When Amber Tapley went into labour with her first child, she jumped in a car and drove two and a half hours west.
The Sydney, N.S., woman was determined to have a midwife deliver her baby and throughout her pregnancy had travelled to Antigonish, the closest town with registered midwives.
With just three areas of Nova Scotia providing the service, Tapley's experience isn't unique, despite repeated calls from moms who want to access the service where they live.
"It seems ridiculous that I would have to be in a car for two and a half hours to access services that could be offered here," Tapley told CBC's Information Morning.
"There's a lot of people I talk to and they would love to have a midwife but it's not an option, and for most people their lives don't allow them to travel."
By the time Tapley arrived at the hospital in Antigonish, the two midwives were no longer working so a doctor delivered her baby.
'Big concern' for rural areas
That was six years ago, and the Midwifery Coalition of Nova Scotia says little has changed in terms of access.
The group is urging people to mail purple postcards to the provincial government to lobby for provincewide access. Midwives currently operate out of Antigonish, the South Shore and Halifax.
Before midwifery became regulated in Nova Scotia, women had to pay out of pocket for the service. In 2009, midwives began working from hospitals and had access to blood work and ultrasounds.
But there were negative consequences too, said Renee Meuse Bishara, a member of the coalition's board.
"Seven years ago, more women actually had access than they do now," she said. "The Annapolis Valley had a very lively midwifery practice and culture and they've had zero access ... so it's a big concern for that area."
In 2011, a team of consultants was tasked by the province to research the challenges of regulating midwifery care. Their report recommended increasing the complement of midwives to 20 from nine. But changes to the Nova Scotia Health Authority and a strapped health-care budget mean that still hasn't happened.
"But the dust is settling a bit so we feel like it's a good time to look at this again," said Meuse Bishara.
According to the Canadian Association of Midwives, in 2016 midwives attended an average of 2.8 per cent of all births in Nova Scotia, compared with more than 20 per cent in B.C. and about 15 per cent in Ontario.
The fight to regulate the profession began in the early '90s when midwifery was seen as "very much of an alternative, fringe movement," said longtime midwife Maren Dietze.
Dietze, who recently ended her career on the South Shore, says midwives are now seen as an important aspect of maternal health, especially for marginalized populations and women in rural regions.
"People are ready now for it on the government, health authority side, midwives and nurses side and I'm not quite sure what's holding it up now," she said.
Provincial planning underway
The Nova Scotia Healthy Authority says it's working on a health services plan, which includes midwifery, that will result in recommendations to the province by the end of the year.
Sally Loring, senior director of maternal and child health, says examples like Tapley's are good to hear because it lets the health authority know where the needs are.
But expanding the service will require more money. Each midwife employed by the Nova Scotia Health Authority costs the province about $100,000 a year including salary, benefits and pension, but there's also travel and set-up costs to consider, said Loring.
"It's not just midwifery," she said. "We have to be fiscally responsible and there are other top-ticket items that will be required across the province to assist with health care."