Friday September 26, 2014

Haves & Have Nots: Midwifery in Canada

where's midwife

Protesters decry the lack of midwives in P.E.I at a 2012 rally. Newfoundland & Labrador the Yukon Territories don't have licensed midwives either. (Federico Cahis/CBC)

In the Netherlands, they've had midwives since the 1600s.  In Sweden, the first midwifery school opened in 1711.  In developing countries, they're the go-to professionals for low risk births. In Canada overall, midwives attend just 4.3 percent of all births.  At 70 percent, obstetrician-gynecologists do the lion's share - including many of the low risk births that midwives could do easily. Part of that might be explained by the fact in Canada, being able to have a midwife, depends entirely on where you live. 

This week on White Coat, Black Art -  a check up on midwifery in Canada. We look at the state of midwifery in the 'have and have-not' provinces of Ontario and Newfoundland. 

In Ontario midwives have been licensed for 20 years and the province is now piloting two midwife-led birth centres.  Midwife Sarah Wolfe of Seventh Generation Midwives gives us a tour of   Toronto's new birth centre which she hopes is just the first step in putting Ontario midwives at the forefront of low risk births. 

"I think that 70 per cent of people have normal births, so why can't 70 percent have access to midwifery care," says Wolfe. 

Midwives at the Toronto Birth Centre expect to deliver 450 babies this year -- but Wolfe sees the potential for midwives to attend many more low-risk births and even expand their scope of practice. 

"The time is coming for midwifery to look at what are the different ways we can practice midwifery and how can we maintain and stay true the model and still be innovative. Do we have midwives working in hospitals in more leadership roles, do we have midwives working more in community, or have midwives working in expanded scopes perhaps with more high risk families?" 
Meanwhile, in Newfoundland, the province doesn't have a single licensed midwife -- something the government has promised to change. But with an election in the offing, long time midwives  Karene Tweedie and Ann Noseworthy are feeling anxious about whether that promise will be kept.

"I could have gone elsewhere. I guess my love of Newfoundland kept me here. But I have to say, I always thought, it's going to happen. I don't need to move to Ontario. I'll stay here and I'll be practising midwifery. Now I'm thinking I might be dead before it happens," Karene Tweedie told Dr. Goldman. 

Leading Canadian health researcher  Ivy Bourgeault  argues that provinces would actually save money in the long run if they relied more on midwives for uncomplicated births and less on obstetricians. 

"Data shows midwifery care results in lower rates of intervention in child birth, such as epidurals, episiotomies and instrumental delivers. So all of those things cost the system more money....The question to ask is, what is the cost of not having midwives attend low-risk pregancies?"