Birth in Bella Bella: emergence and demise of a rural family medicine birthing service.

Objective: To explore a once successful rural maternity care program and the variables surrounding its closure.
Design: Analysis of archived logbook data, reports, and communications with medical staff.
Setting: Bella Bella, a Heiltsuk First Nation community on British Columbia's central coast.
Participants: Every patient delivering at the Bella Bella hospital since 1928.
Methods: We extracted delivery rates, cesarean section rates, and local perinatal and maternal mortality rates from the hospital logbooks. In 2003, a consultant's report reviewed the viability of surgical and maternity care services in Bella Bella; this was also reviewed. Finally, several personal communications with past and present medical staff added to an understanding of the issues that initially sustained and, in the end, closed the local maternity care program.
Main Findings: Bella Bella had an intrapartum service with operative backup, and intervention and perinatal mortality rates were comparable to national data. There was only 1 maternal death in 80 years of intrapartum service. In the 1990 s, with sparse cesarean section coverage, more mothers were obliged to travel to referral centres, until an eventual closure of the intrapartum care service in 2001.
Conclusion: Bella Bella provided safe and comprehensive maternity care until, in the context of an insufficient supply of family medicine generalists trained in anesthesia, surgery, and maternity care, the service closed.