A midwife crisis

Not enough doctors, not enough midwives: it’s a bad time to have a baby in Canada

A midwife crisis

Joanne Jacyk, a 31-year-old Toronto-based environmental engineer, was all of five weeks pregnant with her first child when she picked up the phone to call a midwife—only to find that she was too late. “They were already full for my due date,” she says. “I thought, ‘I just got my blood test!’ I basically called as fast as I could.” Anxious, Jacyk got online, found a list of every midwifery clinic in the Greater Toronto Area, and phoned them all. “When I started getting calls back saying, ‘We can’t take you,’ I got really upset,” she says. “I didn’t realize how badly I wanted a midwife until I thought the option wasn’t there.”

There’s a joke circulating among the new-mommy set in Ontario, one of seven provinces where midwifery services are now or will soon be publicly funded: if you think you might be pregnant, first you call the midwife, then you pee on the stick. Jacyk, now the mother of a healthy three-month-old boy, was one of the lucky ones. Eventually, persistence and fortuitous planetary alignment landed her a placement. But last year in Ontario, 40 per cent of pregnant women who sought out midwifery care—roughly 6,000 of them—were turned away. Demand has so outstripped supply that in some parts of the province, finding a midwife is harder than securing the kid a spot in a decent daycare.

For many people, the word “midwife” still evokes patchouli incense and homemade yogourt. But midwives’ growing popularity, fuelled almost entirely by word of mouth, reflects the mainstream’s rapidly changing perception of their profession. “We generally have waiting lists every month,” says Andrea Lennox, a registered practitioner at Kensington Midwives in Toronto and vice-president of the College of Midwives of Ontario.

Because there are only 400 registered midwives to serve the entire province, savvy mothers-to-be have taken to “strategizing” to secure a coveted spot, says Raquel Parra, the clinic’s office administrator. For instance, if they don’t live within the clinic’s catchment area, they’ll lie about their address. They’ll lie about their intention to have a home birth (which well-informed women know places them higher up on the waiting list). And from time to time, they’ll fudge their due dates. “There are months in the year that you’re more likely to get a midwife,” says Parra. “December is really difficult because of the holidays. They know this so they’ll call me and give me a date several weeks earlier, and we’ll find out later when they do an ultrasound.” For midwives themselves, the impossibility of helping everyone who wants help can be stressful. “I know some midwives, when they’re going to parties, they lie and say they do something else for a living,” says Lennox, “because they just get bombarded.”

More than anything, midwife-mania is the product of deeply rooted problems within the larger maternity care system. With each passing year, the shortage of maternity care providers in Canada is becoming more pronounced. According to the Society of Obstetricians and Gynaecologists of Canada, there are currently only 1,650 OB/GYNs practising in this country, an estimated 500 of whom have shifted their practices away from deliveries, choosing instead to focus on gynecology, fertility and family planning. Moreover, roughly 34 per cent of the OB/GYNs now working are set to retire in the next five years.

At the same time, fewer family physicians are delivering babies—13 per cent in 2004, down from 36 per cent in 1990. In five years, reports estimate that up to 10,000 women in Ontario alone will not find access to a maternity care provider of any kind—not a midwife, not a physician, not anyone, until the day they find themselves doubled over with contractions in an emergency ward.

Compared with what is currently available in traditional medicine, midwifery is felt by many to be infinitely more personal. Instead of five-minute appointments with an obstetrician, clients get roughly 45 minutes with their midwife during each visit. Midwives have a policy of placing mothers-to-be at the heart of the decision-making process. They care for their clients through the entire labour process, and after the birth make home visits for the first 10 days to help families adjust to nursing and life with an infant.

In part, midwives say the surge in demand is a rejection of the “too-posh-to-push” school of maternity, whereby childbirth can be pencilled in like a reiki appointment—and tied to a broader social trend toward pared-down, natural living. Women who seek out the service are generally those with low-risk pregnancies who are looking for a de-medicalized experience—whether via a natural birth (midwives can’t administer epidurals, for instance) or, increasingly, a home birth—though midwifery offers, in many cases, the best of both worlds: approximately 75 per cent of midwife-assisted births in Ontario take place in a hospital so that, in case of an emergency, care can be swiftly transferred to an MD.

This emphasis on one-on-one care is something that Canada’s wildly overburdened obstetricians are simply unable to provide. Already they have an unusually demanding lifestyle. “Time-wise, they have to be on call on weekends and at night,” says Dr. André Lalonde, executive vice-president of the society, “whereas in family medicine they have fewer emergencies.” Moreover, in the last five years, he says, the society has witnessed a “feminization” of the specialty. “Now 80 to 85 per cent of new graduates in obstetrics are women,” he says, “and, rightly so, they want to have children of their own and family life, so they’re not going to do 250 to 300 deliveries a year. We have some people doing 450 or 500 deliveries a year. That’s not going to happen. They want to work reasonable hours.”

