It is a proposal that could serve as a model for other small-town Canadian hospitals struggling to fund their maternity wards: Leave the birthing units dark and unstaffed until a labouring woman turns up.
This part-time approach – operating the maternity ward on a "turn-on-the-lights" basis – is the chief recommendation of an expert panel's report on the fate of the obstetrical unit at the only hospital in Leamington, a southern Ontario town that was in danger of becoming at least the 43rd community across the country to lose its maternity ward in the past 10 years.
The panel's advice does not guarantee Leamington District Memorial Hospital's birthing unit will stay open, but the report does make it harder to shut it down. The 14-member panel concluded that closing the ward outright would pose an "unacceptable" risk to mothers and babies in the town of 30,000 about an hour east of Windsor.
Still, some in Leamington are already expressing concern that the proposed part-time model could have complications of its own.
"I can appreciate the cost savings, as long as it doesn't come at the risk of safety to the moms and babies locally," said Sandra Dick, a member of the group lobbying to save the ward. She gave birth to her second daughter, Kara, there last week. "I don't want to have to show up to hospital and not have [obstetrical] nurses on standby. That's concerning."
Last year, the Leamington hospital's board faced a dilemma that is not uncommon in small-town health care in Canada.
The hospital was not delivering enough babies to cover the $1.4-million ward's costs, meaning it was "losing" about $740,000 a year under the Ontario government's hospital funding formula.
An outside consulting firm recommended closing the unit and shifting resources elsewhere, which the hospital's board reluctantly endorsed last fall.
But a fierce backlash from the community prompted the Local Health Integration Network – the regional health authority that approves significant changes to health services – to stop the closing temporarily and appoint a group of experts to give it a second look.
Ontario Health Minister Eric Hoskins would not comment on the proposal directly, but said in an interview that allowing extra time for a "made-in-Leamington" solution is an approach he would like to see replicated elsewhere, and not just for maternity wards.
The panel's report, released this week, recommends that the "turn-on-the-lights" unit be supplemented by a "navigation centre" that would bring together doctors, midwives, doulas and the town's sole obstetrician in one place to co-ordinate pre- and post-natal care for women outside the hospital.
The navigation centre would be funded with "existing resources," while the hospital would save money by no longer paying obstetrical nurses to wait on standby in the maternity ward when it is empty.
"I think it has tremendous potential," said Martin Girash, chair of the local LHIN's board. Although he could not speak on behalf of the full board, he plans to vote in favour of the panel's recommendations at a public meeting on May 5, after which community members will have 30 days to submit written comments before a final decision is made.
Angelina Chan, Leamington's only obstetrician-gynecologist, also voiced reservations about the panel's proposal. The navigation centre, she said, sounds like a duplication of the kind of integrated care Ontario's family health teams already provide. And the "turn-on-the-lights" approach at the ward could be perilous, depending on how it is implemented, she added.
"Is there still an [obstetrical] nurse in the building to do that initial triage and assessment or, when the [woman] arrives, are we calling in anybody that's obstetrically trained to handle the situation?" Dr. Chan said. "If it's the latter situation, I don't think that's safe."