous risks to the health of pregnant people and their babies. 

The places that are close to the larger centres are closed first because it's easiest.— Dr. Peter Hutten-Czapski, author of the study on maternity care deserts

"There's been a study in the States that shows that's associated with increased prematurity rates, which we know is problematic for how well babies do and that's what we don't want to have happen here," he said. 

"What happens is that typically the places that are close to the larger centres that are closed first because it's easiest." 

Hutten-Czapski's study included 35 rural and five urban hospitals and found that the number facilities not offering obstetrical care has risen sharply from 35 per cent in 1999 to 60 per cent in 2020. All the service closures have been at rural sites. 

Access to caesarian sections

What's more is that within a 21-year-long period, the study found that the average travel to maternity care services has doubled from between 19 and 41 minutes, to over an hour to access things like caesarian sections. 

To put it into perspective, Hutten-Czapski said that about one in four pregnant people require a caesarian section. 

Hutten-Czapski said the increase also means higher levels of stress for pregnant people and a greater risk for deliveries while en route. 

Buffy Fulton-Breathat is a practicing midwife with the Sudbury Community Midwives. The facility delivers between 375 and 400 babies each year. She said while the study's findings are troubling, the issue in northern Ontario stretches back decades. 

"Even in urban settings, we've absolutely seen a decrease in other low-risk care providers. I believe we only have one family physician, one GP left in Sudbury who is providing obstetrical services as part of her work," she said, "Whereas if you looked even 10 years ago, that would have been closer to four or five GPs."  

"There's huge impact to this. There's value in these services being offered in our communities, continuity of care is possible when midwives or family doctors take care of mom and baby," Fulton-Breathat said. 

Hutten-Czapski said the role of midwives has become crucial in rural communities but they cannot reverse the maternity care deserts in northern Ontario. 

We can't negate the risk of people having to leave their communities to access those services because babies choose to come when they want to come.— Buffy Fulton-Breathat, midwife with Sudbury Community Midwives

He points out that the predominant midwifery practice model in the region remains anchored to the presence of hospitals, which provide obstetrical services — effectively limiting their impact on rural regions.

The study found that currently about 50 midwives provide services to northern Ontario within 16 practices. Overall, the average time midwives travel to provide home birth care is roughly 50 minutes. 

And in the cases of two midwifery practices, both located in Thunder Bay, they did not offer delivery services but instead provide prenatal and post-natal care.

An inherent risk 

"There's a limit to what supplies you can bring to the home ... there's only so much in your bag and after a certain point and things are going south, you need to go south," Hutten-Czapski said.

He attributes the lack of services to what is likely a combination of factors including family doctors ceasing to provide obstetrical services, staffing shortages and funding challenges on the part of the facilities. 

"There is inherent risk in not having skilled providers in a community able to offer those services," Fulton-Breathat said.

"We live in a liability culture, in a fear culture. The malpractice insurance for care providers is certainly massive for midwives, family physicians and obstetricians. So there are economic decisions that are inherent to whether or not you continue to practice and offer obstetrical services," Fulton-Breathat said.

"But I really think that we can't negate the risk of people having to leave their communities to access those services because babies choose to come when they want to come."

Fulton-Breathat added that if family physicians and obstetricians continue to cease providing maternity care, workload for midwives will only increase as time passes. 

Hutten-Czapski suggested stronger, more supportive government policy and programming to reform and correct the pervasiveness of maternity care deserts.