Months before Danielle Goward’s due date, doctors informed her that she would be transferred to another hospital to deliver her twin girls. Her higher-risk pregnancy, they said, required more specialized services than were available at the local hospital in Williams Lake, in B.C.’s Interior.
Ms. Goward and her husband accepted the plan as a small inconvenience and figured that when the time came this spring, they would be transferred to Kamloops, or possibly Vancouver. Instead, a shortage of maternity care doctors in British Columbia saw Ms. Goward shuffled through four hospitals in 12 days – in Williams Lake, Kelowna, Prince George and Kamloops. The transfer process involved three flights for the flustered first-time mother, who called the experience “terrifying.”
“We thought it would be a minor bump, but it ended up being absolutely insane,” Ms. Goward said in an interview.
A shortage of obstetrician-gynecologists and other maternity care providers in B.C. has meant that some expectant patients are travelling hundreds of kilometres to give birth.
OB/GYNs routinely take on extra shifts to fill critical staffing gaps, and doctors have gone public about dire conditions that they say threaten patient safety.
The impact has been especially acute in the province’s north and Interior.
In July, the regional health authority Northern Health warned that a shortage of obstetrical specialists at Prince George’s University Hospital of Northern B.C. – the only tertiary care hospital for obstetrics in the region – would mean that pregnant patients could be transferred elsewhere through August and into the fall.
That crisis was only averted when providers and locums from other parts of the province stepped up to fill the gaps, an arrangement for which they were guaranteed a minimum of $4,250 per 24-hour shift, with flights, car rentals and hotel accommodations covered.
At the same time, Interior Health warned that shortages of maternity department physicians at Royal Inland Hospital in Kamloops meant that expectant patients could be transferred out of community for care through at least the month of August.
This, too, was averted when obstetricians stepped forward to take uncovered shifts; however, staff shortages have persisted into September.
Victoria General is one of several B.C. hospitals that shut down pediatric units this year due to staff shortages.Dirk Meissner/The Canadian Press
The specialist shortage has had knock-on effects. Kelowna General Hospital’s inpatient pediatric unit was closed for six weeks beginning on May 26 as pediatricians were reallocated to support high-risk deliveries and work in the neonatal intensive care unit (NICU). Victoria General Hospital’s Urgent Pediatric Assessment Clinic similarly shuttered on Sept. 1 for an unspecified period, with an Island Health statement attributed to the hospital’s pediatricians saying staff were being diverted to provide “more emergent care.”
And in mid-September, the Thompson Region Family Obstetrics physician group stopped accepting new referrals because their doctors were needed to provide critical labour and delivery services at Royal Inland Hospital.
Chelsea Elwood, vice-president of the Society of Obstetrics and Gynecology of British Columbia, said the situation has resulted in a lot of uncertainty for patients at a particularly vulnerable time in their lives.
“It’s a lot of stress for people – emotional stress and mental anxiety,” she said. “There’s also the practical financial stress of having to relocate and take time off work.”
Other provinces are also feeling the pressures of such shortages. Sensenbrenner Hospital in Kapuskasing, Ont., the sole hospital between Timmins and Thunder Bay, has only two family doctors trained in obstetrics – a shortage that chief of staff Dr. Jessica Kwapis said makes it impossible to provide around-the-clock coverage. Lethbridge, Alta., saw a near-collapse of obstetrical services in 2022-23, with only one full-time OB/GYN at Chinook Regional Hospital owing to attrition and leaves.
The Canadian Occupational Projection System, a government tool that analyzes and projects labour market conditions, identified a “strong risk of labour shortage” nationally through to 2033.
Chelsea Elwood, vice-president of the Society of Obstetrics and Gynecology of British Columbia, says the bottlenecks in B.C. can cause ‘a lot of stress’ for patients who may not know which hospital is equipped to give them maternity and OBGYN care.Jimmy Jeong/The Globe and Mail
Ms. Goward went into early labour on May 20 and, as she had been warned, was told by staff at Cariboo Memorial Hospital in Williams Lake that she would be transferred out, owing both to the complexity of her pregnancy and to the shortage of specialists available. After hours of waiting, she was transferred by aircraft to Kelowna General Hospital, where she was told within a couple of days that a high volume of deliveries paired with staffing challenges meant she would have to be moved again.
Around this time, all nine members of the hospital’s department of obstetrics and gynecology issued a joint statement to media saying that a critical shortage of family physicians was threatening to collapse the maternity ward. OB/GYNs were being asked to take on additional roles, specifically providing primary maternity care to low-risk patients without such a provider, on top of their existing high-risk consultative and surgical responsibilities, the statement said.
Ms. Goward was flown from Kelowna General to the University Hospital of Northern British Columbia in Prince George, where she delivered her twins through emergency C-section two days later. Though healthy, the babies faced risks of complications from being born at 32 weeks and required a stay in the NICU. Ms. Goward recalled a nurse mentioning the specialized unit was full that day, and that locals with uncomplicated pregnancies were being transferred to hospitals in Quesnel and Vanderhoof to deliver so that UHNBC could accommodate high-risk pregnancies.
Within several days, Ms. Goward and her newborn girls were transferred again, this time to Kamloops, because her babies were the most stable out of all those in the NICU, which needed to make space. Hospital staff also said it was best for her to be in her own health authority – a point that Ms. Goward contested unsuccessfully, wanting to stay put.
Ms. Goward said she was overwhelmed throughout it all, nauseous from medications used to delay her labour and anxious over transporting her newborn twins. Her husband, Chance Tobin, travelled separately, driving hours between each hospital so that the family would have their vehicle full of supplies.
“I was trying not to think the worst, trying to trust the process – like, okay, these are medical health professionals making decisions that are best for us,” she said. “But by the time we were getting transferred to Kamloops, I’m like, ‘What is going on?’”
