But Is It Good for Non‐Urban Women's Health? Regionalizing Maternity Care Services in British Columbia*

Abstract

La Colombie‐Britannique, comme la plupart des autres provinces ou territoires canadiens, s'est orientée au cours de la dernière décennie vers une régionalisation de ses services de santé. Il en a résulté un glissement dans la planification et la prestation de services du centre vers la périphérie et un accent plus important mis sur la prise de décision locale. Cette étude explore les effets de la régionalisation sur la planification et la prestation de soins en maternitéà l'extérieur des grands centres urbains en Colombie‐Britannique. L'article fait la lumière sur la perception qu'ont les futures mères des répercussions de la régionalisation et établit des comparaisons avec les attentes des artisans de réformes à l'endroit du processus mené par le gouvernement. British Columbia, like most other Canadian provinces and territories, has in the last decade moved towards regionalization of health care services. This process has resulted in a shift in service delivery and planning from the core to the periphery, and a greater emphasis on local control and decision making. This study explores the impact of regionalization on the planning and delivery of maternity care services outside of large metropolitan areas of B.C. The paper sheds light on how birthing women perceive the impact of regionalization and compares this information to reform makers' expectations about the government‐led process.

The Reality of Resistance: The Experiences of Rural Parturient Women

“…There has been a significant decline in the number of rural communities in Canada offering local maternity care since 2000 1–3 . This has resulted from a confluence of factors, including the regionalization of health services delivery in many jurisdictions, 4,5 physician recruitment and retention challenges, 6 and diminishing access to midwives and nurses trained in obstetrics 7–9 . In Ontario, for example, 11 small hospitals ceased providing obstetric care between the years 1988 and 1995 2 .…”

“…[1][2][3] This has resulted from a confluence of factors, including the regionalization of health services delivery in many jurisdictions, 4,5 physician recruitment and retention challenges, 6 and diminishing access to midwives and nurses trained in obstetrics. [7][8][9] In Ontario, for example, 11 small hospitals ceased providing obstetric care between the years 1988 and 1995. 2 A similar trend has been documented in Nova Scotia, where 32 of 42 hospitals closed their services between the years 1970 and 2002.…”

Planning the optimal level of local maternity service for small rural communities: A systems study in British Columbia

“…In the past 10 years, many small rural maternity services have closed in British Columbia and across Canada [2,5,11], with 20 closures in British Columbia alone since 2000 [8,12]. These closures have occurred for a variety of reasons including the centralization of services within a health authority [4,13,14], concerns about the safety of a small unit in the face of bad outcomes [5], and difficulties in recruiting providers to staff small rural maternity units [4,[15][16][17][18]. These closures have taken place against a backdrop of policy recommendations that speak to the importance of supporting women to be able to give birth closer to home [19,20], and a relatively thin and inconclusive body of literature about the safety of small rural maternity services with and without cesarean section capacity [21][22][23][24][25][26][27].…”

Cultures of risk and their influence on birth in rural British Columbia

“…There has been a sudden decline in the number of rural communities across Canada offering local maternity care since 2000 [1-3] due to a confluence of factors including the regionalization of health services delivery in many jurisdictions [4], physician recruitment and retention challenges [5], limited access to midwives [6,7], and diminished access to nurses trained in obstetrics [8]. A significant number of communities that continue to offer local maternity services to parturient residents in the absence of surgical back-up are witnessing a high outflow of women leaving to give birth in larger centres in order to ensure immediate access to caesarean section capabilities.…”