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21st Century Midwifery

Not in Nova Scotia

by Palmira Boutillier

Midwife Simone at work. [Photo: jon.hayes]
Midwife Simone at work. [Photo: jon.hayes]

Halifax — In the age of the C-sections and scheduled birthing, many women still want to give birth "the old-fashioned way" (that is, at home with a midwife). Presently in Nova Scotia this is no easy feat.

Midwifery was regulated in 2009 and went from a private, for-profit, service to one offered free under provincial health care.

This should have been a step towards making midwives more accessible to women, but instead it served to completely remove the service for half the province. Only three out of nine health authorities submitted to become model sites: the IWK maternity hospital serving the HRM, Guysborough / Antigonish, and the South Shore. Women outside of these areas lost midwife services.

Three years later, Nova Scotia is still lacking a comprehensive midwifery service. This is a problem for many women in this province as it creates a lack of choice about where and how they can give birth.

The Annapolis Valley, a former hub for midwifery in Nova Scotia, is now one of the areas in the province with no service. Devon Koeller, 32, lives in the valley with her two children: Olwynn, 10,  and Finn, 7.

"If I was going to have another child now under the new restrictions (no midwives available in my region)," says Koeller, "it's something that is so big for me that it would make me consider whether I want to have a child right now."

Olwynn was born in Halifax under the care of an obstetrician and nursing staff and Finn was born at home in the valley under the care of a midwife. It was Koeller's disappointing IWK birthing experience that left her searching for a midwife the second time around.

In 2002, Koeller was 22 and having her first baby at the IWK hospital. "You have nurses that you don't know from a hole in the ground," says Koeller. "Some are young, some have been doing it for years, some are really old school, some are progressive and … they have shift changes and all of a sudden (it's) somebody new."

Koeller came into the IWK with a birth plan and says that her first nurse respected her space. "She was just letting me do my thing and listen to my body and if I needed something I would say so."

Unfortunately, after shift change, under the care of a new nurse, that space disappeared. "This lady was right beside me and being like: 'Are you OK, are you OK? It's going to get a lot worse, at this point it's going to get a lot worse'," says Koeller. "It was just constant and she freaked me out and I actually ended up getting an epidural."

Koeller hadn't planned on getting an epidural and says she definitely felt pressured into it. "I was completely paralyzed," she says. She went from moving around and stretching, to on her back lying in the prone position, hooked up to a monitor. "My contractions, which had been almost back to back, as soon as I got the epidural … went from being back to back to being five minutes apart again," says Koeller. "Now how good is that for your baby?"

Although Koeller got the epidural removed and regained sensation in time to experience Olwynn's entrance into the world, her experience at the IWK was disappointing. "I felt like I had a plan and I wasn't really supported through it," says Koeller. "I found them too apt to intervene. They wanted to do something and treat the situation like a normal medical case. That's what I didn't like about it. Birth is a natural process. You're not there because you are sick, you are there because you are doing something … So I wanted to make sure I had a different environment the second time."

Luckily for Koeller, she was able to have her second birth at home under the care of a midwife before midwifery was legislated and no longer available to her in the valley. "What I thought was really cool was I could be doing the dishes, cleaning, hanging out with my daughter," says Koeller, "and what felt like discomfort when I was in a hospital doing nothing, except watching my belly, felt like nothing when I was at home doing other things. So that was a really nice contrast."

Having a midwife attend her home birth was empowering, Koeller says, "You were able to listen to your own body and respond to what it needed. You are making your birth your own instead of something that is controlled by the medical system. It's in my own home, I am making the choices about where I am having the baby and how I am doing it."

Koeller isn't the only woman to feel that the IWK's specialty in high risk care is not a bonus when it comes to easy healthy births. In a 2011 report commissioned by the Department of Health and Wellness called Midwifery in Nova Scotia the external assessment team highlighted one of the IWK's challenges as a midwifery test site as: "Developing a culture of respect and support for normal birth when the dominant ethos is that of high risk care and preventing untoward events."

For Heather Chamberlin, 27, having a midwife attend your delivery is about more than just birth. "To be able to be given the freedom and a safe space to choose what I felt was best for myself and what I felt was best for my baby was the best first step for parenting because that is kind of what you have to do for the rest of your life with them," says Chamberlin.

Chamberlin has two children, both delivered at home with the help of midwives: Aidyn, 9, was born pre-legislation in the valley and Sabine, 2, was born in Halifax post-legislation.

In 2010, shortly after Sabine's birth, the Midwife services in Halifax fell apart, resulting in only one full time and one part time midwife remaining to serve the HRM. No home births have been offered in the past two years.

The Midwifery in Nova Scotia report contributes this failure to "a short leadā€in time to have midwifery established, … creating a fit between a model of midwifery practice and the large maternity care service that is known for excellence in perinatal high risk care, and … the awkward fit of a hospital employment model when midwives are autonomous primary maternity care providers …"

Just this month, two new midwives were hired at the IWK, but there are still no home births. The IWK website states: "The IWK is supportive of offering home births again. We are working to re-establish this service while ensuring that it can be stable and maintained. Currently, we are working to orient our new midwives to the service. We expect to have home births back up and running in the New Year."

This is good news for residents of Halifax, but health care is a provincial responsibility and the service needs to be available across the board. According to a Canadian Press article from August, "the Nova Scotia government says it’s not feasible to fund such costs across the province."

According to the report Uncomfortable Positions, an evaluation report put out by the Midwifery Coalition of Nova Scotia:

"The implications of lack of access should not be underestimated. The families who contacted us went to great lengths to access midwifery care, including traveling substantial distances within Nova Scotia to receive care or moving out of the province temporarily to give birth. Others choose to give birth without assistance, or to delay or cancel their plans for subsequent pregnancies."

Chamberlin agrees: "People are leaving Nova Scotia because they want to have kids, or they want to have more kids and they are not willing to have sub-par care. So they are going to move back to Ontario, or they are going to move to B.C. where there are really really good midwifery systems in place that provide excellent care. We already have models out there that are doing it and for some reason Nova Scotia, as per usual, feels like they need to re-invent the wheel."

Midwifery has been legislated in Ontario since 1994 and the outcomes are amazing. The  Association of Ontario Midwives states that a health ministry survey found a 98.7 per cent satisfaction rate with the care they received. Ontario has 366 midwifes to Nova Scotia's eight and they are estimating 10,700 births for 2012, which only allows them to meet 60 per cent of the demand for midwife care in Ontario. If Ontario is any indication, women want midwives.

For Chamberlin hospital care was never an option. "Even a good doctor, typically around birth, is like OK here are the terrible things that could happen and we are going to try and prevent those things from happening" says Chamberlin. "So I think all of the tests and all of the mentality around it is an enormous system of fear and fear disempowers you."

"Obviously midwifery is supposed to provide amazing holistic care that deals with the individual woman, there is a continuity of care so you can get to know somebody. It is a model of care that is based on giving women and their families the information they can use to make the right decisions for themselves."

There is a forum on Midwifery Sunday Nov. 25 in Halifax put on by the Midwifery Coalition of Nova Scotia. It is being held at the Women's Council House (989 Young Avenue — corner of Young Ave. and Inglis St.) at 11:30 a.m. There will be a panel discussion on what midwifery care can look like, as well as updates, and future planning. Come out and share your stories and ideas.

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Topics: GenderHealth
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