It doesn’t help that the governing body for OB/GYNs is having trouble attracting young medical students to the specialty. The hours aside, one deterrent to practising obstetrics is an emerging fear of litigation. It is said that the record number of women undergoing Caesarean sections (one in four) is due in part to a belief among doctors that the procedure is safer, and less apt to result in a lawsuit, than a potentially complicated vaginal birth. “The liability piece is big,” says Bridget Lynch, a Toronto-based midwife and president of the International Confederation of Midwives. “The self-protection that goes on in terms of not only do I not want to be sued, but I don’t want the personal grief that accompanies a loss for one of my patients.”

Another deterrent is the pay, which is deemed inadequate compared with other, less taxing specialties. If a patient goes into labour in the middle of the day, an obstetrician has to cancel all of her appointments, and lose those billings. Meanwhile, the amount she can bill for the delivery is fixed, no matter how long or complicated the labour. “There is better payment now at night—30 per cent more after midnight, 40 per cent in some places,” says Lalonde, “but that has been slow in coming.” Compared with the billings a physician can rack up in a walk-in clinic, where she might see dozens of people a day, it’s not a great deal. “You may only deliver one woman in a whole night,” he says, “but you’re going to be a lot more stressed than someone seeing all these people with a common cold or earaches.”

With obstetricians spread so thin, and midwives eager for greater representation, one might think they’d be eager to help each other out. First, however, they need to overcome what remains of a long-standing culture clash. Traditionally, midwives and medical doctors have looked at each other with suspicion: midwives are critical of the medicalization of childbirth, while the medical community has been dismissive of midwives’ touchy-feely approach and perceived lack of expertise.

In some communities, doctors are still reluctant to grant them hospital privileges, which would give them the right to practise alongside medical doctors. In Squamish, B.C., says Lehe Elahar, a Vancouver-based practitioner, midwives have been working for years, with support from the public and local health authorities, to get privileges at the hospital, to no avail. “The hospital is putting obstacles in place and we really can only assume that it’s for political reasons,” she says. “There are women that are travelling perilous journeys, driving through the mountains to get to Vancouver to get care, when really they should be getting care in their communities.” As recently as 10 years ago, Lalonde says, obstetricians didn’t see the need for midwives. “Physicians were doing more deliveries,” he says. “Now, faced with an inhuman workload, they’re saying we need to find a solution.”

That solution, he says, is the implementation of the SOGC’s “National Birthing Strategy,” a plan that demands that doctors, nurses and midwives learn to play well together, and ideally work in collectives, to create sustainable models of care over the next five years. “In rural regions especially, you need a team approach to care,” says Lalonde.

The plan would cost Health Canada $43.5 million, but Lalonde says the consequences of not rethinking maternity care in this country are very real. Already our maternity safety record is slipping. In 1990, according to the SOGC, Canada was ranked one of the safest places in the world to give birth. In 2006, data released by the Organisation for Economic Co-operation and Development showed that Canada’s rank had slipped to 21st with regard to infant mortality (compared to sixth in 1990), 14th in perinatal mortality rates (down from 12th), and 11th in maternal morbidity (down from second).

At the same time, there are more high-risk pregnancies than ever. “We have a lot more complex medical conditions,” says Lalonde. “Women are older having their babies. There’s more obesity. Multiple births are on the rise—some of which is related to IVF.” A 2006 study found that a stunning 75 per cent of all births in Canada involve some form of medical intervention—ranging from epidurals to induction to C-sections—contravening healthy standards set by the World Health Organization.

Midwives, in fact, are desperately needed to help carry the load by facilitating as many low-risk pregnancies as possible, to help create a more efficient system. Advocates point out that among midwifery clients, about 25 per cent give birth at home, with no hospital stay or additional costs to the health care system. Those who do give birth in hospital usually stay on half as long as the average patient attended by an MD. “One of the stated huge advantages of midwifery care is that if everything is fine with mother and baby, they are discharged within three to six hours after their birth,” says Lynch. The subsequent home visits help keep them out of the emergency rooms.

Midwifery care is proven safe, too. According to the Canadian Institute of Health Information, those who use midwives are less likely to be hospitalized prenatally, to undergo a Caesarean, to give birth prematurely, to have labour induced and to have an episiotomy. Also, they are significantly more satisfied with the care they received. A 2007 study by Statistics Canada found that 71 per cent of women who used midwives described their experience as “very positive,” compared to only 53 per cent who gave birth with the help of an obstetrician, nurse or family doctor.

