Starting Life With A Midwife

I am a registered midwife and just a few hours ago I returned from a beautiful homebirth in a semi-rural home amidst the mountain landscape of the Fraser Valley, 20 minutes from a level two obstetrical unit. In the safety and security of her home, my client moved about in labor, in her own space, with her partner at her side and her mom on her way. When the time came, she settled down in her favorite room, lit brightly by the sun, surrounded by her family and the two registered midwives who have worked with her over the past seven months. She gave birth to nine pound baby Nicholas. Haley, almost three, was ushered in by her grandmother just moments later to delightedly welcome the newborn, cord still attached, nestled pink, snug and warm on his mom’s belly.

Canadian midwives are getting busier! The drive to resurrect midwifery in Canada was born from the quest of women and their families to normalize maternity care. Enlightened governments in British Columbia, Alberta, Manitoba, Ontario and Quebec have responded by enacting changes to provincial legislation. The emerging Canadian model embraces informed choice, choice of birth place and continuity of care as basic tenets.

In response to this new approval and availability, women are seeking midwifery care in growing numbers. Most practices are unable to meet the demand.

Midwives are accountable for the care they provide and must practice within standards set out by the provincial regulatory body. They can order diagnostic tests, including specific blood work and ultrasounds, and have limited prescriptive powers.

As integrated health care professionals, they carry malpractice insurance, have hospital privileges (with the exception of Quebec, where midwifery practice is restricted to birthing centers) and consult with obstetricians and pediatricians when complications occur.

But some physicians continue to see midwives as competition. Some are resentful of the salaries offered to midwives by provincial contracts. Some doctors lack an understanding of the skills and knowledge midwives hold. This gap in knowledge of midwifery and its benefits perhaps exists amongst physicians because they have lived and trained in Canada, a birth culture that has had no midwife mentors. This will now change.

Witnesses to midwifery care are gaining an appreciation for the time and skills that registered midwives offer women and their families. In addition to this growing acceptance, the number of family physicians who want to deliver babies is falling. There is an urgent need to offer women skilled and specialized care in this area. In a recent opinion article published in the Journal of the Society of Obstetricians and Gynecologists of Canada, Dr William Green predicts midwives will fill this gap and provide care to the majority of women, with the back-up for complications provided by obstetricians.

Nurturing Care In Action

Midwives see the physical, developmental and spiritual events of birth as a normal physiological event. Relationships between women and their midwives create nourishing partnerships and encourage women to take ownership of their health and prepare for both birth and parenting. There is no quick way to do this. Appointments typically last an hour and women usually visit with their midwife at least 10 to 12 times before the birth.

Midwives also screen for problems in pregnancy at each visit, including appropriate diagnostics, testing urine, taking blood pressure, monitoring the baby’s and the mother’s growth and listening to heart tones.

At the onset of active labor, midwives attend their clients in their homes or in hospitals, stay with them and monitor the baby throughout the birth process. But the care doesn’t stop there. Postpartum is a fatiguing and stressful time for new families and midwives offer expert advice and support for breastfeeding and other parenting issues. This continues during the early days and weeks through many home and clinic visits. They monitor the health of the newborn and provide health screening, like breast exams, birth control education and PAP screening.

There is a large body of evidence that indicates this natural support system lowers maternal and neonatal morbidity and mortality. It also reduces such expensive or traumatic interventions as caesarean sections, forceps and vacuums births, narcotics and epidurals and perineal traumas like episiotomies. Women who use midwives are more likely to breastfeed and do so for longer duration. Providing physical and emotional support is simply good for moms and babies.

Midwifery care is fully funded by the provincial governments in BC, Ontario, Manitoba and Quebec and women who employ midwives use less of the health care system’s expensive resources. They also suffer fewer of the problems associated with medicated births and surgical interventions. Midwifery is safe, it saves money–and women love and need the nurturing care!

Homebirth

The idea of homebirth often stands in the way of medical and public acceptance of midwifery. Midwifery care and homebirth are two separate issues.

While midwives support the right of low-risk women to birth at home, they also practice in hospitals.

The World Health Organization has stated that "home is the most appropriate birth setting for most childbearing women. Women (and their attendants) choosing this option must be provided with necessary diagnostic, consultative, emergency and other services as required, regardless of place of birth."

Support for homebirth sometimes comes from interesting places. In a recent consensus symposium held by the British Columbia Reproductive Care Program, representatives from around the province, including obstetricians, family practitioners, pediatricians, nurses, midwives, ministry of health officials and hospital administrators came to a consensus on the right of women to give birth in their rural or remote community hospitals. They decided normal women experiencing low risk pregnancies should be able to give birth in their community hospital, even if that hospital does not provide caesarean section capability or if that hospital is hours from another center that does offer caesarean sections.