The Midwives Club

Lucy Sanna was pregnant with her second child when her maternal instincts for an alternative care option kicked in. She had mused about midwifery during her first pregnancy, but as other women before and after her, wasn’t so certain about its scope of practice. She wondered about its quality of care, safety and benefits. She wondered if there was a fee. Heeding the referrals of others, she placed a call to a midwifery clinic near her place of work in Etobicoke, Ont. “I was trying to figure out what to do. I have two cousins of mine who went with midwives as well, and they tried to convince me from the beginning with my first [pregnancy] to go, and the second time, I said, ‘that’s it, I’m going to do it,’” recalls the Bolton, Ont. resident. Nine months later, Sanna welcomed a full-term, healthy baby girl she and her husband named Mariah.

Apart from selecting baby names and paint chips for the nursery, women in Canada have choices when it comes to where, how and who will deliver their little one. But with more babies being born, a maternal health-care crisis looms due to a shortage of delivering doctors and a slowly growing number of midwives.

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Sanna’s decision on a midwife-assisted pregnancy reflects the burgeoning interest of Canadian women who are considering the alternative birthing experience. While Sanna – as well as other women – expressed initial hesitancy in embracing the practice, others like her are pushing past the archaic perceptions of a practice that smoothly transitions women into motherhood while relieving pressure off delivering doctors and obstetricians. “More women are hearing about midwifery, are knowing that it’s an option,” says Kara Brockington, who received a bachelor of health sciences in midwifery degree in 2004. “I would say seven years ago [that] I wasn’t seeing that quite often. A woman would come to us in her second pregnancy and she would say, ‘I didn’t know I could have a midwife.’” Brockington is employed at Midwives of York Region in Newmarket, which has hospital privileges at South Lake Regional Health Centre. In February of this year, the clinic expanded into Vaughan with Family Care Midwives, which services women in Woodbridge, Thornhill, Richmond Hill, Concord, King City and Oak Ridges. The practice, which has hospital privileges at York Central Hospital, is open to helping women in other areas as well.

According to The Canadian Perinatal Surveillance System’s Canadian Maternity Experiences Survey (MES) 2006 – 2007, 71.1 per cent of women praised their labour and birth experience with a midwife as a positive experience. “It was always, ‘here are your options, this is your pregnancy, this is your birth.’ My midwives would check with me before proceeding with everything. I felt in control of my situation,” says Sanna.

Midwives are recognized health-care professionals that provide primary care to low-risk healthy women during pregnancy, labour and birth with a personal and attentive approach. Once a family physician confirms a pregnancy, one can contact a midwifery practice that services her area to schedule prenatal appointments at its clinic, just as you would do with a doctor. No referral from a general practitioner is needed. Conducting care in groups of two, midwives are trained in spontaneous vaginal deliveries. They stay by your side for the duration of your delivery – sometimes up to 24 hours. A midwife’s post-partum care brings many benefits to a tired mom, with home visits up to six weeks after delivery. “I would see them every couple weeks and the last four weeks every week, and they were with me the whole delivery,” recalls Sanna. “It’s nice, too, because instead of getting nurses that are changing shifts, I had my two best friends there, my midwives, that I had known for nine months. I had my friends there that were going to help me through this and they knew what they were doing.”

Every two years, midwives must re-certify in CPR, neo-natal resuscitation, post-partum hemorrhaging, breached deliveries, and other emergency skills. If a complication or emergency caesarian-section is needed, transfer of care to a delivering physician or OB/GYN is immediately arranged. Registered midwives also provide pregnant women with the same tests that doctors order, like genetic screening and ultrasounds. They can prescribe various medications, and some are now able to administer an epidural if you so choose to have it. Midwives are considered colleagues by medical doctors, and have hospital privileges, allowing an expectant woman to decide between an at-home or hospital birth. However, those unfamiliar with the practice may circulate uninformed views of midwifery, which include untrained labour coaches using aromatic oils during at-home births. “The demand for midwifery has spread through word-of-mouth … but there are myths out there,” says Lisa Weston, a midwife and president-elect of the Association of Ontario Midwives. “A lot of people think you have to pay for midwifery care. Clients say, ‘when I tell people the kind of care I got and that you came and did home visits and that someone was available for me all the time by pager, they asked me how much I had to pay for it. They were amazed when I said they didn’t.’” In 1994, Ontario became the first province in Canada to regulate and support midwifery. The Ontario Ministry of Health and Long-Term Care fully funds midwifery services.

According to a Statistics Canada report, there were 377,886 live births across the nation in 2008. A disparity between the rising number of births and available human resources in Canada is placing a strain on our maternal care system, with demands to quality care outweighing supply. The Canadian Institute for Health Information says that in 2009, there were 1,767 OB/GYNs in Canada, with 704 practising in Ontario. The majority of expectant mothers in this nation receive prenatal care from an obstetrician, gynecologist or family physician. A 2008 report by the Society of Obstetricians and Gynaecologists of Canada (SOGC) says that overburdened obstetricians (who prefer to practice in populated urban cities) deliver about 80 per cent of babies in this country, making the need for obstetrical care urgent in a climate where women become pregnant later on in life and/or have pre-existing conditions.

Low-risk, healthy women can be placed under the primary care of midwives, who deliver about three to four per cent, or about 45 babies each per year. There are close to 1,000 registered midwives across Canada, of which 528 reside in Ontario, says a representative from the Canadian Association of Midwives. This low number, coupled with the hands-on approach of a midwife, results in long waiting lists at midwifery clinics. Appointments with a midwife are often 45 minutes long, filling the silent gap left with brief appointments by beleaguered OB/GYNs. Solving the shortage of maternal care in Canada is critical.

A joined force of obstetrician-gynecologists, family physicians, registered nurses and midwives is required to advance women’s health, advises Dr. André Lalonde, executive vice president of the SOGC. “The problem we are having with health care right now is that everybody is in kind of their own area in their little box; everybody has their own separate practice. What needs to improve in Canada is to break down these barriers. People should be working in groups; you should be able to go to a prenatal office where you have midwives and doctors working in the same office.” The efforts of the SOGC include a 2003 policy statement entitled the “National Birthing Strategy and the Multidisciplinary Collaborative Primary Maternity Care Project” in 2006, which urges a collaborative approach between maternal health-care professionals. Goals to increase the availability and quality of maternity services for all Canadian women include reducing key barriers so that a collaborative approach can be fulfilled.

If you’re one of hundreds of thousands of women pregnant in Canada each year, you’ll know that the excitement of having a baby goes hand-in-hand with providing quality care for baby and you. “A pregnant woman has a lot of choices in Canada,” says Dr. Lalonde. “She can contact a family physician, she can contact a midwife, she can contact an obstetrician. I think the three professions in Canada provide essential services for women – they are [all] very competent.”

www.midwivesofyorkregion.com
www.sogc.org