But with only 700 registered midwives in Canada, there aren’t nearly enough to make even a dent in the load of over 350,000 births a year. (By comparison, Britain employs 28,000, who attend over 70 per cent of all births.) Across the country, access to midwives remains spotty. This year, New Brunswick, Saskatchewan and, most recently, Alberta announced plans to introduce regulated, publicly funded midwifery services. In Quebec, the Ministry of Health and Social Services aims to have midwives delivering 10 per cent of the province’s babies in birthing centres by 2016. In Vancouver, midwives are just beginning to see waiting lists, although they’re not nearly as long as those in Toronto. “I think that supply and demand is sort of matched now,” says Elahar, who co-founded Pomegranate Midwives, a community-oriented clinic with yoga, massage and acupuncture services, in 2006. “But I do think that in the coming years the demand is going to be greater. We are walking into that.”

Unfortunately, right now, the profession is growing too slowly to avoid the crunch. For one thing, funding is only available for a small number of spots in the six midwifery education programs in universities across the country. Even if more spots were added, at the moment there aren’t enough placements to absorb more student practitioners.

Equally significant, each province caps the number of births a midwife can take on each year—usually somewhere around 40. Beyond that, midwives feel they can’t provide the quality of care and individual attention necessary. The SOGC wants to see the caps lifted. “They should be able to take more than 40 deliveries in a year,” says Lalonde. “The average right now for OB/GYN is over 250 deliveries per year because we don’t have the choice. If 20 women come into the hospital with no doctors, we still have to deliver them. Midwives in the U.S. and in Europe do about 120 deliveries a year. With 350,000 deliveries in Canada, it will take a lot of midwives at this rate. No wonder midwives have a waiting list.”

The ideal model, according to Lalonde, would involve a collective of four or five midwives—each delivering two to three times the number of babies the current caps allow for—and one obstetrician to back them up. This, he says, is an arrangement that might reasonably appeal to an OB/GYN offered a rural posting. “What we’re worried about,” says Lalonde, “is in five to 10 years [small and medium-sized] communities will not have an obstetrician within a reasonable distance to do a surgery, if the need arises. Then you’ll see maternal mortality go even higher. We have a very small window of opportunity.”

Across the country, initiatives designed to quickly and safely bolster the number of midwives are springing up—programs designed to speed up accreditation for internationally trained midwives, or offer advanced standing to nurses who want to transition into midwifery. “One thing our college is working on is increasing midwives’ scope of care,” says Elahar, “giving us more training so we can do things like, for example, a vacuum delivery. Especially for those in rural areas. It’s not great science, it’s just something that we need training for.”

Jacyk’s delivery, in a Toronto hospital, is a perfect example of the type of collaborative care Lalonde envisions. Her midwife was on hand through 16 hours of early labour and 11 hours of arduous active labour. When it became clear that complications had arisen, Jacyk’s care was transferred to an OB/GYN, who ultimately performed a C-section, with the midwife standing by to care for the baby when he arrived. “They were so willing to work around each other,” she says. “My hope was to have a natural birth, but having gone through all that, the care I got before and after was amazing. It was pretty seamless.”

Unfortunately, the resources to provide this sort of one-on-one care are available to almost no one. “Ninety-eight per cent of women have to deal with maybe one nurse part-time to follow you during labour and delivery,” says Lalonde. “We have to offer every woman the same level of care. We have to be careful we don’t create two groups of women, one with midwives and the rest can just take care of themselves.”




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A midwife crisis

  1. I totally agree that we need to work differently as maternay care providers. This issue will not go away and, as explained in this article, will only get worse. I’m a solo midwife in a remote community and work side by side with a FP….we share an office together and we take each others calls whenever one is not available for a certain amount of time. He’s just down the hall for consults and he’ll send me a client of his if he needs a second opinion. We are a great example of midwives and doctors working and supporting each other….not only because we have to, but because we want to. He realized a few years back, through an obstetrical emergency course, that midwives are very competent in maternity care and was a great asset when I decided to return to practice midwifery in my hometown.
    However, the fee for service system does not work since it does not attract doctors to work with midwives. Major changes to the way doctors and midwives are paid need to happen if we eventually want collaborative maternity care, and midwifery care across the country. There also needs to be changes to the midwives’ scope of practice so that doctors and not “bothered” for a simple procedure such as administering antibiotics or narcotics in labour. And believe me, we really do not enjoy having to do that!
    I’m not sure that midwives in Canada are willing to do 120 births a year since it could potentially decrease the quality of care that they bring to their clients i.e. 45 min visits etc. and also decrease their, already altered, quality of life. But I agree that midwives can occupy the spots for low risk clients and that OB’s can perform what they were trained to do i.e. high risk pregnancies and deliveries. I sincerely hope that doctors and midwives across the country can learn to work together to provide the best maternity care possible to Canadian women. I think that it’s beginning to be quite obvious that that’s what we’ll need to do.

