Moms and soon-to-be moms in the South Cariboo are extremely frustrated with the lack of prenatal care in the region.
Ashley Caines is just one such mom, who’s currently about 17 weeks pregnant with her second child.
“When I first found out I was pregnant, I contacted all the clinics in 100 Mile only to be told no one was taking prenatal patients. I spoke to my family doctor who said he also couldn’t do prenatal care because it costs doctors extra insurance per month to be covered to do this kind of care.”
Next, she considered a midwife in Kamloops, she says.
“I phoned around to all the midwife clinics only to be told that no one had any room. I phoned a bunch of the clinics in Williams Lake, again, only to be told that everyone was very busy. As you can imagine, I felt quite helpless. I was constantly being turned down for prenatal care by everyone and it is my right to be able to receive proper medical care.”
Deliveries were performed in the 100 Mile District General Hospital up until this year, when the lone general practitioner anesthetist retired, according to Dr. Nancy Humber, a senior medical director with Interior Health (IH) for the interior west rural region.
“The [Health Authority] is thankful for the dedication and commitment of the departing physician for supporting this service. With this departure and other staffing challenges in obstetrics, obstetric services and maternity care will be suspended at 100 Mile District Hospital, and care will be provided through a coordinated plan with the perinatal team at Cariboo Memorial Hospital in Williams Lake. All pregnant women in 100 Mile House will be connected to a provider for the delivery of their baby outside of the community.”
Caines says it was difficult to find that connection.
“No one could provide me any direction,” she says.
“My last option was to get a referral to my previous prenatal doctor (who is amazing but I was hoping to do my prenatal care up to 30 weeks in 100 Mile. It’s tough having to travel to Williams Lake for prenatal care with a toddler and a husband who works a lot) in hopes he would accept me even though the office told me no one was taking any more patients. Luckily, he accepted me. Otherwise, I have absolutely no idea what I would do.”
The appointments can get quite frequent, exacerbating the problem. For her last pregnancy, Caines had to go for non-stress tests three times a week for the last few weeks of pregnancy due to high blood pressure.
Caines is a stay at home mom and her husband is an RCMP officer.
“I don’t have daycare. We are posted provinces away from our families so we don’t have family we can drop my son off with. I just book appointments on his days off, with fingers crossed he doesn’t end up having to work.”
The issue affects mothers from Lac la Hache to the Interlakes area who are often travelling for more than an hour each way every week or even multiple times a week.
100 Mile is not unlike other communities in the province, says Humber.
“There has been a change in the number of physicians who are there. There’s been new physicians who come as well as older physicians retiring,” she says. “It’s really common for us to see the older family physicians [have] a very broad skillset, more of a rural, generalist skillset and it’s becoming harder on a provincial level to recruit into that skillset.”
Rebekah Brown. Max Winkelman photo.
More than just one mom
Rebekah Brown, a mother herself, runs the 100 Mile Moms’ group on Facebook.
“Interestingly enough, one of the hottest topics in the Facebook group that I run, has been prenatal care. Many moms that have recently moved to the area are baffled and horrified when they hear that no one is currently accepting prenatal patients and that the closest option with a running birthing unit is 45 minutes away (more like an hour with the construction, if we are being honest.)”
Travel times could be far greater than that for those who live on the “wrong side” of 100 Mile.
Living in a small town without proper prenatal care has been difficult for her, her friends and family, she says.
“I have multiple close acquaintances that are currently pregnant and have had an extremely difficult time finding a prenatal doctor to take them on. This has been filled with many frustrating phone calls and emails on their end, as they scramble to find someone to take them on.”
When she was pregnant, she started her prenatal care with Dr. Joanne Lapin, the last general practitioner anesthetist in 100 Mile House, whom she’s got nothing but praise for.
Dr. Lapin, however, had to step aside before Brown gave birth.
“This left us with seeing two different doctors in the 100 Mile area for the remainder of my pregnancy, and then having my baby birthed in the Williams Lake hospital by a doctor that I had only met the day of (moments before) my son’s birth,” she says adding that Williams Lake staff were spectacular.
She’s now pregnant with her second baby, which is due in April. Even before Lapin retired, she decided she’d seek care in Williams Lake for her next baby to avoid being juggled around, adding that 100 Mile just doesn’t have the resources or consistency.
She was thrilled that the doctor who ended up delivering her first baby in Williams Lake was willing to take her on as a patient. But she says that having to drive to Williams Lake for appointments, ultrasounds, and labour, is challenging for her as a stay at home mom to a very busy 16-month-old.
She adds that working out times when family or friends can watch him, or needing her husband to take time off of work for her doctor’s appointment is definitely not ideal.
