In rural Alberta, giving birth can mean a long-distance road trip
Nicole Gauthier didn't expect she would be in an ambulance when she was in labour last fall with her first child.
The paramedic had planned for a home birth.
But when her daughter Emery was born, Gauthier's plan changed.
Gauthier lives in Plamondon, a small hamlet 200 kilometres northeast of Edmonton.
Her local hospital in Lac La Biche, 30 km southeast of Plamondon, hasn't had a doctor with anesthesia capabilities since May 2022. Staff are unable to provide epidural anesthesia or support high-risk deliveries.
"I got pregnant in February," said Gauthier. "We were hoping that by October — by my due date — we'd have hospital facilities available, so it wouldn't even be in question, but that was not the case."
Doctors told Gauthier the birth was expected to be low-risk, so she hired a midwife with a clinic within minutes from Gauthier's home, an acreage outside the hamlet of Plamondon.
But when she went into labour on Oct. 10, Gauthier's midwife told her the baby was breech. Emery's feet were folded up to her head. That hadn't been revealed in an earlier ultrasound.
She was still at home with her midwife so she had no choice but to be taken by ambulance two hours to Cold Lake, the closest hospital with an operating room.
Both Bonnyville and St. Paul have hospitals closer to Gauthier's home, but neither had enough staff to provide surgery at the time. Several hospitals in northeastern Alberta have had extended obstetrics closures in the last year.
En route, her midwife found she had dilated to 10 centimetres.
"I remember looking at my midwife asking her how far we were," Gauthier said. "She told me we were 30 minutes out. And I looked at her and I said, 'I don't know if I have 30 minutes.'"
Once she arrived at the hospital, Gauthier learned her baby's hips were stuck in her pelvis. Doctors immediately performed a caesarean section.
"I was actually able to see in the reflection of the lights during the C-section when they pulled her out," Gauthier said of Emery. "She was crying right away. She picked up right away. She did really, really well."
Stories like Gauthier's are becoming increasingly common in Alberta: hospital staffing shortages are forcing pregnant women to travel long distances to get the medical care they need for high-risk deliveries. Some who can't afford to travel in advance of their due date, or have to stay home for child care and other obligations, have few alternatives.
"We're concerned about women who want to give birth here and are not being given that option," said Ashlyn Moench, who started Mama Movement, a Lac La Biche advocacy group for parents who want improved local obstetrics care.
Moench's son was born in Lac La Biche 15 months ago by emergency C-section. She wants to have another child but worries she will have to travel to give birth next time.
"It was still a stressful situation and I can't imagine having to go to Edmonton for that," she said.
Bonnyville, the next closest community to Lac La Biche with a hospital that can do C-sections, suspended all obstetrics care from July 25 to Sept. 7 last year.
Bonnyville Mayor Elisa Brosseau said she can't recall another time since she was elected in 2017 when staff shortages have led to so many closures at the hospital. Some mothers from Bonnyville have had to give birth in Edmonton or Lloydminster, she said.
'Our new normal'
There is no date set for the operating room at the Lac La Biche hospital to reopen. Physician shortages are contributing to closures across the province.
"This is our new normal," said Chantal Gauthier-Vaillancourt, Gauthier's midwife.
Gauthier-Vaillancourt and her business partner Marianne King at Tree de la Vie Midwifery in Plamondon are the only two registered midwives in a large area of northeastern Alberta. They have clients from Athabasca to Lloydminster.
They have seen a significant increase in clients in the last year despite another midwife practice opening in Fort McMurray, Gauthier-Vaillancourt said. The lack of hospital resources has also changed the way she and her partner practise, she said.
In 2022 they added more procedures to their list of recommended prenatal tests. Long travel distances to hospital have made it even more important to clearly inform parents about the possible risks, she said.
"Transportation around here is as much of an issue as everything else, so in an emergency you can literally wait up to two hours sometimes for an ambulance, which is very stressful."
The pair of midwives at Tree de la Vie have delivered dozens of babies this winter. Both must be present at each birth. They are on call 24 hours a day.
Their practice supports clients from the beginning of pregnancy until five weeks after the baby is born. Some clients have been in labour as long as 40 hours.
"There's been no real reprieve for the last two years," Gauthier-Vaillancourt said.
After the only physician with anesthesia capabilities at the Lac La Biche hospital left in the spring, Alberta Health Services found a locum doctor to bring some relief more than half a year later.
The physician was expected to start a temporary position in January, but according to local doctors, she left over a contract dispute on her first day.
Dr. Tracy Lee Lindenberg, the only obstetrics doctor in Lac La Biche, said the lack of pregnancy-related resources throughout the region is troubling. Smaller hospitals in the region aren't equipped for obstetric emergencies, she said.
While midwives are a preferable local alternative for some, they can't support high-risk deliveries.
AHS covers the cost of hiring a midwife for obstetrics care and delivery, but not if the patient also has an obstetrician.
There are also some additional personal expenses for a home birth. Gauthier-Vaillancourt said booking the birthing suite at Tree de la Vie costs $400. For a home birth, the midwifery charges $100 for supplies.
Ambulance shortages can add even more complexity.
"It's definitely not ideal to have a baby in the car," Lindenberg said, "but if that ambulance is not available, it's kind of an impossible situation."
Gauthier's daughter Emery is now a curious, happy four-month-old. As a paramedic, Gauthier said she was well trained for the interrupted sleep schedule that goes with being a new mom.
She and her husband Derek want to have another baby, but next time, Gauthier plans to be near a hospital that can handle obstetric emergencies.
"[It's] kind of a shot in the dark when you go into labour if you have the [operating room] available or not," she said.
"It's very tough giving birth in a rural community right now."