  2. Canada has a vast ocean of doctors driving cabs and delivering pizza, unable to perform what they did for years in their country of origin. If the government won’t interfere in the old school protected society, that grants them the recognition of their credentials, don’t expect to have this and many other Canadian problems solved in a short to medium term…

  3. I am an Ontario midiwfery student.

    I am pleased to see a national magazine focusing on this issue.

    I would like to make two small comments. While midwives cannot “administer” epidurals,, it is within our College’s scope of practice to monitor and maintain labour care with epidural administration. Some hospitals in Ontario extend this scope to midwives and some do not. Where they do, like at the Hopital Montfort in Ottawa, the aneasthiologist administers the epidural while the midwife continues to care for the woman and the baby. OBs do not admisniter epidurals either.

    Also, while some midiwfery clients may have their babies in the hospital due to indication (a medical reason why they need to be in hospital during labour and birth), many women have their babies in hospital with a midwife because they choose to.

    Having made ethese comments I would llike to affirm that part of the reason we are so popular is because our principles: non-alarmist, low intervention birth with continuity of carer, shared decision making and choice of birthplace (with strong support for homebirth) evoked through a caring relationship is sound practice and works. Clinical outcomes associated with lower interventions, less pharmacological pain relief, better breastfeeding rates, and higher maternal satisfaction are associated with this type of practice.

    Thanks,
    Jasmine Chatelain

  4. Jasmine,
    I know when I had an epidural I labour stopped along with my active participation in it, effectively making me ‘the patient etherized upon the table’ like in the famous poem by T.S. Eliot. Also, my belly became dotted with electronic monitering devices to keep tabs on my baby’s heart. There are two in the delivery and a baby’s health is impacted by the use the epidural. Are midwives sufficiently medically trained to handle the emergency outcomes that may arise from epidural use (for both mother and baby)? I know that the intravenous I had to go on concurrent with taking the epidural caused some problems breastfeeding (that is, I got edema of the aureola which made it hard for the baby to latch). There was no support for these problems in the hospital, where I had to remain for two days since they plunged the epidural needle in too far taking out some spinal fluid necessitating an epidural patch, and the epidural caused a loss of sensation during delivery resulting in a bad tear. Can midwives sew up a bad tear, advise which complications to expect from it, monitor a baby for effects of epidural use during and after birth?

    It is my opinion that a mid-wife is a specialized nurse but cannot replace the services of doctors when those are needed. I would like to see doctors and midwives work together to keep births as natural as possible and to do education throughout pregnancy to help women be full participants in their births. I would like to see doctors who specialize in birth and work in birthing centres along with midwives. I don’t think there should be an expectation that the person you work with during your pregnancy must be available for birth. This is totally impracticle given the expense of assistance for high-quality births. The birthing centre (be it in a hospital or stand-alone) needs to liase with healthcare professionals that serve women and babies before and after birth. Doctors and midwives should be able to assist in home births and have hospital / birthing centre priviledges, and I think that every GP should do births for part of his/her career if they also look after women.

    This country has some very strange ways when it comes to serving women for pregnancy and birth. This country likes abortion better than birth.

    • The epidural was the first mistake.
      I am not a midwife, but I support them fully. It irritates me when women like yourself have complications from the procedures that the DOCTOR preformed on you, by your consent, and then turn around and say that the doctor "saved" you or somehow "helped" in your birth.
      Let me tell you. He didn't.
      OB/GYNs are surgeons. They specialize in surgery. Not Birth. Midwives spend 4+ years training in normal birth and the complications that arise from that.
      Please educate yourself on what midwives are trained for before you spout your rhetoric.

  5. Adding more spots for educational purposes is obviously badly needed to increase the number of midwives. Increased numbers will assist the medics and prevent many future over-medicalized birthing procedures.
    I am a Chiro. and if I might suggest something to you midwives that in delayed and difficult births a Chiropractor can help tremendously by aligning the pelvis . Also, for those of you who didn’t know, this procedure of un-twisting the pelvis enhances fertility! Sounds amazing and it is amazing. Results are often rapid and anecdotal evidence exists confirming this little known fact.

