Research in Maternity Wards effect on the Community

Research in Maternity Wards effect on the Community
(CLICK HERE to goto Dr. Klein’s website)

In his so-called retirement, Dr. Michael C. Klein is PI on a 4 year CIHR funded multidisciplinary study of attitudes and beliefs of all maternity care providers: obstetricians, family physicians, midwives, maternity care nurses, doulas and the women they serve—across urban and rural Canada.

PLEASE put your questions to Dr. Klein, use the ‘comment’ tag below to write him a question – don’t be shy 🙂

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11 thoughts on “Research in Maternity Wards effect on the Community

  1. Alberta Health Services and the administrator of the Mineral Springs Hospital are trying to blame the problem on low number of deliveries ie 48 last year and nurse competence. MSH has ongoing clinical education with Moreob. Patient satisfaction is high from patient surveys. Where lies the problem?

    • There has been much discussion about the competence of the nursing staff and that the problem of maintaining competence is one of the main reasons for recommending closure of the maternity service in Banff. First of all, there has been no evidence that nursing is a problem. Outcomes are good and nursing morale is high. A good way to undermine confidence is to say there is a problem with nursing. Nursing has been enthusiastically participating in the ongoing quality assurance program called MOREOb. This puts physicians and nurses into a collective study group together as they would be in real practice. This is how you assure quality.

      Another issue is volume. The volume is large enough at 50 births to maintain quality, providing you engage in exercises like MOREOb. and other review exercises. But why is the volume declining? It has been declining because Alberta Health has been actively discouraging staff, like other family practitioners from practicing in Banff BECUASE they have been giving out the information for a long time that maternity services are closing. Hence when doctors receive that message, they choose to practice elsewhere–like Canmore. This is a self-fulfilling prophesy–meaning that Alberta Health is causing the very thing to happen that they then tell folks is happening. Hummmmmm?

      On the other hand, if Alberta Health were to support the continuation of the high quality maternity care already in place in a gem of a hospital, then doctors and nurses would be drawn to the facility. Who would not be so drawn? It is a great place to practice and live. Banff needs cosmetic plastic surgery? Hardly. What a community hospital needs is what the community needs. A community needs those services that define community–like maternity care, supported by high quality general surgery and anesthesia services, and orthopedic services (the latter due to the ski environment, public health services, school health and pediatric services. There is a pediatrician ready to practice in Banff but again only if the maternity services are not systematically destroyed.

      Services around maternity are all related. High quality maternity goes with pediatric care. Physicians and nurses drawn to both–care about community. Loss of maternity care will lead to a cascade of long term consequences for the community and the hospital. The kind of physician who practices maternity care will be permanently lost to Banff. Those physicians that will replace this kind of physician will likely stay a shorter period of time, and they will be very different in approach and commitment to the community.

      Canmore is not too far away in good weather but this is about so much more than convenience. It is about quality of care and the health of community long term. Short term financial gain as everybody has acknowledged is not the issue. The perfect Canadian hospital is one without nurses, beds, doctors or patients. The budget will always be balanced. But to make a real service to the community takes vision, energy and continuous quality improvement and study of the ongoing needs of the community it serves. That is what defines quality. High quality nursing and physician recruitment and retention will never be a problem in Banff, so long as the administration does its job. Banff has the perfect setting for all that to take place. Don’t loose it.

      Michael C. Klein, MD

  2. Pingback: Research in Maternity Wards effect on the Community | savebanffmaternityward

    • Centralization or the concentration of care in larger centres might appear to save money and sometimes does. But a much bigger question is not just saving money for the hospital but what is the effect on the viability of the community where the service is closed. The Health Authority is still responsible for the care. In the end it may cost more for the system to transport families to a distant location, pay for their housing and more. And if the outcome is better in the centre being closed–for babies and mothers, then large costs of these differences need to be factored into the equation. For example, if the cesarean section rate is much higher in the centre “down the road,” and the cost of a cesarean is double that of a vaginal birth in nursing and staff time, that matters . greatly in terms of excess cost over the cost of the centre being closed. And if the outcome for the baby in the downstream centre is worse than it would have been if the family had stayed well-supported in their home community, then costs go way up. One damaged baby can cost the system millions and millions more for the family. And that is just the beginning. If young families in the child-bearing age group cannot be attracted to the community that winds up with a downgraded hospital then businesses suffer. The community can loose financial, social, and cultural capital.

  3. Small communities life Banff have better maternal and newborn outcomes for average low risk mothers and babies than they have when looked after by skilled and well-meaning strangers in a distant location. Has something to do with stress of travel and absence of local support. Keep up the good fight.

    • Michael,please could you reply to any questions that people might have about centralization of services and why it is not a good idea to remove maternity services from a community. Thank you.

          • I have previous said that obstetrics is a core service, no matter where it takes place or wherever it is delivered. The question of whether it is a core service in Banff is the essence of the discussion. It is a core service if the elimination of the service will cause damage to the population of Banff and the several upstream communities that receive their obstetrical services in Banff, and who would have to travel much greater distances to get to Canmore. The much more subtle long rang consequences of the removal of a core service on future recruitment and retention of the right kind of family physician is rarely taken into consideration or even appreciated by the decision-makers.

            Regarding the legal obligation of the Alberta Health Authority to consult the population before altering services, I cannot say. As a resident of BC all I can say is that hearing are normally held before such a decision is made, so that the government can say that they consulted, and then the government makes the decision. The real question in BC or Alberta is whether the Health Authority truly consulted in a way that all considerations were heard and taken into consideration. Normally decision-makers in a Health Authority are most concerned with safety and finances. Much more complex consequences for a community of the removal of a service are rarely taken into consideration, as the health authority normally feels that complex consequences on the cultural, social, ethnic, financial capital of a community are outside their area of responsibility.

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