As a community member and medical doctor practicing obstetrics in Banff I am deeply concerned about the recent decision to close obstetrics in the Banff hospital and consolidate services in Canmore.
I believe that the decision making process was not transparent. Only 0.44% of the Bow Valley community was chosen to sit on the planning committee. How were these individuals selected? How well were they informed of all the facts, options and consequences of consolidating obstetrics in Canmore? Whose interests did they represent?
70% of the Banff community said “yes that they are loosing an important service,” Question of the Week, in the Banff Crag and Canyon. However, research shows no improvement in the quality of care in consolidating services. If anything there will be added risk to the labouring mother.
While Banff and Canmore might appear close, they are separated by a good portion of highway that is periodically closed due to winter conditions. As community members loose confidence in their hospital, expectant couples will be under stress as they will have to consider the added travel time, intensified with winter driving conditions. Over time the population will be required to travel to Canmore for an increasing numbers of medical issues, not just those that are birth related, overburdening an already stretched medical service in Canmore.
On December 11th , 2012 a memo was released from Barb Shellian Director of Bow Valley Community and Rural Health to Banff Hospital staff explaining the changes pending to medical service profiles for the Bow Valley. I would like to bring to the community’s attention some inaccuracies in this memo that have been relayed to the press.
The low risk obstetrical clinic in Canmore is not a specialty clinic. The physicians are general practitioners just as they are in Banff.
Increasing the number of deliveries at a given hospital does not on its own ensure quality, nor does it guarantee appropriate staffing, safety and long-term sustainability.
The Canmore Hospital does not have better outcomes compared to the Banff Mineral Spring Hospital. Indeed, the caesarian section rate is substantially higher in Canmore as is the rate for severe maternal vaginal trauma. These statistics are undisputed and readily available from The Alberta Perinatal Health Program. Canadian National Guidelines show that there is no required number of births to maintain competence. The nurses and medical staff at the Mineral Springs Hospital maintain their skills through an established ongoing Obstetrical Risk Management program and on site workshops.
Research shows that while centralizing maternity care may seem like a good idea, it exposes mothers and babies to unforeseen complications that can result in far reaching effects on the functioning of a community and its long-term sustainability. Among the consequences of loss of maternity care is the shift from a fully functioning community to one known as a ‘high outflow community.’ In such communities, physicians and nurses become less satisfied with their work and less committed to their communities. Physicians, nurses and the community suffer the loss of an entire skill set related to women’s health.
The loss of one service, obstetrics, often means the loss of other services such as general surgery and ultimately more rapid turnover of medical/nursing staff and difficulties in recruitment of a stable medical/nursing workforce. Ultimately loss or reduction of medical services has a negative impact on social and educational services. As the community spirals downhill businesses find it difficult to recruit employees where medical, health and community services are limited. Centralizing maternity service will lead to the de-skilling of the maternity service providers at the Mineral Springs Hospital along with other services as well. Some of these workers will leave as their work brings them less satisfaction. This will put the hospital in a precarious state as maternity cases will inevitably still present at the Mineral Springs Hospital emergency department to be looked after by a staff that has lost increasingly the skill to care for women and babies. Paradoxically, and tragically, a decision thought to improve risk and outcome will have the opposite effect.
Birth, and its support services, is a central pillar of community. We need to maintain maternity care in Banff so that health care providers can continue to care for the women and children of our community and bring new members into the world.