    • Anecdotes are not evidence and do not make their subject a fact, little known or otherwise.

  6. Women should know how to align their own pelvises long before the day! I wish more Chiropractors knew the <a href=”http://www.orionbooks.co.uk/MP-20780/The-Alexander-Principle.htm”Alexander Principle.

  7. The crisis situation within the childbirth industry has reached horrendous proportions, and as the article states, will only get far worse. I am natural childbirth advocate and an active member of several online communities that support mothers. Not a week goes by that I don’t hear the plight of several mothers that are desperately seeking to find a midwife to deliver their babies. …from all over Canada!

    When I lived in the interior of BC, I desperately searched for a midwife myself, and actually considered driving 2.5 hour to Kelowna to get one. But being due in February, and pregnant with my third child, we decided that the drive would of been reckless. And so I had an OB and a hospital birth….and a cesarean section!! I still mourn our decision not to make the long drive through the snow covered highways!!

    Until the Hospitals and Doctors start working WITH the midwifery groups, allowing hospital privileges, and not interfering with the way that midwives do their jobs, the crises in the childbirth sector will only get worse and the ones that will suffer will be the mothers and babies.

  8. I am about to graduate from the midwifery program at Ryerson University in the spring. I want to mention something missing in this article is an explanation of our education. Midwives receive a four-year bachelor of health sciences in midwifery. The first year and a half is spent on campus taking classes such as pharmacology, reproductive physiology, anatomy and life sciences. Our last two and a half years are spent in the field, working with midwives and attending classes. This leads to 70-80 hour work weeks and pretty much your every waking thought midwifery. Two and a half years of learning about pregnancy and childbirth leave you extremely knowledgeable.

    To answer some questions:

    Truemuse
    1) Although I hold nurses in the utmost respect, and work at a hospital were the nursing staff is wonderful, I have to point out that we are not just a specialized nurse. We consult with doctors when pregnancy, labour or birth creep outside the limits of normal. While it is true that we can’t replace doctors when forceps, vacuum or cesarean section are warranted, they cannot replace our home births, labour support, home visits or prenatal education.

    2) Yes, midwives are fully trained to monitor an epidural and the potential risks. We have extensive emergency skills certification in everything from postpartum hemorrhage to shoulder dystocia to undiagnosed twin and breech deliveries. We are also re-certified in neonatal resuscitation annually.

    3) Yes, we are trained to repair vaginal and perineal lacerations, also called 1st and 2nd degree tears. Unfortunately as of now we are unable to suture tears that involve the sphincter, but of course we know exactly how to tell women to care for it and what to expect. In fact, midwives are especially good at preventing these types of tears through slow delivery of the head.

    4) Yes, we provide excellent breastfeeding support. That is why midwives see their clients on days 1,3,5 at home. Aside form learning through our mentors, many of us have done time training with lactation consultants and have taken breastfeeding support instruction classes. We are knowledgeable in breastfeeding and latching difficulties and our clients tend to breastfeed their babies much longer than obstetric clients.

    Our clients are fully informed, and are full participants in their pregnancy and birth. We do in-depth prenatal teaching and every decision is made by the client.

    Jim Wickstrom:
    We love chiropractors, accupuncturists, naturopathic doctors, homeopathic doctors, massage therapists, all alternative medicine practitioners. We often refer our clients to them. In fact, the clinic where I work has an in-house chiropractor.

    I encourage everyone to become more acquainted with what a midwife is. Our governing body, the College of Midwives of Ontario (CMO) has an amazing website that describes our scope of practice, and ethical guidelines as well as who is eligible for our care.

    Cheers, and I hope I have provided some further insight into what a midwife is.

  9. Although I have great respect for midwives, I also am at a loss as to why your article is titled Midwife crisis. Physicians have as much if not greater training to provide prenatal and obstetrical care. It is the current public health care system that is at fault. If all pregnant women were to be under the care of midwives, it would put a tremendous financial strain on the medical health care. Presently, they have a quota of 40 pregnancy and delivery a year and provide 45 minutes consultation/prenatal appointments. A physician simply cannot afford to have a roster of only 40 patients. I once knew a family physician who regularly provided prenatal care and obstetrical care and who jokingly stated that she should become a midwife as her roster would be smaller, she’s be able to spend more time with patients, have less overhead and perhaps even have a greater take home pay. I fail to see why the current system glorifies the midwives and penalises the physician who would like to provide similar care.

  10. Another thing missing from this article is that doulas will have an increasingly more vital role to play in providing continuity of care and informational support to women who may have decreased access to quality prenatal support. Without stepping into the clinical realm, doulas will be able to give women lots of hands on support that is already missing from all mainstream OB lead births. Doula use is associated with amazing clinical outcomes such as 50% less c-sections and 40% less need for pitocin.

    I agree with all, however, that we need more midwives handling low risk pregnancy and birth, with the caveat that these low risk patients be encouraged to birth at home, thereby reducing the strain on L&D wards and health funds.

  11. I think its too bad that so many OBGYN’s have been moving over to General Practice. I spoke with my GP, who was fortunately and OBGYN before moving over, but she said that the insurance rates are just to high these days to practice gynecology. This is putting a lot of pressure on today’s Midwives to educate expectant parents on what OBGYN’s could be doing.

  12. My sister has a website that many expectant mothers go to to book 3D ultrasounds. Danielle, I notice that awareness & availability in BC seems to be an issue (for more than just me), do you think we should cover this as a story? it would be on this webpage:

    http://www.3dultrasoundvancouver.com

    All the best,

    Jane

  13. To Josée P,
    the physician must have said that he/she should become a midwife in a jokingly manner since a midwifery preceptor of mine actually calculated her rate per hour to be approximately 5$/hr….especially in smaller practices where you might have to do your own administration because we can’t afford an administrator, attend every meeting and be on-call basically all the time. We only do 40 births a year because we spend on average 44 hours with each client….frequently 18-20 hours for births and early postpartum period alone!
    As I mentioned earlier, the fee for service system doesn’t work because it causes too much competition between doctors and midwives. OB’s, specialized in high risk pregnancies can’t survive financially if they only did high risk pregnancies….not in smaller centres anyways (unless there was only one and had to be on-call all the time…which is totally unreasonable). So they do 200, 400 low risk clients instead and then are exhausted because they are, obviously, overworked. If we increase the number of midwives to look after low risk pregnancies and deliveries, that decreases the load on the OB’s…but also their pay! So we need to figure out a way that docs can decrease their workload for the same pay and make room for more midwives. Wether it’s returning to a salaried system or something similar, something needs to be done a quickly because the midwifery crisis AND physician crisis is increasing at an alarming rate.

  14. I have to wonder if the issue of shrinking midwifes across Canada is due to lack of education options. If the system is indeed working away from the idea of education through apprenticeships and more towards the 4 year bachelor degree, I feel like we are going to miss out on gaining more possible midwives.

    Its more difficult to commit to a 4 year, full time program (which seems to be the only prominent option in BC) especially when you are beyond your young twenties and don’t necessarily have the freedom (usually due to family life) or finances to go into schooling for that period of time.

  15. Truemuse,

    While I understand your point- that you want a midwife to be able to care for the complications that may arise during labour and delivery- I must challenge the tone of your email. Your delivery team of doctors, nurses and aneasthiologist- created the complications you had through their practice and care. The very nature of midwifery philosophy of care, would not have created the complications you endured.

    • How inaccurate and uneducated to make a generalized statement such as “your delivery team of doctors, nurses and aneasthiologist created the complications you had through their practice and care.” A mutidisciplinary team which includes a midwife is the most optimal team to have at the bedside when complications DO arise. Complications are multifactorial, and cannot be so easily blamed on the actions of a whole team of people who’s combined knowledge and experience outweigh that of the midwife alone. No one sets out to “create” complications….the circumstances out of which complications arise are often out of the control of the birthing team, or are simply unexpected.

  16. I think in all areas of healthcare there needs to be more of a team effort to ensure the best patient care, and respect the patient’s wishes.

    So many professionals think that their knowledge trumps another professional’s. But I think there’s so much to learn from each other, why not look at it as a learning opportunity rather than another chance to butt heads. Many doctors enjoy working with midwives, but I know there is some resistance still.

    I think there is also a severe lack of programs across Canada. It’s off on a tangent a bit, but I want to go to University to pursue a medical degree. I can’t gain acceptance into any U. in Ontario because I don’t have the proper grade 12 credits. I’ve been in college, but I still need those grade 12 credits, even though I’m 30. I got accepted to University of Michigan for Molecular Biology/ Biotechnology with the same credentials.
    I don’t understand what it is about Canada – we have all these professionals and people who are trained or want to pursue these in-demand careers, but they just won’t give the funding for the extra seats in these programs or to license these doctors.

  17. I agree that health policy should be developed under the larger umbrella of parliamentary authority. The idea that one lobby group, the SOGC, can set a birthing strategy for Canada is quite short-sighted. I know that politicians like Carolyn Bennett have signed on to it. It would be nice to see issues like this become election issues in the next go-aroung.

