Long wait times, rescheduled or cancelled appointments and lots of unanswered questions is what expectant parents are facing right now at Chinook Regional Hospital.
A lack of doctors in Alberta Health Services South Zone, specifically obstetrician-gynecologists, has led to what’s being called a crisis in women’s health.
Chinook Regional Hospital currently has three ob-gyns, one of whom is still currently on maternity leave and another who just recently returned from maternity leave.
Women’s health crisis: How we got here
Alexa Emshey thought she’d managed to dodge any issues with the ongoing ob-gyn shortage in Lethbridge when she became pregnant last year.
She was able to get in with an ob-gyn immediately, only to learn it was short-lived.
“Partway through my pregnancy, I found out she would be going on maternity leave as well, which meant the last small portion of my pregnancy I was going to be without care from her. I would be seeing one of her associates,” Emshey said.
She added the sudden change was scary and stressful. She wasn’t sure who or how she would be cared for as more and more ob-gyns left Lethbridge.
“It kind of became a situation of like: ‘How are they seeing all of these patients all of the time?'”
Dr. Aaron Low, south zone medical director with AHS, said the shortage started about a year ago with a series of unpredictable and unplanned departures.
For months, there was only one permanent doctor in the ob-gyn department.
“We had some unexpected medical leaves in addition to people who decided to leave relatively suddenly. And then maternity leave.
“So we have the medical leaves and then maternity leave and people decide to leave in an unexpected way. And so you could say: ‘Well, why didn’t you plan for this?’ Well, it was hard to plan for the things that happened,” Low said.
Emshey’s pregnancy proceeded smoothly, but that all changed when she went into labour to deliver her son.
“Edwin had been wrapped in his cord pretty good, which explains why I wasn’t progressing and dilating more, and his heart rate dropped.”
She was thankful for the skilled nurses and exceptional care she received during the difficult delivery, but she fears if things don’t change and more ob-gyns aren’t available, that won’t be the case for all new parents.
“It really opened my eyes to how important that care is because I’d had a completely healthy pregnancy for nine months, aside from morning sickness and stuff. He grew perfectly, there was no concerns, nothing was wrong, and in five minutes, I could have lost him,” Emshey said.
Roughly 20 different locum doctors travel from out of town to help cover shift shortages.
Calgary doctor Jonathan Cluett is one of those physicians and said things need to change now to prevent a tragedy later.
“It’s dangerous. The care is not optimal. Things are going to be missed and we are going to realize it after, when the data is put together, how much of an impact this has had.”
Despite the ongoing shortage, Low said expectant parents need to keep something important in mind.
“I want to be really clear: we have safe maternity care and that’s being provided on an ongoing basis,” he said.
Emshey said that reassurance isn’t enough. She says that as long as the shortage continues, she and her husband are holding off on trying for a second child.
“We should not be worried about whether or not we are getting a high standard of care,” Emshey said.
Women’s health crisis: The current situation
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Chinook Regional Hospital has had the help of locum doctors to cover ob-gyn care in Lethbridge. For months, they assisted the one permeant doctor who was managing all of the expectant parents in the Lethbridge region.
Dr. Marguerite Heyns was one of those locums working to help fill that void. She has concluded her duties in Lethbridge and has moved on to another community, but her introduction to ob-gyn care at the CRH was a lot to take in.
“It was a bit chaotic, to be honest, especially my first few shifts were incredibly busy.
“My first shift was a 36-hour shift because I signed up for it not really knowing what I was signing up for and I was on my feet for 34 of those 36 hours,” Heyns said.
It was the same experience for locum ob-gyn Dr. Cluett, who said the model in Lethbridge is concerning.
“I’m worried for the women I see and am taking care of in Lethbridge. I’m overwhelmed by the responsibility that happens on this singular shift, to be in three places at once,” Cluett said.
Heyns said an average day covering in Lethbridge typically meant doing the work of multiple physicians.
“Emergency coverage for gynecological services in the ER, it was doing all of the high-risk delivery upstairs and and the emergency C-sections that needed to occur for women who were actively labouring, and it was also covering this prenatal clinic which you also do on-call,” Heyns explained.
She said she has voiced concerns about the current model to Alberta Health Services.
“Just too many hats and too many tasks for one physician to be completing safely.
“That’s something I’ve been concerned about from the beginning.”
With so many things to juggle while on call, she says it puts everyone at risk.
