Island Health is shoring up its hospital-based maternity service amid a critical shortage of maternity physicians on the south Island.
The health authority announced Friday it will soon add 24/7 in-house access to a registered midwife at Victoria General Hospital, where there’s a clinic for people who are pregnant and don’t have a midwife or family doctor specializing in maternity services in the community.
So far, 16 registered midwives have signed on to support the position.
Since it was established in March, the Urgent Antenatal Care Clinic at Victoria General Hospital, operated by a rotation of maternity doctors, has handled about 500 appointments and about 50 births.
A registered midwife has been on-site for shifts since Sept. 25. Island Health says it has secured funding to build up the service in the next few months, with the goal of having a registered midwife at the hospital around the clock to add to the rotating team of maternity doctors.
The latest move comes as the number of family doctors providing maternity care has shrunk to about 25 from 48 over the past two years in south Vancouver Island. For some period out of every 24 hours, there is no family physician-obstetrician at Victoria General Hospital.
That’s especially problematic, as the south Island has the highest maternal age in the province, which means a larger number of medical issues requiring family physician-obstetricians, said Saanich physician Dr. Jennifer Lush.
Lush said she appreciates Island Health’s attempt to find solutions, but notes that midwives, while vital team members, are not trained or licensed to care for medically complex pregnant patients.
Typically, a family physician specializing in obstetrics would help a midwife manage a patient’s medical issues, but the shortage means “we are burning out our midwives, who feel they are being pressured to function beyond their scope and midwives are having to consult specialists directly,” which costs more and draws away the specialists from other patients, said Lush.
If a medically complex woman comes into the hospital and there’s no family physician specializing in maternity, the endocrinologist gets called, for example, which is inefficient and costly, said Lush.
“So when are we going to see Island Health making a similar announcement about family physician-obstetrics coverage?” asked Lush, who notes that more than 1,000 pregnant women in Greater Victoria don’t have a physician or midwife.
Expectant mother Danielle Garber was at Victoria General Hospital on Friday and is due to give birth any day now. Garber began receiving care from the Urgent Antenatal Care Clinic in May at 17 weeks’ pregnant, after being unable to secure a primary maternity practitioner.
At that time, Garber was expecting twins, but she later lost one child. Most recently, she was placed on the induction list, and has been waiting for six days while higher-risk pregnancies “take priority.”
She said the risks increase as each day passes, adding during her first pregnancy, she waited just two days on the induction list. “This is a reflection of how busy labour and delivery is right now — late September, early October tend to be a popular due date.”
Garber applauded Friday’s news of the beefed-up midwife access, “though it is certainly not enough.”
Health Minister Adrian Dix, in a statement issued Friday, said the province is committed to working with Island Health, midwives and physicians to ensure “care plans are in place for unattached labouring patients” and that pregnant people receive the care they need.
Aside from delivering babies, the midwife at VGH is expected to provide emergency assessments for patients who don’t have a maternity care provider in the community or can’t immediately reach their provider; to deliver care for pregnant people who are already clients of VGH’s Antenatal Care Clinic; to assist other family doctors at the clinic; and to provide in-hospital postpartum care and arrange community-based postpartum care following the client being discharged.
Family physician Dr. Vanessa Young also applauded Friday’s announcement, saying “the more hands on deck, the better.”
Young said Island Health could also fund more “new-to-practice” positions to improve maternity care. She said two such doctors are wanting to join a maternity clinic here in Greater Victoria but just one position is funded.
Leah Hollins, board chair for Island Health, said the midwife position is an important step but acknowledged there is much more work to be done to develop a “sustainable maternity service” that meets the needs of all pregnant patients on the south Island.
With funding for the position approved, Island Health is working to develop staffing models and recruit more registered midwives to support the role.
Pregnant patients who don’t have a primary maternity care provider can contact the Urgent Antenatal Care Clinic at VGH by calling 250-727-4187 and leaving a voicemail message.
>>> To comment on this article, write a letter to the editor: [email protected]
