The Northwest Territories’ largest hospital no longer has enough staff to handle births and will instead send families to Edmonton for weeks at a time.
Staff and expecting families were told on Monday that anyone set to give birth at Stanton Territorial Hospital between December 10 and February 21 “must expect to travel outside Yellowknife to give birth.”
Regular birthing services are being suspended. An emergency service will remain, such as for preterm births or urgent prenatal assessments.
The territory’s health authority says there are simply too few trained staff to safely operate the obstetrics unit. According to the health authority, this is the second time Stanton has transferred birthing services. The first was in 2002.
Affected families who had been set to give birth in Yellowknife were being contacted on Monday. Services in Inuvik, Hay River, and Fort Smith aren’t impacted. Some Sahtu families may be allowed to transfer to Inuvik.
In a document circulated to staff, the NWT’s health authority wrote: “In most cases, travel will be arranged for during or before the 37th week of pregnancy. For those impacted, they will have their care transferred to Edmonton as our main referral site for care and services.”
The document adds: “Duration of stay will differ depending on how pregnancy progresses. Individuals can expect to be in Edmonton for three to five weeks, but it may be longer or shorter.
“A support person or partner – a non-medical escort – is approved for all those travelling to give birth. Individuals can expect direct outreach from NTHSSA staff to discuss their situation, timelines, needs, and to answer questions.”
Families wishing to bring more than one member in support must do so at their own expense.
Those travelling will be supported by the NWT’s medical travel program. The health authority said Alberta officials had confirmed the province’s healthcare system is “confident” it can provide the care needed.
In a statement, NWT health authority chief executive Kim Riles said: “These are difficult circumstances and decisions and we empathize with everyone whose birth plan is now changing. However, we want people who are impacted to know that at the core of this decision is the safety of them and their newborn child.”
All options ‘exhausted’
The hospital’s inability to operate such a core service is the latest in a series of crises to affect the health authority. Some are related to staffing and others to the infrastructure itself, such as leaks in the two-year-old building and an inability to deliver oxygen at the level Covid-19 patients in intensive care ideally require. For months, surgical equipment could not be properly sterilized.
Meanwhile, morale among Stanton staff is understood to remain low. Various hospital workers recently wrote to health minister Julie Green to say as much, claiming they felt neglected compared to provincial counterparts in the way they had been compensated for their efforts during the Covid-19 pandemic.
In explaining the latest staffing shortage, the territory’s health authority referred to the nationwide shortage of nurses that is playing out alongside the NWT’s own problems.
“The obstetrics unit is required to provide 24/7 services to residents across the NWT. For safe staffing levels, Stanton would have two shifts each day, with each shift staffed by three nurses with specialized training and skills in labour and delivery or obstetrics,” the health authority wrote.
“The standard of care is one-to-one nurse to patient ratios during active labour and delivery. Current staffing levels are not adequate to guarantee these ratios can be met. They also are not at a level to support surge capacity that is required to operate a safe obstetrics unit in periods of high demand.
“Capacity that does exist will be retained to ensure readiness to provide emergency and urgent obstetric care.”
The health authority said remaining obstetrics staff had already agreed “to cover shifts above and beyond usual levels,” while other staff with relevant experience had been asked to redeploy. Nursing agencies have been approached.
An email sent to Stanton staff on Monday, signed by chief operating officer Georgina Veldhorst and medical director Claudia Kraft, acknowledged: “This is a difficult situation and will undoubtedly have an impact on pregnant individuals and their families over the next few months.”
Veldhorst and Kraft wrote: “At the core of this decision is patient safety, as this is always our priority. Staffing levels, specifically nursing, within this unit at Stanton in the months of December and January are such that it will not be possible to ensure safe staffing for regular volumes of labour and delivery services.
“This is despite past, current, and ongoing efforts to exhaust all possible options to staff this service and nursing positions across the territory. These specialized nursing roles are in high demand across the country and we are competing with all other jurisdictions for the same pool of talent.”
The email reiterated a call for staff to redeploy. “We have a most acute need between now and December 12 for staff,” it stated.
Travel vaccination questions
Generally, around 160 births are recorded in the Northwest Territories in the months of December, January, and February. The majority of those would be expected to occur at Stanton.
The cost of now sending dozens of families south for weeks at a time was not estimated in documents produced by the health authority on Monday. Beyond the financial implications, expecting families now face weeks of surprise and vast upheaval at what is already an uncertain time, particularly for prospective first-time parents.
The Covid-19 pandemic only further complicates that.
“Up to November 30, individuals who are unvaccinated can travel with proof of a negative Covid-19 test … provided at the airport,” the health authority’s documentation stated.
“NTHSSA is working to determine what the process will be for anyone travelling after November 30 and will provide more information when this is clear.”
Following the circulation of that document, the federal government issued new advice regarding air travel from November 30. That federal advice appears to suggest medical exemptions to vaccination will be available.
A spokesperson for the NWT’s health authority said families returning after giving birth in Alberta would be able to apply to the chief public health officer for an exemption from isolation. Technically – as the baby would be unvaccinated – families without such an exemption would be expected to isolate, ordinarily for 10 days.