Dr. Jeanette Boyd, Lead, Rural Obstetrics Network, with Dr. Robert Woollard of the Provincial Rural CPD Collaborative.
The Rural Obstetrics Network is a forum where BC’s rural maternity care providers can come together to brainstorm ideas, share resources and knowledge, and find ways to improve the delivery of obstetrical health care in rural and remote communities. The Network – currently led by GP Obstetrician Dr. Jeanette Boyd – works with physicians, midwives, specialists, nurses, health authorities, and professional organizations to identify and address the obstetrical needs of rural women throughout the province.
Why is it so difficult to sustain rural obstetrics in some rural BC communities?
What makes rural obstetrics sustainable is multi-factoral. You need a critical mass of people willing to provide the service, and to work collaboratively together. In a rural context, you need a strong surgical service, nurses with competence in maternity care, and resources like public health nursing and breastfeeding support to help the new families when they return home. In a rural community, all of these factors are essential for safe obstetrical practice – the loss of even one of these aspects can jeopardize a community’s maternity program.
How do you see the Rural OB Network supporting rural maternity care in BC?
Our biggest advantage is that we make connections to other rural service providers within the province and foster the development of those relationships. We have stories of successful collaborative care that we can share with communities that are looking to integrate midwives into their community of practice. The Network is a source of information and experience that any practitioner can access.
What are some of the barriers to providing collaborative maternal healthcare in BC?
Rural communities are often collaborative out of necessity; but the barriers that do exist can make collaboration daunting. The current fee structures do not allow physicians and midwives to easily share patients or a call roster. Other care providers, such as maternity and public health nurses, can be restricted in their capacity to collaborate by pre-existing health authority mandates that make it challenging to quickly respond to the evolving needs of a rural community, despite the best of intentions. We need to continue lobbying the Ministry to be open to collaboration that allows for a shared care model.
Does the Network have a role in that advocacy work?
Yes, we certainly do. Over the past couple of years, the Ministry held several meetings to find ways to make obstetrical care more sustainable. One of our suggestions was an alternative funding payment plan that would allow for more collaborative care between midwives and physicians.
What other roles does the Rural OB Network currently serve?
The main priority over the last year has been to establish relationships and work collaboratively with other groups, such as the Provincial Rural CPD Collaborative, to try to get a sense of what the obstetrical needs are of rural communities.
One of our most critical health collaborations involves working with GP Anaesthetists and GP Surgeons. Drs. Stefan Grzybowski and Jude Kornelsen’s research is really clear that a core team of care providers are essential to provide safe and sustainable maternity care. As the primary care provider, you need safe access to surgery, post-partum care, and good nursing care. You need a community that wants interprofessionalism and is really supportive of it. Without that core team, you’re vulnerable on many aspects.
Do you see the Rural OB Network eventually sitting at the table with health authorities to find solutions to existing challenges?
The Divisions of Family Practice already have a table established with the health authorities and are a wonderful, empowering medium for family physicians to have their voices heard at the health authority level.
The Network might play a strong role through supporting the Divisions and individual physicians to be their own advocates, as well as providing them with the resources, connections, information and guidance to do that.
What are the next steps for the Rural OB Network?
We want to reach out to individual rural obstetric communities and offer our help. We want to find out what their needs are, where their resources are, and look for ways to support them. We want to set a table where rural obstetric providers of all bents – midwives, GPs, specialists, public health, maternity nurses, health authorities – learn from each other and from successes and try to address the existing systemic needs. The Network can advocate at the level of the JSC (Joint Standing Committee on Rural Issues) to really promote rural obstetrical practice and work towards that sustainable model.
RCCbc seeks to improve rural health education and advocates for rural health in BC. It works on behalf of the Joint Standing Committee on Rural Issues (JSC), an entity that includes representation from the BC Medical Association (BCMA) and the Ministry of Health (MoH) and the health authorities. The JSC advises the BC Government and the BCMA on matters pertaining to rural medical practice.