“I wish that we had prenatal care locally because so many growing families would greatly benefit from it. Not to mention, it would be so much smoother for those of us that have children or babies at home while being pregnant. I know many families are turned off of our charming community, because of the lack of our medical resources, specifically prenatal. Which makes me sad, as I want to see growth and for our community to blossom.”
There have been some very good studies on the effects of maternity care being only available after a long drive, according to Dr. Jeanette Boyd, a family physician and the co-lead for the Rural Obstetrics Network with the Rural Coordination Centre of BC:
For women who live more than four hours away from a place where they can receive maternity services, there’s a much higher risk of perinatal mortality, she says. If they’re two to four hours from maternity care they’re at higher risk of induction of labour and other interventions, including a higher risk of C-sections. Even if they’re living one or two hours away it can lead to higher rates of unplanned out of hospital births with increased risks of children needing to be in the neonatal intensive care unit and longer stays in the hospital, she adds.
“Probably an even more significant risk is women who live in areas that do not have access to maternity services have 7.4 times the rates of moderate to severe levels of stress and stress can lead to other things like increased pre-term births,” she says. “The other broader aspects of the significance of stress is really hard to measure. We know it can have an impact longer-term on mental health and wellness and certainly, they would be at higher risk for depression and anxiety that has implications down the road for their children and their families.”
When it comes to prenatal care, women struggling to find a provider may also miss out on some critical care in early stages.
“There is some very critical information sharing that needs to happen between a woman and her maternity care provider, ideally as soon as possible as soon as she becomes pregnant and most importantly really before she’s pregnant.”
This includes blood-type, a dating ultrasound and genetic testing, she says.
“There is a very small window to do the genetic testing of that particular child that she’s carrying that can have implications for to when and where they seek care or even if they choose to carry out the pregnancy or the type of care she needs throughout the pregnancy.”
There definitely is evidence that if women have to travel or if they’re not aware where maternity care may exist, they are much less likely to get the appropriate testing done within the appropriate time windows and less likely to find a provider.
“If geography and weather are an issue it’s very challenging for women to be able to access care.”
In B.C. we’re quite blessed, says Boyd, because prenatal care can be provided by family physicians, specialists, midwives, and nurse practitioners.
“All four of them are absolutely appropriate for a woman to seek out to get their primary maternity care. In a community with any of those care providers access to prenatal care should be available. It is unusual if a community has any one of those four care providers that a woman wouldn’t be able to access it unless, of course, there isn’t the number of care providers there to meet the demand of the community.”
As to why providers who are theoretically capable of providing prenatal services, such as family physicians, might not provide it can be multi-factorial, says Boyd. Some could be related to the volume of their practice and an absence of other support but it’s really hard to say why a practitioner would not offer that service if it’s within the scope of their practice. She couldn’t comment on 100 Mile House specifically.
For maternity care as a whole, it’s a different story, she says.
Since 2000 more than 20 rural communities have lost the ability to have planned births in their hospital, she says.
”That is a significant loss to women within those communities for all those risks that we had outlined earlier.”
The challenges surrounding both prenatal care and maternity care are multi-factorial and need to be looked at from a system-wide approach which IH is doing, according to Humber.
Humber adds that it’s difficult to replace people who have been there for 30 years and can do everything.
“The Health Authority, the physicians and health sites in both communities and the Divisions of Family Practice are working together to try and find the best solution to allow patients to have the most care closer to home but transitions to a different model take time and sometimes they’re difficult. So we’re working out how exactly that would work. She says IH is looking to support any physician who is interested in prenatal care in a team-based networked model with Williams Lake.
“The newer physicians or physicians that are new to Canadian practice often feel more comfortable in team-based networked care to provide maternity services.”
It’s not just about seeing a doctor but about receiving care at the right time, making sure the system can accommodate all of the women and how the information travels between the different people trying to deliver the care.
Maria Reti and daughter Lily Roddick. Max Winkelman photo.
The issue of receiving prenatal care in 100 Mile House, however, has been difficult for mothers for far longer than March of this year.
Maria Reti became pregnant in 2015.
“At that time, I was not able to find a doctor locally who could perform my prenatal care. A friend of mine who was also pregnant recommended that I check out the clinic she was going to in Williams Lake. They were able to take me on immediately as a patient and saw me throughout my pregnancy, the birth of my daughter, and for another month or so postpartum. The care I received there was incredible and I was grateful for the opportunity to go there.”
However, like other soon-to-be moms that still presented the challenges of winter driving.
Reti was working at Pet Valu at the time.
“We had a small amount of staff then, so having someone cover my shifts when I had to go out of town could affect the whole team. Thankfully my coworkers were really helpful and understanding when they needed to cover my shifts because I couldn’t be there due to travelling out of town.”
Humber stressed the importance of the issue.
“Maternity care and access to maternity is something that’s very important to the health authority and we’re working very hard to resolve the challenges that have been created with the change in maternity service delivery.”