Birth in Bella Bella: emergence and demise of a rural family medicine birthing service.
OBJECTIVE
To explore a once successful rural maternity care program and the variables surrounding its closure.


METHODS
Analysis of archived logbook data, reports, and communications with medical staff.


METHODS
Bella Bella, a Heiltsuk First Nation community on British Columbia's central coast.


METHODS
Every patient delivering at the Bella Bella hospital since 1928.


METHODS
We extracted delivery rates, cesarean section rates, and local perinatal and maternal mortality rates from the hospital logbooks. In 2003, a consultant's report reviewed the viability of surgical and maternity care services in Bella Bella; this was also reviewed. Finally, several personal communications with past and present medical staff added to an understanding of the issues that initially sustained and, in the end, closed the local maternity care program.


RESULTS
Bella Bella had an intrapartum service with operative backup, and intervention and perinatal mortality rates were comparable to national data. There was only 1 maternal death in 80 years of intrapartum service. In the 1990 s, with sparse cesarean section coverage, more mothers were obliged to travel to referral centres, until an eventual closure of the intrapartum care service in 2001.


CONCLUSIONS
Bella Bella provided safe and comprehensive maternity care until, in the context of an insufficient supply of family medicine generalists trained in anesthesia, surgery, and maternity care, the service closed.
Iglesias
Alexandra
A
Family Medicine, University of Toronto in Ontario, Canada. ali.iglesias@utoronto.ca
Iglesias
Stuart
S
Arnold
David
D
D001719:Birth Certificates; D016550:Birthing Centers / Q000706:statistics & numerical data*; D001955:British Columbia; D002585:Cesarean Section / Q000706:statistics & numerical data; D003625:Data Collection; D005260:Female; D006271:Health Facility Closure; D006276:Health Facility Size; D006303:Health Services, Indigenous / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*