DILEMMA OF RURAL OBSTETRICS - ONE COMMUNITY SOLUTION

PROBLEM BEING ADDRESSED Increasing workload and concerns about physici an exhaustion necessitated reorganizing the delivery of obstetric serv ices on Manitoulin Island in Ontario. OBJECTIVE OF PROGRAM To organize obstetrics in a remote rural community to provide safe, accessible ca re, improve working conditions for local physicians, and involve the l ocal hospital and health care workers in the solution. MAIN COMPONENTS OF PROGRAM A prenatal clinic for all obstetric care on the island was established. It was based at the local hospital and organized by a nu rse-midwife. Local physicians rotated through the clinic and provided obstetric coverage on their on-call days. CONCLUSIONS The clinic has h elped improve working conditions for local physicians and maintain hig h-quality obstetric care in this remote area. Local women's initial re sistance to the clinic seems to be disappearing with time. Ongoing cha rt audits reveal intervention rates similar to those found in other Ca nadian studies of rural obstetric care.