You've pretty much described our situation. I even got my fingers slapped about 15 years ago because we were running L&S to the L&D with a maternity and the Ministry of Health told me that I am trained in childbirth and there is no need for us to be in a rush. Here's the problem, the only way to determine if birth is imminent (besides the obvious crowning and other external signs) is an internal exam. Not even our ALS providers have that in their scope. Our local hospital can do imminent childbirths and will keep the patient in the hospital if it appears the mother will deliver within the hour, but, 95% of the time the labour has just started and might be 2 - 3 cm, basically, the ambulance is a taxi ride to the L&D. Our local docs are being over taxed with unnecessary ER visits and are seeking ways to reduce being phoned at home in the middle of the night. In the case of a maternity, they come down, assess the patient, and send her to an obs. Waste of time for the mother and ruins his night. What he would like is for us to take these maternity patients direct to the obs instead.
I'm fine with the idea, but he and we both answer to the public via the health region board of directors and the Ministy of Health. It is they whom we need to persuade to permit this bypass. Our Emerg can handle childbirth, but there are two types, elective and emergent. Our ER doesn't do Elective Childbirths and will only do Emergent (imminent).
I hope I didn't muddy the waters any more.