Some Canadian doctors say they’ve noticed an increase in so-called “birth tourism” patients who may present ethical and legal challenges for health care professionals.

Dr. Fiona Mattatall, a gynecologist and University of Calgary professor, told CTV News that hospitals in Calgary have seen an increase in uninsured patients from overseas who come to Canada to deliver their babies with the sole purpose of gaining citizenship for their child.

“I am not sure most Canadians are aware of this way to obtain citizenship without going through proper channels,” said Mattatall.

Her research showed these “passport baby” births increased from 67 in 2013 (0.5 per cent of total births) to 112 in 2015 (0.8 per cent of total births) in Calgary. She outlined her findings at a recent Society of Obstetricians and Gynecologists of Canada conference in Vancouver.

“They are small numbers, but the concern that we have is they do indicate a trend up,” Mattatall said in an interview with CTV News.

She also said that caring for those patients is “complex and challenging” for multi-disciplinary teams, which can involve a midwife, an obstetrician, a family physician, a pediatrician and sometimes an anesthetist. Sometimes patients pay. Sometimes they do not.

“I think the potential harm in all of this is a matter of fairness and I feel that I work in a health care system that is limited in terms of dollars and resources,” Mattatall said. “Sometimes we are very stretched in terms of providing care to our own patients who are insured in Canada and I think the challenge I have from patients coming from overseas to use our services. It does take away from our own patients.”

The issue of “birth tourism” is being debated once again, after a B.C. woman launched a petition to end the practice.

Mattatall’s study found that the majority of doctors in Calgary feel ethically obligated to provide emergency care for patients who came to Canada for the purpose of obtaining citizenship for their babies. However, many do not feel an ethical obligation to provide non-emergency preventive prenatal care to such patients.

Mattatal said she personally saw one patient from the U.S. who came four times to Calgary to have a child, “and explicitly stated each time that she was here to obtain citizenship.”

“I felt in a way I was becoming the gatekeeper for healthcare and for citizenship for the child,” she said.

Saul Pytka, an Alberta anesthesiologist, says the practice is putting doctors in a bind.

“We are in a bit of a dilemma because we have to provide care but at the same time I feel we are being taken advantage of,” he said.

Pytka said he decided to speak out because he is “frustrated” and “angered by the fact that as a society we are being abused.”

“I think we are a very generous society,” he said.

Some doctors are also concerned about treating uninsured “birth tourists” in case the patient subsequently launches a lawsuit related to the medical care received in Canada. The Canadian Medical Protective Association says in a statement to CTV News that “physicians are generally given medical liability protection by the CMPA for medical care provided in Canada. That would include medical care provided to patients who give birth in a Canadian hospital regardless of that patient’s country of origin or their personal motivations. “

With a report from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip