title: Birth in Bella Bella: emergence and demise of a rural family medicine birthing service.
abstract: 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.
authors.affiliation: Family Medicine, University of Toronto in Ontario, Canada. ali.iglesias@utoronto.ca
authors.forename: Alexandra
authors.initials: A
authors.lastname: Iglesias
authors.forename: Stuart
authors.initials: S
authors.lastname: Iglesias
authors.forename: David
authors.initials: D
authors.lastname: Arnold
mesh_terms: 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*