Family doctors play a big part in maternal care in B.C., but they've been in short supply over the past few years. A 2022 rally in Victoria brought that to the legislature's attention with help from Wally, a Rhode Island red hen whose veternarian caregiver had retired from practice.Chad Hipolito/The Globe and Mail
Maternity care in B.C. is provided by midwives, some family doctors and obstetricians, based on a patient’s needs and desires. Generally, midwives provide pregnancy care for healthy, low-risk pregnancies, while family doctors who provide maternity care services manage low- to moderate-risk pregnancies.
Obstetricians, who have completed five years of additional training, are responsible for the vast majority of operative deliveries, both vaginal and by cesarean section, and all multiple births. They also support family doctors and midwives in lower-risk deliveries for which they are not the primary provider and can be called in for emergencies that require surgical intervention.
In 2023-24, obstetricians were the primary providers in 57 per cent of B.C.’s 41,088 deliveries, followed by family physicians at 26 per cent and midwives at 16 per cent, according to Perinatal Services BC.
The province had 6.7 OB/GYNs per 100,000 population in 2023, compared with a national average of 6.3 per 100,000, according to data from the Canadian Institute for Health Information. But when broken down by B.C.’s 16 health service delivery areas, the numbers show wide regional disparities, from 2.87 per 100,000 in the northeast to 15.9 per 100,000 in Vancouver, according to 2023-24 data from B.C.’s Ministry of Health.
However, doctors say those numbers don’t tell the whole story. Some OB/GYNs, for example, focus their practice on gynecology and do not deliver babies. As well, the health service delivery area data obscure the uneven distribution within those regions. In the Northern Interior, which has 5.96 OB/GYNs per 100,000 population, Prince George has five OB/GYNs who deliver babies, compared with one in Quesnel. In Thompson Cariboo Shuswap, which has 5.48 OB/GYNs per 100,000 population, Kamloops has seven and Williams Lake has one.
Dr. Elwood said hospitals will often transfer patients elsewhere when an OB/GYN is not available, in case there are complications. This can create bottlenecks throughout maternity and gynecologic care.
“We as generalists do some of the cancer surgery for gyne,” she said. “When I’m being pulled into a labour unit more times than I would normally because we’re short-staffed for OB/GYNs, what suffers is my office and gyne care, including gyne cancer care, because the baby has to come out now."
Doctors attribute the shortage to several factors, including wearing on-call demands, unpredictable hours and the high-risk nature of the work. Because mistakes can result in life-altering consequences for both mother and child, OB/GYNs have one of the highest malpractice insurance rates in medicine.
Changing demographics over the past several decades have also added to the workload and complexity of obstetrical care. In 2023-24, one-third of deliveries in B.C. involved patients over the age of 35, and 35 per cent of people delivering were overweight or obese, according to Perinatal Services BC. Such births can carry higher risks, including of gestational diabetes, pre-eclampsia, prolonged labour and surgical complications.
There are also more people entering pregnancy with pre-existing medical conditions (37 per 1,000 deliveries), more people giving birth for the first time (50 per cent) and more deliveries by cesarean section (41 per cent) – all factors that can increase the risk of complications.
In a C-section, surgeons deliver a baby by cutting into the mother's abdomen. The procedure is getting more common in Canada.Jorge Cabrera/Reuters
Another factor is the fee-for-service compensation model, which OB/GYNs say fails to capture the full scope of their work. When an obstetrician supports a midwife at a delivery, for example, only the midwife can bill B.C.’s Medical Services Plan for the delivery itself ($1,186).
The obstetrician can claim lower-fee services, such as a consultation ($172) or specific interventions if performed. A delivery that requires forceps – a high-risk procedure billed as a complicated delivery – is compensated at $649.
There is also the gender pay gap. A 2020 article published in the Canadian Medical Association Journal reported that Canada’s female doctors consistently earn less than their male counterparts. The disparity exists within every medical specialty and also between specialties, with physicians in female-dominated fields being paid less, the research found.
“Obstetrics and gynecology is one of the lowest-paying surgical specialties. It’s also the surgical specialty with the highest proportion of women,” Tara Kiran, a primary-care researcher at the University of Toronto who co-authored the article with Michelle Cohen, said in an e-mail to The Globe and Mail.
“Women physicians are more commonly operating on women patients, and the procedures being performed on women are often lower paying than similar procedures performed on men.”
The gender divide in medicine was one of several areas The Globe investigated in its 2021 Power Gap series. In this video, journalists Robyn Doolittle and Chen Wang broke down some of the key findings.
The Globe and Mail
Reached for comment, B.C.’s Ministry of Health acknowledged the shortage and expressed gratitude to physicians who have stepped up to cover shifts as it works to fill vacancies.
It cited its Health Human Resources Strategy, launched in September, 2022, which includes the expansion of its Longitudinal Family Physician Payment Model to include maternity care. This change has meant that family doctors providing these services can be paid through a blended model based on time, patient interactions and complexity of patients, rather than by the service.
Midwives have also been offered alternative payment models that can provide better and more predictable pay for their work. However, alternative payments are limited for OB/GYNs, offered only to select specialists working at rural sites where the fee-for-service model would be infeasible because of low volumes.
Ms. Goward said she is grateful that her husband’s job allowed him to travel with her throughout the ordeal and to cover substantial up-front costs.
She also credits her mother for advocating on her behalf, advising her that the First Nations Health Authority supports First Nations clients with medical transportation costs, something her husband was able to claim.
“We’re definitely feeling very sad for the families that don’t have those supports, because it can be a huge burden on families,” she said.
“This was our first pregnancy. Everything was so new to us, and so scary, that it was just wild.”
Rick Magnell/The Globe and Mail
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