For pregnant women in Fort Nelson, B.C., part of the prenatal routine includes agreeing not to have their babies in the northern community.
"Due to staffing issues, we are unable to conduct safe obstetric care," says the memo from the health centre.
An official with Northern Health, which oversees health centres in the region, says while physicians and staff are equipped to respond to an "unplanned delivery," women are advised to leave up to a month before their due date because "the safety of both the mother and the baby must come first."
Fort Nelson, a community of 3,500, is one of dozens of rural communities in Canada where maternity services have been eliminated, in part because of the ongoing struggle to recruit and retain doctors in remote parts of the country.
The lack of intrapartum care means some women have to travel hundreds of kilometres and pay thousands of dollars to have their babies, even though health experts say long-distance delivery can come with greater health risks.
The pricey wait
The next closest hospital to Fort Nelson is in Fort St. John, 380 kilometres away. But Courtney Cornelius and her partner Remi Dore chose to travel the 450 kilometres to Dawson Creek because it's closer to family members in Alberta.
When they checked into a hotel in December, the couple had no idea how long they would be staying or how much it was going to cost.
"It is a big burden considering we still have to pay for rent in Fort Nelson and pay for our living down here," Dore said.
They estimate that when they had their daughter two years ago, the cost for accommodation, gas and food totalled $4,000. This time around, family is helping pay their expenses, but Cornelius says many other women don't have the same kind of support.
"It's ridiculous," she says. "I know everyone is stressed out. They would like a little more help financially."
Their son Jaxon ended up being born two weeks before his due date, which the couple estimates saved them about $2,000.
The cost and inconvenience are enough to lead some women to alter their family plans, says a rural health researcher.
"I have heard women say we will not have more children until we move or until there are local services, because we can't afford it," says Jude Kornelsen, of the University of British Columbia.
The greater the distance, the higher the risks
Kornelsen has done extensive research on access to maternity care in rural B.C. and says more than 20 communities in the province have had their services cut since 2000.
She says the same trend is playing out across the country, forcing more women to travel farther away to deliver.
According to the most recent analysis, published in 2013, by the Canadian Institute for Health Information, 40 per cent of women living in rural Canada drive more than an hour to give birth; 17 per cent drive more than two hours.
"The risk will increase incrementally the further you have to travel, " says Kornelsen.
A study by Kornelsen and her colleagues published in 2011 found:
- The infant mortality rate is three times higher for women who have to travel more than four hours to deliver.
- There was a higher rate of preterm births and babies with low birth weights for women who drove more than two hours.
Kornelsen says even driving one hour away can be risky because women often don't leave for the hospital until they are already in labour.
Jaspreet Sandhu was already a week past her due date when she started having contractions in the early morning hours of December 16, 2015. She and her husband, Bikram, live in Weyburn, Sask., where there are no maternity services, so they were advised to drive the 115 kilometres to Regina.
They had to pull onto the icy shoulder of the highway halfway through their journey.
"Everything was happening so fast, I had to deliver the baby," Bikram said.
Next thing he knew, he was holding his newborn son. He was cleaning off the slippery infant when he and Jaspreet realized the umbilical cord was wrapped around the baby's neck.
Sandhu carefully untwisted it then called for an ambulance, and the operator asked if the baby boy was breathing.
Sandhu cleaned out his son's nose and mouth, and the 911 operator instructed him to clamp the umbilical cord with a shoelace. But his boots were covered in snow, so he used his iPhone charging cable instead.
A moment later, his son started crying.
He says it was a moment of relief after a traumatic experience.
"It leaves a scar in your mind forever," he said, "because to see your wife in [that] condition, and to have your baby in these circumstances.... It was –25 degrees out."
Sandhu, who immigrated from India with his family in 2010, was surprised to learn a city the size of Weyburn, with a population of around 10,000, didn't have maternity care.
Kornelsen says it would be unrealistic to expect every small community to have a maternity ward, but she says in areas where the population level warrants it, the provinces need to do more to bring back services.
Kornelsen says a "culture of risk aversion" has convinced some women they should only give birth in fully equipped hospitals capable of performing a C-section if required. But that's not necessary in most births, she says.
Most communities can use the midwives and nurses they already have in the area, and that can be supplemented with additional training and better access to emergency transportation.
"We are taking tentative first steps," she says.
"But I think we need to go further — and I am sure all the pregnant women across Canada would think that we have to move faster. "
A previous version of this story incorrectly stated there was no prenatal service in Fort Nelson. In fact, there is no intrapartum service.Feb 20, 2018 8:32 AM PT