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British Columbia High-risk pregnancies face transfers from Vancouver Island

Vancouver Island women facing high-risk pregnancies will be forced to travel to the mainland for specialized care, says the Vancouver Island Health Authority's chief medical officer

Obstetricians at Victoria General are concerned that without a round-the-clock anesthetist on their ward, the health of women and babies could be put in jeopardy.

The situation on Vancouver Island will affect up to three patients a month from the Central Island and North Island regions, who will be dispatched to Vancouver's Women's Hospital and Health Centre, instead of receiving care at Victoria General Hospital. South Island patients will not be affected. The transfers could take place as early as Monday.

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Women from across Vancouver Island and beyond, with complicated pregnancies, travel to Victoria General, some staying for extended periods.

Chief medical officer Richard Crow said in an interview on Sunday that he does not expect the quality of care will be affected by the situation.

"Centre and North Island patients will continue to receive excellent care at whichever hospital they are transferred to for high-risk care," said Mr. Crow. He noted that high-risk patients transferred in such a manner are usually flown between Vancouver Island and the Lower Mainland.

Mr. Crow linked the situation to ongoing talks with anesthetists to come up with a rate structure to allow for them to focus on obstetrical care. Now, an on-site, on-call anesthetist handles obstetrical matters and other situations, seven days a week. In addition, there is a second backup anesthetist.

Bob Burns, the health authority's acting medical director for population and community health, said in an interview that there have been instances where high-risk mothers require an anesthetist but the specialists are "tied up" on other wards.

A serious vehicle crash, for example, could result in the hospital's anesthetists working in the emergency ward. Suddenly, mother and babies are at risk, Dr. Burns said.

Physicians at Victoria General have been "increasingly alarmed" about the risks they face in providing safe care for mothers and babies, Dr. Burns said.

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Mr. Crow said obstetricians indicated a month ago they would decline transfers from other hospitals to Victoria, calling it a "negotiating tool" to move along the provision of enhanced service.

"We've already offered the anesthetists the top rate for service contracts, and that rate is agreed between the BC Medical Association and government," he said. "They have refused to provide the service. They are trying to get a higher rate than the agreed-upon rate."

Until there are enough anesthetists to provide round-the-clock service, obstetricians at Victoria General will only accept Victoria-area patients, said Dr. Burns.

Having anesthetists available 24/7 may lead to changes in procedures.

In Quebec, where anesthetists are available 24 hours a day on obstetrical wards, epidurals are given in 69 per cent of vaginal deliveries, according to a 2008-09 report from the Canadian Institute for Health Information.

In B.C., only 30 per cent of vaginal deliveries are preceded by epidurals, the study found.

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