Scope of Problem in Primary Maternity Care

The shortage of maternity care providers in Canada (including family physicians, obstetricians, nurses and midwives) is a well-documented crisis. It is believed that the impact of the human resource shortages can be addressed by maximizing the interaction and collaboration of health care providers through the implementation of multidisciplinary collaborative maternity care models with 24 hour / 365-day coverage for low risk intrapartum care.

However, significant barriers stand in the way of multidisciplinary collaborative primary maternity care. These include jurisdictional issues, flawed regulatory and funding mechanisms, a lack of policy development in professional associations and regulatory bodies, and medico-legal issues that prevent practitioners from collaborating. More specifically, the obstacles include:

Regulatory issues - There are a variety of regulations governing the provision of maternity care which are different from one health profession to the other, including delegated acts, supervisory acts, accountability with regulatory colleges, provincial and territorial governments and hospitals.

Limitations and inflexibility in scope of practice - There are significant limitations in the scope of practice of various health professions, as regulated by federal, provincial and territorial governments and professional health organizations. In addition, there is usually no flexibility in their implementation.

Financial and economic issues - Reimbursement mechanisms for health care providers are a significant barrier to collaborative care. There is a need to consider alternative reimbursement schemes for the funding of multidisciplinary maternity care teams.

Medico-legal and liability issues - Insurance companies do not work together to provide an integrated system of liability insurance. Health care providers working within a multidisciplinary collaborative primary maternity care team do not share common or equitable liability coverage. This encourages a silo approach to patient care.

Women and their families identify with a particular health care provider through which they access the larger health system. As a result, there is a lack of awareness and understanding of the different models of care that could be made available to women and their families.

Health care providers need to be encouraged to consider working within alternate models of primary maternity care. They require information on how to implement a multidisciplinary collaborative primary maternity care model within their health care setting (rural, urban, etc.).