“You are constantly spreading yourself too thin and that results in things being missed and patients not being seen in a timely matter and sometimes also result in crisis happening.”
These doctors said the hectic days of multi-tasking and managing the prenatal clinic mean shuffling patients and trying to stay on top of each person’s needs.
“Sometimes it’s busy enough that I and other locums have had to cancel the entire clinic so women will have been waiting two hours, three hours to see me and then are told to go home because it’s too busy and I can’t come down to see them, which feels awful,” Cluett said.
Low said despite the ob-gyn shortage, pregnant women are being given safe and dependable care.
He added AHS is working on improving scheduling at the prenatal clinic and on-call shifts, but added the clinic came together quickly to help address the shortage and acknowledges there is room for improvement.
“We are trying to sort that out. They still have to cover sometimes but we are doing the best we can with the few people we do have, so it’s still something we are working out,” Low said, adding: “The prenatal clinic is working well but it’s absolutely not perfect.”
Women’s health crisis: The path forward
AHS has been working hard to recruit ob-gyns and retain them, but in the meantime, other measures have been put in place to help ensure care for pregnant people.
One of those measures has been the addition of a prenatal clinic running within Chinook Regional Hospital Doctor. Sharon Rowan is one of the doctors working in the prenatal clinic, dedicating all of her time to the patients in the clinic.
She said the development of the clinic is giving a bit of light at the end of the tunnel.
“I think that it’s a great strength that has been born out of the crisis that’s been happening locally over the last six to nine months.”
Dr. Rowan is a family physician who works exclusively in obstetrics dealing with low-risk pregnancies.
She is one of a number of doctors from the community helping run the prenatal clinic for patients who have been referred or don’t have a family doctor.
“AHS establishing that prenatal clinic has been a huge help because it’s allowed groups of doctors who may have all worked independently previously to kind of coalesce all into one cohesive clinic,” Rowan said.
It is something that Low said has really helped in continuing safe and adequate care for pregnant people in Lethbridge.
Chinook Regional Hospital sees roughly 2,300 to 2,500 babies born each year, and the prenatal clinic is ensuring those parents have care leading up to delivery.
“We didn’t have budget for this,” Low said. “It was created because it was necessary, but long-term, we expect that it will be part of our solution. What exact shape that takes, we don’t know, but it’s going to stay.”
The prenatal clinic is small, and shares a space with another clinic, posing challenges like having to share desks and minimal exam rooms. Low said AHS acknowledges the location within the hospital isn’t perfect, but it’s still an asset.
“We recognize that it’s not in an ideal space to run the volume we might be able to run but we are doing the best we can. Right now there is no plans to move that clinic because there isn’t really any other place to move it without causing a domino effect.”
While AHS looks for more solutions for expectant patients, Cluett wants to make sure another group of patients isn’t forgotten.
“When we are talking about this crisis, what’s really important and being lost in the narrative is this is not just an obstetrical, pregnancy, pre-natal issue. Fifty per cent of what obstetrician-gynecologists do is gynecology, which is women’s health,” Cluett said.
Currently only emergent gynecology patients are being seen, with others being referred outside Lethbridge.
“We acknowledge that when you have to deliver a baby, you have to deliver a baby, and so that’s been our priority to get that care developed,” Low said.
“We know that we are not doing women’s health — the gynecology side of ob-gyn.
“The solution really is recruitment for our obstetrics and gynecologists,” Low added.
Low said AHS would ideally like to eventually have 12 full-time ob-gyns in Lethbridge, but eight would suffice. Low added he is in conversation with multiple ob-gyns.
“At any given time right now, we have about 10 to 15 that we are actively talking to, some that we are closer with than others,” Low said.
“We are hoping to get them to sign and then really get them working as soon as possible but we are very optimistic. We’ve had a number of good, really great obstetricians, Canadian-trained, who are eager and hopeful to come here.”
Alberta’s health minister was given a new mandate courtesy of Premier Danielle Smith in July.
In a letter to Adriana LaGrange, Smith specifically addressed the doctor shortage.
She is asking the health minister and her cabinet and caucus to support Albertans by “adding more obstetrics doctors for communities in need, including Lethbridge and Fort McMurray.”
Dr. Rowan said she hopes to see all levels of government and healthcare take a stand to improve what she calls a dire situation.
“The time now is rife for the system to support the provision of women’s healthcare in Alberta and particularly in southern Alberta.”
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