Fort McMurray nurse looking to become a midwife turns to U.S. distance education

Maddie Amyotte says the lack of midwifery services in rural and remote communities and the lack of local educational options to train people to provide the services is a cause for concern.

Rural, remote communities without midwife services also lack local training programs

The number of registered midwives varies between provinces. Ontario has the most with 877 registered midwives. (Andrew Shurtleff/AP)

The day Maddie Amyotte, 28, a registered nurse in Fort McMurray, Alta., found out she was pregnant, she knew she wanted to use a midwife. But that wasn't going to be as easy as she thought.

"I traveled four hours away just to have a midwife during my pregnancies," said Amyotte.

Amyotte, a Métis woman originally from the Fort McMurray area, works primarily with women during pre- and post-natal care in the Indigenous communities in the RM of Wood Buffalo. She says the lack of midwifery services in rural and remote communities and the lack of local educational options to train people to provide the services is a cause for concern.

"There are very few Indigenous midwives, and midwives in Alberta in general," said Amyotte.

"There are lots and lots of Indigenous women who are wanting to become midwives, who would love to bring those services to their communities, but they would have to leave their communities in order to get their degree in midwifery."

The Regional Municipality of Wood Buffalo, located in the northeastern corner of Alberta, is the second largest municipality in the province in area, comprising 68,000 hectares.

The area includes Mikisew Cree First Nation, Athabasca Chipewyan First Nation, Fort McKay First Nation, Fort McMurray First Nation and Chipewyan Prairie Dene First Nation.

According to the Canadian Midwives Association website, there are currently six midwifery education programs in the country — one in Quebec, three in Ontario, one in Alberta and one in B.C. Amyotte's closest option would have been the Mount Royal University program in Calgary — 750 km away.

"In Canada we have very few options in terms of education for midwifery," she said.

"There are only two educational programs on the west side of the country and neither of those are anywhere close to where I live."

Being a new mother and having already put roots down in Fort McMurray, Amyotte said moving wasn't an option, so she began to search for other alternatives to obtain the certification.

Now Amyotte is enrolled in the Frontier Nursing University out of Kentucky in the U.S, the only distance education option that was available. She has estimated she spent close to $25,000 on her tuition, books and travel costs for her clinical placement and says she is expecting even more.

"It has been a lot of hurdles to get to this point," said Amyotte.

'The want is there'

There are approximately 1,700 registered midwives across the country, with the majority of those being in Ontario. It is estimated that there are 115 registered midwives in Alberta, with the majority of them located in the southern part of the province in larger cities and some rural areas.

There are currently no midwives in the Wood Buffalo region of the province, there is currently an open call out for the position. 

Kayla Lushman, a co-chair with the Wood Buffalo Women and Baby Care Association, an organization that advocates for maternity care choices in northern Alberta, said midwives in Indigenous communities would greatly improve community-based birthing options.

"Our organization did a survey of 884 respondents and 50 per cent of respondents said they would choose a midwife. So the want is there, we just need to fill those spots," said Lushman.

Currently, depending on their location, pregnant women in the surrounding communities have a two to four drive to the Fort McMurray hospital to give birth.

The association hopes recruiting a midwife would mean that they can practise in the local health centre and be able to provide clinical placements and shadowing for other prospective midwives in training.

Successes elsewhere

A program in the Nunavik region of Northern Quebec has been providing midwifery care to Inuit communities and training local women to become midwives for 30 years.

Three Nunavik communities have birthing centres staffed by midwives that serve seven villages. The Puvirnituq Maternity Centre has been delivering babies since 1989, and the most recent centre opened its doors in 2004.

"It was very much the communities that wanted it," said Jennie Stonier, senior mentor midwife for the Nunavik region. 

Stonier said about 84-89 per cent of the babies born in northern Quebec are now born within their own communities, instead of flying women to a city to give birth. 

"It keeps families together number one; it keeps the birth normal," said Stonier.

Stonier said bringing birthing back to the communities was an initiative propelled by the villages' elders. 

"Now we are seeing families together — children are also present during births," she said.

She said having those family and cultural supports available is important for pregnant women in Indigenous communities anywhere in Canada.

Funding for midwifery services

In 2017, the federal government allotted $6.2 million over five years to First Nations and Inuit midwifery services. Since then, Indigenous Services has began to allocate funding to programs put in place for midwifery initiatives.

There are two categories: projects on a larger scale where communities are at a stage to establish midwifery services within their communities and smaller scale developmental projects where communities are beginning to raise awareness and build up capacity for the introduction of midwifery services.

"So it can include training for support workers, nurses, and doulas," said Valerie Gideon, senior assistant deputy minister for First Nations and Inuit Health at Indigenous Services Canada.

"We have provided the flexibility to these communities to look at what will make sense for them."

The National Aboriginal Council of Midwives of Canada represents Indigenous midwives across the country and is looking to help regional organizations like Wood Buffalo Women and Baby Care Association.

"I think if we have our dream scenario it would be that we have access to culturally safe midwifery education as possible," said Claire Dion Fletcher, co-chair of the National Aboriginal Council of Midwives.

Amyotte is still hoping to one day practise midwifery in the communities around Fort McMurray, and fulfil her dream.

She said bringing birthing back to communities through midwifery can "bring the biggest change to the health and wellness of the family in bringing back the culture and the importance of cultural tradition."