More spending now can save millions down the road, B.C. midwives argue

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Training more midwives could provide better access to maternity care in British Columbia and improve health outcomes for mothers and babies, midwifery advocates maintain.

And while the recommendations unveiled Thursday by the Midwives Association of British Columbia (MABC) would require upfront spending by the province, that investment would be more than offset by savings that would result, the group says.

"Our vision is about improving access to maternity care, improving health outcomes and delivering cost savings to make better use of limited health-care dollars," Kelly Hayes, a registered midwife and vice-president of the MABC, said Thursday at a news conference.

The group has put forward five policy recommendations, including new payment models for midwives in rural and remote communities.

The recommendations would cost about $3-million per year, or about $21-million by 2020, the group estimates, but result in savings of $60-million.

Those projected savings would come from increasing home births – which are cheaper than hospital births, shortening hospital stays and reducing cesarean section rates, the group says.

The program calls for the province to pay for a "bridging program" that would bring up to 15 internationally trained midwives per year to the province while B.C. midwives are being trained.

Currently, there are 20 spots in the University of British Columbia's midwifery program and 192 registered midwives in the province.

The MABC would like to see the proportion of babies delivered by midwives in B.C. – currently about 17 per cent – climb to 35 per cent by 2020.

That increase, the group maintains, would result in several benefits, such as improving access to maternity care in rural, northern and First Nations communities and freeing up an estimated $60-million for other health-care priorities.

"Research shows clearly that when women have to leave their communities to receive essential community care, there are increased stresses to both the mother and baby and the health risks increase," Dr. Michael Klein, professor emeritus of family practice and pediatrics at UBC, said at the news conference.

"Even when women travel from rural communities to ultimately be delivered by very well-intentioned strangers in excellent facilities, the outcomes are often less good than if they had stayed at home and received the care in their own communities," he added.

The MABC, which has been advocating on behalf of B.C. midwives since the province began funding and regulating midwives in 1998, is making its pitch for beefed-up midwifery service as the current maternal care system is under strain.

A potential maternity care crunch is not a new concern. In 2008, the Society of Obstetricians and Gynaecologists of Canada called for a national birthing initiative, citing an expected decline in the number of obstetricians and gynecologists and the declining numbers of general physicians.

Since then, the situation has not improved. There are roughly half the number of family doctors delivering babies in Canada as there were in 1993, Dr. Klein said, while at the same time the average age of obstetricians is nearing 60.

The provincial Health Ministry "looks forward to reviewing" the MABC document, a ministry representative said Thursday in an e-mail, adding that the province recently put $1.9-million toward doubling the spots at UBC's training program from 10 to 20.