The costs of separation: The birth experiences of women in isolated and remote communities in British Columbia

Cet article est le risultat d'une enqukte qualitative des expkriences dhccoucbkes dans les communautks kloignkes de la Colombie-Britannique. Les rksultats donnent uneplus haut tauxde mortalitk causkepar lbbligation pour lesfemmes de quitter leur communautk pour accoucber. There has been a precipitous decline during the past few years in the number of rural communities across Canada offering local maternity care services (Hutton-Czapski 200 1, 2000; Rourke). There have been sev-eralcontributors to this trend includ-ing health service delivery restructur-ing, difficulties in physician reten-tion and recruitment in rural com-munities (Statement ofMaternity and Newborn Care in Canada), and the trend towards the "medicalization" of childbirth in industrialized coun-tries (Wiegers). Communities that have lost services now join other small rural and remote communities where, due to health human resource capac-ity, geographic isolation, and econo-mies of scale, local birth has not been part of the health services infrastruc-ture for several decades. Pregnant women in these small communities face significant challenges to access-ing care, which in many instances leads to stress and anxiety during the childbearing year (Kornelsen and Grzybowski 2004b; Chamberlain and Barclay). There is a growing understanding of the physiological consequences of stress during pregnancy, with research focusing primarily on the relation-ship between stress and preterm la-bour (Mackey and Boyle; Misra