Nova Scotia's recent move to regulate midwifery and fund services in only three areas is forcing a 21-year veteran midwife out of the business.
Louise MacDonald plans to close her business in the Annapolis Valley, one of the regions excluded from the government's initial plans.
"I don't feel very good about it," said MacDonald, who has been lobbying for government-funded midwifery services for 30 years. "The families that I've cared for don't feel very good about it."
The Department of Health is funding two full-time and two part-time midwives at the IWK Health Centre in Halifax, and two full-time positions each at the hospitals in Antigonish and Bridgewater.
Publicly funded midwifery services will be available for home or hospital-based childbirth in Halifax and Bridgewater, and at the hospital only in Antigonish.
The eventual goal is to expand publicly funded midwifery services to other parts of the province.
Until then, midwives outside those three areas could be forced out of work, which means less access to those services for expectant mothers, said MacDonald.
University degree required
Though private midwifery is still permitted, midwives need a university degree in the field or recent certification from another province. They also have to buy malpractice insurance, which MacDonald said can be very expensive.
Angela Johnston of Port Williams wonders what she'll do without a midwife.
"For my next birth, it's not just planning my life, it's planning my next battle because I won't have a birth where I have to plan to go to the hospital," said Johnston.
Kelly Chisholm, with the Association of Nova Scotia Midwives, admits the long wait for regulation has split the profession.
"It's one of those sad realities of regulation. But the main point of regulation — which we have supported the government throughout this whole process — is to ensure public safety," Chisholm said.
The Midwifery Act, passed in 2006, takes effect Wednesday.
The Guysborough Antigonish Strait Health Authority, which oversees St. Martha's Regional Hospital in Antigonish, expects its two midwives will begin work in June.
Dr. Jeremy Hilliard, the district's chief of staff, said the midwives are expected to deliver 80 of the approximately 480 babies born in the region each year.
"The big advantage in labour or during delivery is that they can spend a lot of time with the women," he said. "And we hope that by having midwives working with us, we'll have a reduced rate of interventions in those low-risk pregnancies."