Lack of midwives puts some women in harm’s way

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A midwife cuts the umbilical cord on a water-born baby. (iStock)


October 26, 2011
Lack of midwives is making women who want a home birth choose a dangerous option— doing it without medical supervision.

Folami Jones, a midwife from Toronto who is now based in Halifax says there are families who have travelled outside HRM to find midwives, and others who have had unassisted births because no midwife was available.

“They refuse to go into a hospital,” she says. “They’re within normal terms of care and they’re like ‘we want to have a baby at home, so we’ll go without.’ So now we’re pushing birth underground and in a more unsafe place.”

One of the seven principles of midwifery care, says Jacquelyn Hollohan, co-chair of the advocacy group Midwifery Coalition of Nova Scotia (MCNS), is a woman’s ability to choose where she wants her baby born. Having only one midwife—the IWK’s Kelly Chisholm—HRM is “pretty insufficient,” she adds. Chisholm couldn’t be reached for comment.

Midwifery in Halifax took a big hit in December of last year after the Capital Region Health Authority fired two midwives, and one quit. When the fourth midwife went on leave, the program was suspended. Families and children held a rally, supporting the midwives and changes to the program.

When asked about the shaky relationship between midwives and IWK staff that led to the program being suspended in December, Jocelyn Vine, IWK VP of patient care, told Openfile, “I can’t really go into any particular detail.” But MCNS’s Erin Hemmings told CBC at the time that part of the issue was the IWK not recognizing midwives as independent health-care providers that should operate community-based practices, rather than out of hospitals.

Hollohan thinks this environment will make it hard to find new ones: “I don’t think the midwives felt like they were in a comfortable work environment, so it’s tough to see who would come out of school with midwifery training and want to go into a place of work where their professional standards may be challenged.”

Ready to work
Despite this, Jones says she’s been waiting for months to work as a midwife in Halifax and recently had an interview at the IWK. She hasn’t heard back, but is here to be with her family. Not all midwives have that reason to stick around.

The problem is unlike in other parts of Canada, says Jones, “you can’t register as a private midwife. You actually have to be employed.” In the HRM, because of new regulations, the IWK—the one place with a midwifery program in Halifax—is the only place a midwife can work. “And because the IWK is not employing (right now),” says Jones, “you’re stuck.”

report on midwifery in Nova Scotia, released in July, emphasizes the need for midwifery access in marginalized communities. It may be hard for women from these communities to get to clinics and hospitals far from their home for appointments, or find childcare for their other children, which means some just don’t go, says Jones: “That means women that need care, that need women-centered care, that need culturally appropriate care, can’t get it,” she says, “So it’s devastating.”

Halifax’s lone midwife operates out of the IWK now, but Vine says they’re “in an active process of recruitment.” Their first hire will be a professional practice chief—a senior midwife—who supervise and guide the other midwives.

Vine thinks having a senior midwife “will really be a tremendous step” to combating some of the past problems. She says, “I think that [position] really is going to make quite a difference for us.”

But she says even after the practice chief position is filled, the IWK only has funds to hire one more midwife, so services will still be limited.

Jones says the current state of midwifery in HRM is saddening on a lot of levels. What’s especially saddening is that with the current system, midwifery isn’t reaching the population where it’s most needed.

The Health Nova Scotia report, compiled by a four person team with “expertise in primary maternity care,” gave recommendations to make midwifery more accessible. Hollohan says the MCNS influenced a recommendation to transfer midwife employment to the Capital District Health Authority and have midwives in community-based settings like the North End Community Health Centre. And, she says, the North End walk-in clinic, is “willing” to take the lead. “They are community based,” she says, “and they have a lot of standards that are consistent with the midwifery principle of care—standards that weren’t really in the hospital.”

Jones thinks Ontario’s setup, which lines up closer to Nova Scotia’s new recommendations, is a very workable one. Midwives are “autonomous,” says Jones— “they’re basically freelance.” The midwives run their own clinics and are their own practicing body. “So you don’t have to answer to a hospital, you’re not employed by a hospital and you’re at par with physicians,” she says.

Jones also thinks HRM needs satellite clinics.
“Here we are, saying we need to support marginalized communities, but we’re not in those communities,” she says. And, says Jones, “we need to re-educate the community.” The report agrees. It stresses that women, especially those in marginalized communities, should be aware of midwifery care.

“The birth outcome, the family vibe, the wholeness to the experience,” says Jones, is part of why midwifery is so important. Jones has experienced the value of midwifery first hand as a patient, with the home birth of her second child.

“It was phenomenal…the power always came back to me.”

Charlene Davis is a Halifax-based freelancer.


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