I want to think out loud about the implications of a person being forced to leave their home community in order to have a baby. /~22 https://twitter.com/janisirwin/status/1247683260429168640

Ideal scenario: birthing parent (BP) knows they have to travel, they know close friends or family where they are travelling to, they don’t need to pay for somewhere to stay or for childcare, and labour, delivery, and postpartum all go perfectly, they are probably home 4-7 days pp

That ideal scenario sounds pretty far fetched already, right? So let’s see what reality looks like:

Let’s start with prenatal care... does the BP have a physician* locally that can give prenatal care? If they do, that’s great, except that doc won’t travel with them when they leave to deliver, so that means the doc that delivers doesn’t have any rapport built with the BP. Risky.

They don’t have a local doc that can do prenatal care? Well, that means they will probably need to travel for appointments: Every 4wks until 28wks, every 2wks until 36wks, and every week after 36 weeks. If they are high risk, double that frequency.

One of the major causes of deaths in our provinces is motor vehicle collisions. Do you think driving an hour or more one direction, at that frequency, increases your risk of being in an MVC? It sure does. And again, where do they stay? How do they afford travel costs?

Okay so the BP is now due to have their baby. If they have to deliver over an hour away, they have 3 options: stay in the place they’re delivering well in advance of being in labour, leave when labour starts, or schedule a cesarean.

If they pick the first option, where do they stay, and how do they pay for it? Do they bring other children with them, or do they leave them behind with someone? If their partner is working, that further complicates it, not just for the parents but the other children.

Older siblings can have a hard time coping with the transition that is having a new baby in the house. If that child is young, they may perceive their parents leaving for several weeks as abandonment, which makes the transition much harder.

If the BP takes their children with them, do they have childcare in their destination city? Where will their child be while they labour? During the postpartum?

Let’s say they pick option 2: labour is unpredictable. Sure, the average first timer has a 14 hour labour, but I’ve caught a baby 30 minutes after a first timer felt a little bit of indigestion, but had no strong labour signs. If this isn’t their first labour, it can be quicker.

It’s possible they’ll make it in time, but it’s also possible they won’t. Active labour contractions are DISTRACTING. I would not advise any of my clients to drive in active labour unless it was a DIRE emergency. So, is someone driving them? Or do they drive and risk it?

What happens if as they deliver their baby on the side of the road, alone, they have a shoulder dystocia, haemorrhage, or cord prolapse? If any of those complications happen with out an attendant, the risk of injury or death to parent and baby can be very high.

What happens if they make it to the hospital, only for the hospital to say “it’s too early, go home”? Do they go all the way back home or do they find a place to stay? How much does that cost?

The third option:
A scheduled cesarean. First, that’s MAJOR ABDOMINAL SURGERY, so that comes with it’s own set of risks, including increased risk of haemorrhage, infection, and worse, and makes postpartum recovery substantially more difficult.

Second, it means they definitely have to travel for prenatal care, as the OBGYN usually won’t do a scheduled C on someone they’ve never met.
Third, they’re staying in town for a bit postpartum, because they can’t go for a long drive with a new abdominal incision.

If they have older kids, they can’t pick them up for at least six weeks after a c-section. A C impacts older siblings as well.

If they blow their stitches, they have to travel back to the other place to have surgery again.

Postpartum haemorrhage can happen days after delivery and secondary postpartum haemorrhage can occur up to 12 weeks postpartum.
If their local hospital doesn’t have obstetrical services, they won’t be set up for those type of emergencies in the same way as before.

What happens if they go into premature labour? That’s a whole other set of questions. What happens if following their premature labour their baby is in the NICU? More questions.

If birthing people have to be away for their communities for anywhere from 1-26+ weeks, that means they are away from their support systems for that long too. Having a support system is a major determinant of postpartum health; any health, for that matter.

What the UCP is doing to physicians, and rural birthing people, is thoughtless, and reckless, and will increase poor outcomes. My heart breaks for all the pregnant people impacted by this.

*Footnote: I say physician, because Registered Midwives in Alberta are not allowed to practice more than 1 hour away from a hospital with obstetrical capacity.