It's hard enough to get milk
delivered these days, but baby delivery is one of those
things you'd expect would always be around. The fact of
the matter is many Canadian ob/gyns are deciding that
their delivery days may be numbered.
Could midwives be the saviours
of this delivery crisis? The government of Ontario thinks
so. The province has recently pledged an extra $7 million
to its $37 million midwife funding to help offset a
looming obstetrician shortage.
THE
LABOUR FORCE
"There is a crisis," admits Dr Michael Helewa, president-elect
of the Society of Obstetricians and Gynaecologists of
Canada (SOGC) and a practising ob/gyn in Winnipeg. People
haven't stopped making babies, but 34% of ob/gyns will
be giving up obstetrics in the near future, according
to an SOGC survey conducted in 2000. "Seventy percent
of that number is due to age alone � they're over 50,"
says Dr Helewa.
Unfortunately, the next generation
of docs won't be able to fill the gap. "The number of
grads hasn't changed," says Dr Helewa, "but an increasing
number are choosing to practise gynecology alone." Others
are opting for subspecialties and spend a lot of their
time doing research, and so are less available for work
on labour and delivery. "Most take after-hour calls
and work very very hard," he says, "but the number of
hours and calls they're willing to provide is limited.
Working 70 to 90 hours a week is excessive for anyone,"
he adds.
The problem is compounded by Canada's
population boom. "It's meant an increase in physician
workload in the trenches," says Dr Helewa. "The number
of my obstetrics patients has gone up 25 to 30%."
OLD-FASHIONED
DELIVERY
One way to alleviate the pressure on ob/gyns is to fund
more midwives. Members of the 'second oldest profession'
are on call 24 hours a day from early pregnancy to six
weeks postpartum.
"They're integral to the team,"
says Dr Helewa. "I would like to see them involved in
larger numbers in the provision of maternity care."
Right now there are fewer than 500 midwives in all of
Canada; less than 60% of women seeking midwives were
able to access their services last year. According to
Stats Can, only about 3% of births are handled by midwives.
Conditional
love
Traditionally, doctors have held a somewhat negative
view of midwives, but "that's changing," says Dr Morris
Van Andel, registrar of the BC College of Physicians
and Surgeons. Dr Van Andel, a retired GP who's delivered
over a thousand babies, believes most doctors are supportive
of increasing the number of midwives working as part
of a team, but with some restrictions. They should only
be involved with births "in a hospital setting, with
normal deliveries," says Dr Van Andel. He doesn't believe
that doctors generally support home births, which midwives
tend to be involved with. "It's not optimum patient
care," he says.
A lack of public funding is the
main obstacle to using midwives. The cost is prohibitive
for many: a mother in Alberta, for example, has to pay
$2,500 for a midwife. But Ontario, Quebec, Manitoba
and BC have all started covering midwife fees under
medicare.
The next step is to train more
midwives. Ontario's Laurentian, McMaster and Ryerson
universities already have programs, and the University
of British Columbia and the University of Quebec in
Trois-Rivières just recently began offering the
midwife degree. This year, 55 midwives are expected
to graduate in Ontario. They'll be able to assist an
additional 1,200 women to give birth.
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