Doctor in southern Alberta community says maternity ward in crisis

Doctors have dwindled in the southern Alberta town of Pincher Creek, and the area's sole surgeon says he's been on-call 24 hours a day for years — something he says is hitting the community's rural maternity ward hard. 

Dr. Jared Van Bussel penned an open letter last month saying he can no longer support ongoing labour and delivery in the community beyond May 31. Pincher Creek is roughly 210 kilometres south of Calgary.

Van Bussel said as the lone surgeon in the community for the last five years, he has been on surgical call around the clock, except for scheduled time off.

In the letter, Van Bussel describes missing his kids' sports games and family events. When he does get scheduled time off, maternity patients are transferred elsewhere in the province. 

He says rural maternity wards are struggling and they have been for years.

"We definitely need more help. We need more physicians. We need more people who are willing to train. We need more nurses," Van Bussel said.

There used to be 11 doctors in the community, now they're down to five, he said. Those doctors run a 24/7 emergency department, acute care, family medicine and maternity care, he added. 

"We can't plan to do maternity care here anymore … the skill sets won't be there in the same way that they were before."

Van Bussel said after May 31, doctors in the community may be able to perform emergency births, but he added expectant mothers will likely have to deliver in Lethbridge — more than an hour's drive away. Lethbridge also has experienced doctor shortages. 

"Generally, immediate access to C-section is what you need to have in order to be able to do maternity care safely," Van Bussel said. 

But Alberta Health Services says it's committed to maintaining maternity care in Pincher Creek, despite Van Bussel's open letter to the community. 

In an email to CBC News, AHS spokesperson Gwen Wirth said the health authority "recently became aware of a physician's intention to stop providing maternity coverage in the region." 

Regardless, Wirth says AHS isn't planning for a reduction of services or staff, including maternity services, at the Pincher Creek Health Centre, adding AHS can bring in temporary physicians.  

"AHS has reached out to physicians in Pincher Creek in an effort to meet and collaborate on a solution-oriented plan to maintain maternity coverage," Wirth wrote.  

"As is standard practice in Pincher Creek, physicians make arrangements for obstetrical patients to have ongoing care in Lethbridge when they are unavailable to provide such care in their home community." 

She said that efforts are being made to recruit additional obstetrics and gynecology care in Lethbridge. 

The province recently announced it is looking for ways to train doctors in smaller cities in hopes they will be more likely to help relieve a shortage of physicians in rural areas. 

Mothers 'getting lost in the system' 

Jessie Kilkenny delivered her first baby in her hometown of Pincher Creek, but due to complications, giving birth to her second two children meant a long drive to Lethbridge and a lot of uncertainty. 

She said when she had her youngest child it became clear the system was overworked. 

"The staff are overworked, understaffed, burnt out. You can tell that people are just getting lost in the system. I saw six different OBs with my last pregnancy and I didn't even know who was going to be delivering my baby until the day of," Kilkenny said.  

She says it's clear the rural health-care system in her area is under pressure, and it's essential to keep Pincher Creek as a maternity hub.  

"It is scary if you have to travel to a bigger centre. There's not room necessarily for everybody in the centres right now either," she said. 

Stacy Benson had a planned birth in Pincher Creek. But when her daughter's vitals became concerning a doctor from Crowsnest Pass needed to be brought in. 

She said she had great care and felt comfortable with the team of doctors, but she said the possible commute to Lethbridge, especially in the winter, is worrying. 

"That's a scary thought to me. If it was the middle of summer it might be different, but you add in being pregnant or you add in having a baby in the back seat of the car. For me, I personally don't … want to go extra distance when I'm literally two minutes from the hospital." 

'Crisis in maternity care' 

Ivy Bourgeault, a University of Ottawa professor and Canadian Health Workforce Network lead, who has studied maternal health care, says rural maternity care is in a precarious spot in Canada and that means reduced choices for women giving birth in those communities. 

"As we see the challenges of the healthcare system in general, those are acutely felt in rural maternity care," she said. 

She said rural areas may have a midwife or family physician in their community, but it's very rare there will be an obstetrician. 

"Right from the get go you may, or probably may, not have a choice of birth provider.… Will there be anesthesia services? Will there be C-section services in case of an emergency?" 

Bourgeault recalls attending a national conference 23 years ago to discuss the future of maternity in Canada. 

"Everybody across the country came together, midwives, family physicians, anesthetists, pediatricians, obstetricians, and they said 'We have a health workforce shortage — crisis —  in maternity care.'" 

That's an issue, she says, that has stayed the same.