Our niece and her husband from Vancouver, who are now living in Toronto, had their first baby in late December. When I met the little one in February, I learned how pregnancy and birthing have changed since my day. My niece had a wonderful experience using midwives, an option now available to pregnant women and their partners.
Midwives? I have heard about midwives, but certainly didn’t know what they did. Now I appreciate that they have a marvellous role in health care for women that hopefully will increase in the future.
Last spring when my niece and her husband wanted to start their family, they needed to find a family doctor. She used the Ontario Health Care Connect program to find the names of doctors taking new referrals. There weren’t many but, three months later, she found one in a clinic five minutes from their home in Toronto’s east end. Once she became pregnant, the family doctor advised her that she could give care for only up to ten weeks. Thereafter, health care to do with the pregnancy would be provided by either an obstetrician or a midwife, both funded by OHIP. The doctor recommended a midwife as they do home visits and provide ongoing support.
Referred to The Midwives Clinic of East York, my niece learned about their services. They would see her every month until twenty-eight weeks, every two weeks until the 35th week, and then weekly. They offered several options for the actual birth: with a midwife at home, with a midwife at the Toronto Birth Centre on Dundas in Regent Park, or with a midwife in the local hospital, in this case the Michael Garron Hospital (formerly Toronto East General). After delivery, the midwife would visit every two days for the first ten days, see her at the clinic every two weeks until the baby was six weeks old and then they would transfer her back to the family doctor. If there were problems at any time, she would be transferred to an obstetrician. My niece was introduced to two midwives who would give continuity of care throughout the pregnancy and make sure that one or the other would be available when the time came to deliver.
Her pregnancy went well. The only issue was that the baby was late, six days after her due date. When my niece’s waters broke late one evening, she called the midwife, who asked questions to make sure that everything was okay, and told them to call back when her contractions started. Once they did, the midwife was at the house 45-60 minutes later, did an exam to see how far she was dilated, and then stayed with her for another hour of labour. She then left her to continue labour into the morning, but was available by telephone for updates throughout. Ultimately, the midwife instructed them to meet her at the hospital. Now sufficiently dilated for admission, my niece was given an epidural, the baby transitioned into the proper position and at 1:38 in the afternoon, the baby was born. Two midwives attended the delivery, one to attend to the baby, the other for the mother. The baby’s father was present throughout. The only contact my niece had with any doctor was with the anesthesiologist who administered the epidural she requested. Post-delivery, the midwife was at their home to help with the baby.
My niece loved the process, felt very supported, and never rushed. She had assumed that midwives would push the home birth experience but found that they never did. Her midwife delivered seven babies that same week and was, to quote my niece, ” incredibly knowledgeable.” At all times, my niece considered herself well-informed and knew that she had the power to make the decisions that were best for her.
I had not appreciated that midwives have been a self-governing regulated health profession in Ontario for over twenty-four years. They are subject to standards, guidelines and risk-screening protocols set by the College of Midwives of Ontario. According to the Association of Ontario Midwives, as of 2016, there were 839 midwives in the province, 89 midwifery practices, 77 communities where midwives provide care, 93 hospitals where midwives have privileges, and three community-based midwifery-led birth centres. Canadian Association of Midwives statistics show that from April 1, 2015 to March 31, 2016, there were 21,224 midwifery-led births in the province, 15.2% of the total births.
That same year, there were 8,987 midwife-led births (21% of the total) in British Columbia, 3,400 (3.9% of the total) in Quebec, 2,815 (4.9% of the total) in Alberta, 1,110 (6.4% of the total) in Manitoba, 132 (15.4% of the total) in Nunavut, 87 (12.7% of the total) in the Northwest Territories. and 247 (2.18%) in Nova Scotia. In Yukon, New Brunswick, Prince Edward Island and Newfoundland, there were none. These figures come from the latest statistics of midwifery data available on the internet.
Seven universities across Canada: the Université de Quebec at Trois Rivières, Laurentian, Ryerson, McMaster, the University College of the North in Northern Manitoba, Mount Royal University in Calgary and the University of British Columbia, offer Four-year Bachelor of Health Sciences degrees in Midwifery. In addition, Ryerson offers a part-time degree program that is completed in five to six years, and an eight-semester post-Baccalaureate program for health professionals with earlier maternity care experience. Apparently, eighty new midwives graduate from Ontario programs every year.
It is ironic that, although women helping women with pregnancy and birthing occurred historically, midwifery is now one of the new professions which did not exist in Canada before. As with new technology, new approaches to providing health services need new knowledge and new skill sets.
Having midwives as an essential part of the health care team makes so much sense. Their ongoing support and specialized expertise can only enhance women’s pregnancy and birthing experiences. Given that their role providing maternity care in other countries is well-established, it is surprising that midwives are not in greater demand in Canada. Perhaps Canada’s health care systems across the country need to show greater leadership. Maybe more midwifery training programs are needed. Maybe people like me need to catch up on what is actually going on in the field. Undoubtedly, this is the wave of the future.