  18. Truemuse,
    More people might actually read your posts and not skip over them if your tone improved.You seem to have adopted an abrasive writing style.

  19. The wiz, 700 people have clicked my blog to read more of my tonalities. Sorry you don’t like it but writing aside, when something makes me smile my smile is bright! Grin and bear it until things are good, wait it out til things are really good, til you’re authentically happy. Then smile.

  20. oh i see you’re picking up from momtobe above. i think i’m not especially abrasive. but if any website could bring it out in me it’s this one! “The Government Sucks or it Blows”….now that’s why we all keep coming here isn’t it???

  21. Truemuse,
    I went to the link connected to your ‘truemuse’ and while I cannot find where it states the number of hits, it still appears that not one person has commented.

  22. I’m not sure what your deal is, but I posted my website stats for you with a small explanation.

  23. If we want change in our maternity care system, we need to realise that it is going to have to come from us women. “We, the consumer”. But until WE demand it, I’m afraid nothing will ever change.

    As women, I believe the notion of ‘informed choice’ is right at the crux of the matter here – a notion embraced by the midwifery model of care. If Canadian women truly knew and understood the risks/benefits of each and every medical intervention routinely used/offered in pregnancy and in birth, we wouldn’t be sitting here in this sorry maternity mess we find ourselves in today.

    It’s high time we stood up and demanded a better level of care for ourselves… and for our babies ! Do your reasearch. Look into all your options. Make informed decisions based on sound, scientific evidence (and with the ‘information age’, we no longer have any excuse *not* to…). Work on losing the fear that surrounds birth in our culture, in large part by empowering yourself with KNOWLEDGE.

    And most of all, do not simply accept that birth *needs* to be a medicalized procedure, at every step of the way. Because it doesn’t. A safe, joyous birth experience awaits you and your unborn baby.

    But we must first be willing to seek it…

  24. I read the Macleans article with interest, being a full-time midwife in Ontario where I deliver about 40 babies per year both at home and in hospital.

    What can we do about the maternity care crisis? Clearly, more maternity care providers are needed so that every woman can receive adequate prenatal care, a trained birth attendant, and appropriate post-natal care for herself and her baby.

    I understand how Andre LaLonde could suggest that midwives may be able to triple their number of deliveries to be comparable, apparantly, with midwives practicing in the US and Europe. I could triple my caseload if my focus was on delivering babies, rather than providing comprehensive care throughout pregnancy and the first 6 weeks postpartum as well as being on-call (basically 24-7) to provide the intrapartum care normally provided by both doctor and nurse. However, womens’ increased satisfaction with care, lowered intervention rates, increased parental confidence, and increased rates of initiating and maintaining breastfeeding result from the whole package of care I provide, not just the way I assist the baby to be born. I believe the work I do should be the gold standard for maternity care, not just because women like longer appointments and having their decisions respected, but because the way I work increases the health of women and their babies, and costs our medical system considerably less than conventional care.

    I know many Ontario midwives would like to help relieve maternity care crises in their communities but are prevented by being refused hospital privileges. Others, after having privileges granted are not permitted to work within their full-scope (e.g. managing epidurals, managing inductions of labour) which thereby increases the chance that doctors and nurses would need to take over care of that woman. An ideal situation would be midwives working within our full-scope as outlined by the College of Midwives of Ontario providing care to all low-risk healthy women, with OB-GYNs providing the medical and surgical care that higher risk cases and emergencies require. Currently, the numbers aren’t there.
    There aren’t enough midwives, and fee-for-service pay structure for OB-GYNs makes this structure understandably unattractive to them. We need creative thinking to revolutionize our current system to the satisfaction of the professionals involved (midwives, doctors and nurses) and to make Canada a leader in excellent maternity care provision.

    • Your “ideal situation” seems to have completely neglected the role of the family physician in providing prenatal and intrapartum care.

  25. I am happy to see that more and more women are looking into midwifery and seeing that it has advantages to many different kinds of women, not just hard-core hippies! The discussion this article has inspired is also interesting.

    I would like to point out, as an earlier post mentioned, that doctors (at least here in Saskatchewan) also cannot administer epidurals. That is the job of the anesthesiologist.

    Here we are a bit behind the times, with midwifery still not really implemented and up and running. But from my experience with 3 midwives who I had the priviledge of receiving care from during my pregnancies, it was clear that they knew quite a lot about how to deal with the side effects of medical intervention. The effect of epidurals and intraveneous fluids on the success of breastfeeding was discussed and watched for. The midwives I have met in my life seem to share the philosophy that the less intervention a woman receives the less side effects of that intervention you will have to deal with later.

