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Mothers Who Need Emergency Obstetrical Care are Increasingly at Risk

Toronto – December 4, 2008 – The changing face of obstetrical medicine in Canada may put women and their babies who need emergency obstetrical care at risk. As the current generation of Ob/Gyns retires, residents and new graduates have signaled that they are not willing to sacrifice family life and put in long and demanding hours that currently characterize the practice of obstetrics.

This is a key finding of a survey conducted by the Society of Obstetricians and Gynaecologists of Canada (SOGC). The study, funded by Health Canada, surveyed Ob/Gyns, Ob/Gyn Residents, and Heads of Ob/Gyn Departments in Canada’s 17 medical schools.

Health and Safety Concerns

“The delivery of obstetrical services is at a breaking point in Canada. Many people don’t realize that most of the time only an Ob/Gyn can manage the emergencies and surgical births that are happening more and more often,” said Dr. Scott Farrell, President of the SOGC who is also a professor at Dalhousie University and the Head of the Urogynaecology and Pelvic Surgery Division of the Department of Obstetrics and Gynaecology. “Emergency deliveries are not predictable, and they are more common now because women are waiting longer to have children, are often significantly overweight, and have other challenging health concerns.”

Fewer Ob/Gyns, Greater Workload

SOGC found that there are currently only 1370 obstetricians providing prenatal, antenatal (birthing and delivery) and postnatal care, and that this number is forecasted to go down by as much as one-third over the next five years. “These Ob/Gyns are coping with overwhelming caseloads – 200-300 births per year and more -- and putting in hundreds of on-call hours each month. They are very worried about the health and safety of the Moms and babies in their care. After a day in the office, and then 24 hours on call, even the most dedicated physician is going to be tired,” said Dr. Farrell.

Compounding this HR crisis are findings from the Ob/Gyn Residents’ survey that shows incoming obstetricians are not intending to practice in the same way. Respondents said they are seeking more work-life balance and are planning to:

• work fewer hours per week than their predecessors;
• severely limit their on-call duty to a fraction of the hours assumed by Ob/Gyns practicing today;
• job share with other physicians, making “one-in, one-out” retirement replacement scenarios unrealistic; and
• take two to three maternity and/or paternity leaves in order to fulfill parenting responsibilities.

Educational Capacity

The SOGC study also looked at physician education. “Simply graduating more students will not, by itself, address the problem,” said Dr. Guylaine Lefebvre, SOGC’s Past-President. “Provincial and federal governments are going to have to work together to increase the capacity of the medical education system to address this emerging HR crisis,” said Dr. Lefebvre. The survey identified a lack of teaching rooms, simulators, administrative support and e-learning capacity, along with a shortage of faculty, as factors that needed to be addressed in order to increase the number of Ob/Gyns joining the profession.

Meeting Mothers’ Expectations

The SOGC study also surveyed Canadian women who have recently had a baby, or who are planning to have one. Canadian women have clear priorities: they want continuity of care throughout their pregnancy by the maternity caregiver of choice; they want an integral role in prenatal and birthing decision-making; and they want to give birth as close to home as possible.

“This research proves there is a major disconnect between what women expect and what is actually possible,” said Dr. Andre Lalonde, Executive Vice President of the SOGC. “Canadians assume that their local hospital can take care of them when they have a baby. Increasingly, that is just not possible; women in smaller cities, towns and in the rural areas with no choice but to travel away from their homes to ensure a safe and healthy delivery.”

Collaborative Care and Emergency Obstetrics

While the SOGC is firmly committed to a vision of obstetrical care that draws on the skills of other health professionals, especially midwives, Dr. Farrell notes that collaborative care models, on their own, cannot address the looming crisis in maternity care. He notes that while nurses, midwives and other maternity care providers are invaluable in caring for women during a normal pregnancy and birth, they cannot replace the skill set of an Ob/Gyn in an emergency obstetrical situation. For example, if a so-called normal labour being attended by a midwife or a nurse practitioner becomes high risk (e.g. preeclampsia), an Ob/Gyn must be called in. If a normal pregnancy becomes more complex and an operative delivery (e.g. a Cesarean section) is required, an Ob/Gyn must perform what may be a lifesaving surgery.

A National Birthing Initiative

SOGC undertook the Emergency Obstetrical Care HHR survey as part of its National Birthing Initiative, a comprehensive strategy to address the pending maternity care shortages that will have a direct and significant impact on women having babies in Canada in the future.

 

Media Contact

Lisa Robertson
(613) 739-7032

Susan Wright
(613) 730-2020

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(French media)
(613) 863-1828

 

About the SOGC

The Society of Obstetricians and Gynaecologists of Canada (SOGC) is one of Canada’s oldest national specialty organizations. Established in 1944, the Society’s mission is to promote excellence in the practice of obstetrics and gynaecology and to advance the health of women through leadership, advocacy, collaboration, outreach and education. The SOGC represents obstetricians/gynaecologists, family physicians, nurses, midwives and allied health professionals working in the field of sexual reproductive health. For more information, visit www.sogc.org.

Last Updated December 4, 2008