Pregnant women and babies who need emergency care during labour and childbirth could be put at risk if the overwhelming caseload that Canada's obstetricians face isn't alleviated, a report released Thursday suggests.

The Society of Obstetricians and Gynaecologists of Canada surveyed all 1,370 members, including residents and the heads of OB/GYN at Canada's 17 medical schools, about birthing care.

"The delivery of obstetrical services is at a breaking point in Canada," said Dr. Scott Farrell, president of the SOGC, and a professor at Dalhousie University in Halifax.

"Emergency deliveries are not predictable, and they are more common now because women are waiting longer to have children, are often significantly overweight, and have other challenging health concerns."

Some complications in pregnancy may result in the death of the woman or baby if they're not dealt with immediately, Farrell noted. For example, in shoulder dystocia, a woman may be pushing normally and the baby's head has emerged but an obstetrician needs to perform special manuoevres to deliver the baby within minutes, he said.

"That's the problem: obstetrics doesn't wait."

There are currently 1,370 obstetricians providing prenatal care as well as during and after birthing and delivery, a number that the group forecasts could go down by as much one-third over the next five years as current doctors retire and residents work fewer hours, limit their time on call, and take maternity or paternity leaves.

The OB/GYNs face 200 to 300 births per year and more. The majority of the respondents, 73 per cent, said they work 31 to 60 hours per week, excluding on-call shifts, and 42 per cent said they currently work 100 to 200 on-call hours per month.

Delivering away from home

The survey of 334 residents suggested many are planning to job share with other physicians, which means "one-in, one-out" retirement replacement is unrealistic, the report said.

A survey of Canadians who recently had a baby or who are planning to have one suggested women want continuity of care throughout their pregnancy, a role in prenatal and birthing decisions, and to give birth as close to home as possible.

Increasingly, women in smaller cities, towns and rural areas have to travel to ensure a safe and healthy delivery as smaller hospitals lack experienced staff who perform enough deliveries to maintain their skills, the group said.

Governments not only need to increase medical school enrolments but also address the lack of faculty and staff and teaching rooms, said Dr. Guylaine Lefebvre, SOGC's past-president.

Part of the solution would be to have family physicians, nurse practitioners and midwives perform more normal deliveries, but a new funding model is needed, Farrell said. Currently, whoever delivers a baby is paid, but the system doesn't account for those providing prenatal or care during labour, he said.

Accentium conducted the online survey in June 2008. The response rate was 53 per cent.

The study was funded by Health Canada.