    All women have a different set of expectations and desires for our pregnancy and birth plans. That is the beauty of midwives, that you can choose someone who shares your vision and will help you achieve it. I know from experience that just having someone “get you through it” without caring about your vision is demoralizing and detrimental to bonding with a new baby, and for the new family as a whole.

    Thanks for publishing this article and allowing a forum for discussion.

    Heather
    Regina, SK

  26. I’d like to thank Emma Kwasnica for her post because I could not agree with her more! I am very thankful to have been enlightened through KNOWLEDGE about how to take responsibility for my births. Too many women don’t realize what a huge difference it can make to the medical system and the midwifery care system. I don’t think that we would be in this crisis if we would invest in educating women on the fact that normal birth can be the rule, not the exception! Most women, myself included, do need to be assisted in the birthing process. In Ontario, I’ve had one hospital birth with an OB in 2000 and 2 homebirths with midwives (one was a twin birth with 5 midwives) in 2003 and 2004, and in Quebec, one final birth at a woman-centered hospital with a family physician and a doula in 2006 (only because it’s absolutely IMPOSSIBLE to have a midwife in Quebec). Although I could never do this, the present crisis would be even worst if there were no unassisted births in this country. It is not something to be scared about or frowned upon since it occurs all over the world. Complications can occur in all cases. In other words, the medicalization of birth hasn’t made it safer for women, therefore, “informed choice” should include a discussion on unassisted birthing as a viable option. Many women have it in them and many more could given the proper KNOWLEDGE! As they say, KNOWLEDGE IS POWER!

  27. The content of Lianne George’s article regarding the lack of midwives in Canada sadly came as no surprise to me. Most women would be able to relate in their desire to have a midwife only to find out there are none with openings available at their projected due date.
    What the writer did not discuss is that there is an additional professional that women can approach when they desire the services of a midwife but cannot acquire one, or when delivering with an OB/GYN. This option is to obtain the services of a birth doula.

    Birth doulas are dedicated to support pregnant women and their families. Although not medically trained, doulas are professionally trained in pregnancy, childbirth, and the postpartum period. They are also experienced in the physiology of labour and birth, the medical procedures surrounding labour and birth, and all of the risks and benefits therein.

    Note that a birth doula is not intended to take the place of an OB/GYN or midwife. Rather, a doula’s role is to provide the emotional and physical support that a labouring woman and her partner needs during the prenatal, labour, birth and the postpartum period, while the attending doctor or midwife performs their duties for the delivering woman either in the hospital or chosen birthing facility.

    Birth doulas are becoming more widespread in numbers and as a result have great availability. I would seriously recommend for any delivering woman to research birth doulas and how they can help provide the birth experience the mother and partner desire.

    Tammy Crawley,
    Full Circle Doula Services, Barrie, ON

  28. Whether you have the money or time to study midwifery in BC or not, the sad reality is that UBC (the only midwifery progam in Western Canada) takes only 10 students per year from an applicant pool of about 400 per year. How CAN things improve at this rate? I am moving my entire family (husband and 4 kids) overseas to study midwifery in January and it will cost about the same as studying at UBC. No waiting list. Something is wrong when we are in such desperate need for caregivers and we seem to have no way to actually train them here.

  29. The report seems to be focusing in entirely on a medical problem (doctors, hours, midwives, cost, etc) whereas the problem exists with the women (and society) themselves. Pregnancy and delivery are not diseases; they are normal life experiences. The trend is wanting to be in control of absolutely everything, and such expectations are unrealistic. The sooner we get over the trend, the sooner the medical difficulties surrounding childbirth will be overcome.

  30. My wife was declared as having met with ‘brain death criteria’, within only a few hours following her transfer from Kirkland Lake to Sudbury, while under the care of Drs. Sauve and Adegbite. Withholding life sustaining treatment from an “undiagnosed” patient with concurrent hyperglycemia, hypokalemia and electrolyte abnormalities in combination with a severely paralysed motor function and who is under the influence of sedative hypnotic and tranquilizing agents is of questionable legality. For the record, many conditions may falsely mimic brainstem death clinically upon examination, but without excluding them you will KILL a person by homicide, or criminal negligence, despite the reversibility of brain damage.

    http://www.geocities.com/target_injustice/forum-topix-TF4261.html

  31. there is a shortage of midwives because of the abuse student midwives are experiencing from Senior midwives. I believe that if you are truly a jealous and heartless bitch who feels threatened by the young and up and coming student midwives then you really have no place in the industry.

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