Concern is not based on evidence.

Rural maternity care I can certainly relate to Dr de Leeuw’s article in the July issue of Canadian Family Physician.1 My family practice started in Flin Flon in northern Manitoba in 1972. We safely delivered many babies with GP obstetricians, anesthetists, and surgeons. We had a good rapport with our specialist colleagues in Winnipeg, Man. I moved to Mission, BC, in the Fraser Valley in 1976 and continued to provide maternity care with my GP colleagues. We had access to specialty care in Abbotsford, BC, but we essentially ran a GP maternity unit. Then the regionalization mentioned in the article occurred. We lost our maternity unit, intensive care unit, and pediatric ward, and with this loss came the dilution and eventual loss of our GP anesthetists and surgeons. I also discontinued obstetric care. These were meaningful losses to our community and women had to go elsewhere to deliver. However, in 2005, I started providing locums in the Northwest Territories, particularly in Fort Smith, Hay River, and Fort Simpson. Even at that time there was a tendency to electively transfer women to Yellowknife for delivery. The importance of community celebrations around birth mentioned in this article cannot be underestimated. Births in Yellowknife denied families this important cultural event. Fortunately, with the efforts of a group of dedicated midwives supported by traditional midwives, there is a robust midwifery program in Fort Smith and another developing in Hay River. Hopefully more programs will be initiated. Is there a message for the training programs in support of rural obstetric care? It comes down to effective training and mentoring of students and residents. It means giving the opportunity for GP anesthetists, surgeons, and obstetricians to provide appropriate and safe care in rural settings. It means support for the referral centres and their connections to the rural communities. And perhaps most important, it means support of midwifery and nurse practitioner programs and integration of medical training with their programs. Our rural communities deserve better. —Chris A. Finch MD CCFP Vancouver, BC