More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors' group attributes to the lack of a national birthing plan.
The problem has peaked, with British Columbia and Ontario each sending a record number of women to U.S. neonatal intensive care units (NICUs). Specifically, 80 B.C. women have been sent to U.S. hospitals since April 1, 2007; in Ontario, 28 have been sent since January of 2007, according to figures from the respective health ministries.
André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, said the problem is due to bed closings that took place almost a decade ago, the absence of a national birthing initiative and too few staff.
“Neonatologists are very stretched right now,” Dr. Lalonde said in a telephone interview from Ottawa. “We're so stretched, it's kind of dangerous.”
A national birthing initiative, he said, is urgently required to ensure services are planned, guidelines on the best way to care for these patients are implemented, and a stronger focus is placed on maternity patient safety.
Canada, once able to boast about its high rank in the world for low infant-mortality rate – sixth place in 1990 – saw its rank plummet to 25th place in 2005, according to figures published this year by the Organization for Economic Co-operation and Development.
Specifically, Canada's infant mortality rate of 5.4 deaths per 1,000 live births is tied with Estonia's and more than double Sweden's rate of 2.4.
The inability for Canada to care for all of its sick and premature babies has caught the attention of renowned pediatrics professor Shoo Lee, who is studying the health outcomes of infants sent abroad, in addition to those who remain here, often under stretched staffing conditions.
“If you have insufficient resources in the province, what does that mean for those kept in the system?” Dr. Lee, director of the Canadian Neonatal Network, said from Edmonton. “Are they being admitted to the NICU only when they are very sick? Are they being pushed out too early to make room for others?”
Philippe Chessex, division head of neonatology for B.C. Women's Hospital & Health Centre, said every effort is made to avoid out-of-province transfers. Even sick babies who aren't sent to the U.S. can still face several moves while at home.
“We're transferring babies across the province, in all directions, to try to find an extra bed for the next potential birth or for any baby already born,” Dr. Chessex said in a telephone interview from Vancouver. “We now have babies who have been transferred up to six times after leaving here before reaching home.”
For parents, the devastating news that their baby is sick due to a malformation, illness or being born prematurely is compounded by the reality that there simply is not a bed available for their infant close to home.
“Whenever a sick baby is born, it's really a disaster for these families because it was unexpected. And it just puts a terrible stress on them,” Dr. Chessex said. “If they are sent out of country at that moment, it is just unbelievable the kind of pressure that they must go under.”
No one knows that better than Jade Pascoe, of Cranbrook, B.C., who went into labour 15 weeks earlier than her due date. She gave birth on March 29, to Nevin James William Moore, who came into this world weighing 1 pound 10 ounces. “They tried to get me somewhere in Canada,” said Ms. Pascoe, 19. “But there was nowhere to send me.” The hospital where she gave birth does not have a NICU. And when no NICU bed could be located in B.C. or Alberta, her son was sent to a hospital in Spokane, located in eastern Washington.
During that time, doctors, nurses and others took turns using a manual respirator for six hours on the boy, until he arrived by air ambulance at Deaconess Medical Center. He is expected to stay there until July.
Of her son, born at 25 weeks gestation, Ms. Pascoe said: “I didn't know they came that small.” Though he is not yet stable enough for her to kiss or cuddle, she can touch him. Patrice Sweeny, assistant neonatal intensive-care unit manager at Deaconess Medical Center, said Nevin is on a ventilator and requires a lot of support but he is improving.
