This article appeared in the Salmon Arm Observor, May 2, 2007.

Facing Myths of Midwifery

by Leah Shaw, Observor Contributor

This Saturday is International Midwives Day.

No one will be surprised if you let the day pass without a celebration, but regardless, thousands of parents may choose to recall that special bond with the woman who helped them bring their child into this world; last year about 3,000 babies were delivered this way.

This year also marks the 10th anniversary of midwifery's legitimacy in British Columbia , but a publicist hired by the Midwives Association of BC (MABC) says there are still many misunderstandings about the profession and service.

"I'm just shocked about the misconceptions," Jeannette Miller says. But she admittedly comes to her job better informed than most Canadians. Miller is the daughter of an English-trained midwife where they have been accepted as "essential to the birthing process for hundreds of years."

She says B.C. still has a long way to go to make midwifery fully understood and considered main stream. Miller works to help eliminate what she calls the four most common misunderstandings about midwifery in B.C.

These misconceptions are: that a midwife only delivers babies at home; that midwives are not covered by Medical Services Plan (MSP); that midwives are for the "hippie-types" and labour must be "drug-free"; and finally, that midwives are not "well-trained."

Miller speaks to them with a passion that helps explain her decision to choose a midwife for her own pregnancy, now in its last trimester.

Miller says that while many of the 108 practising midwives in B.C. may have attained their qualifications outside of the country, only B.C. and Ontario offer the four-year degree program plus practicum required to license a midwife in this province.

She says midwives work in concert with physicians and obstetricians, but there were some "growing pains" in the past. She says there still needs to be more education about the perception of the role and the skill level of midwives.

Miller goes on to stress that not all midwives deliver babies at home. Most have hospital rights and simply provide a different kind of care for expectant mothers, catering to her needs and requests, including pain-killers when necessary, with the assistance of a doctor.

"In some ways, it's like the Cadillac of care," she says, of the attentive prenatal, labour and post-partum service midwives are contracted to provide.

University of BC accepts only 10 students a year into the midwife program, even though many more are on the waiting list. Jeannette Miller says this means too few midwives are entering the self-employed profession and like many services, the need is growing.

This is a sentiment that Vernon midwife Sylvia Nicholson shares. Nicholson delivers about 10 to 12 Shuswap babies each year as well as her Vernon clients but she, like all B.C. midwives, is limited to a maximum of 40 clients a year.

The good news for midwives and mothers-to-be is that this legislation is currently under negotiation. The Ministry of Health has agreed to increase a midwife’s maximum number of clients and the compensation paid, as well as develop an advisory panel to help address concerns about maternity care.

Ratification of this new agreement is expected on May 31.

This article appeared in the Courtenay Comox Valley Record, May 2, 2007.

Midwives Offer Nurturing

by Colleen Dane, Record Staff

Right as Lilian Ashworth was nearing her due date last year in her pregnancy with little Jonas, she had a terrible day.

Her friend Emma Gledhill stopped by to visit and immediately knew something was wrong. "She just looked at me and she said 'what's happened?" said Ashworth, recalling the day. Luckily, Emma had become a friend, because for the past nine months she'd helped Ashworth through her pregnancy as her midwife.

Her visit was a part of the final professional visits before the delivery - and within a few minutes, Gledhill figured Jonas had turned breech.

It was a scary change of events for Ashworth, who'd planned a home birth initially, and was now facing a Caesarian section in hospital - but the perfect example, she says, of the blessing of a midwife.

"You can feel the nurturing, love, support ... it's a safe place and I think you need a safe place when you're pregnant," said Ashworth.

This Saturday is the International Day of the Midwife - a day where the specialists who deal only with pregnancy and delivery across the world are recognized for their work which, here in Canada is often seen as outside of the mainstream.

Gledhill, who along with Sadie Parkin and Deborah Kozlick, operate Comox Valley Midwifery Birth Tides clinic, hopes the day can be an opportunity to expand knowledge about what midwives do.

"We're all about explanation and choice, and support," said Gledhill. "In the way (general practitioners) are too, it's just that we've got more time because that's all we do."

There is a lot that people don't realize about midwives in the province, she said, like they fact that they're covered by MSP - or that they do receive extensive training through a four year program in the University of British Columbia's medical department.

It's a different culture here though, than elsewhere in the world where midwives are relied upon for maternity care. Both Gledhill and Ashworth hail from Britain where midwives are almost always used.

"It's the norm at home - it was just expected. I didn't know any different," said Ashworth. For Chrystal Berry, the decision to go to Birth Tides came because her regular doctor doesn't handle pregnancies. It turned out really well for Berry, who said the long appointments she could have with her midwife helped through her first pregnancy - culminating in the home birth of her daughter Claire Hanes just a few weeks ago.

"It was really nice to have the support of a midwife," said Berry. "They gave me the time to ask all the questions - with the midwife, I could discuss things."

Claire's dad Chris Hanes praised the support they were provided as well. "They're not just there to deliver a baby - they're there to support the person as well - that's really stood out." For Berry, it also allowed her to give birth to Claire at home, rather than in a hospital where she feels uncomfortable.

The knowledge of the two midwives who delivered her baby, she said, led to a relatively easy birth that mom's healed from quickly.

While using a midwife can allow for different delivery methods, like home or water births - midwives can also be used if the parents plan from the beginning to deliver in hospital, said Gledhill.

It's one of the misconceptions she says there is about her profession, along with the rumour that a woman in labour can't have pain medication if they're with a midwife, or that it's a backwoods or outdated skill set.

Midwives, said Gledhill, are there to help with the information process, and as a part of that must go back every year to update their education.

The biggest difference is that, because they only deal with pregnancies, they have more time to spend - beginning with longer appointments all the time, to being on call for delivery at any time of day, and carrying through with home visits for weeks afterwards to make sure the mom, baby and family are doing okay.

"You know that woman very well, and they know you very well," said Gledhill. "They always know that we're there and will help anytime there's a question."

To celebrate the International Day of the Midwife, Birth Tides clinic will host a baby/child clothing swap and open house from 10:30 a.m. to noon Saturday.

Hopefully, agreed both Gledhill and former patients, it will be an opportunity for people to ask questions and learn more about what they do.

"It's definitely worth it," said Berry. "It takes the clinical side out of it - it makes it the natural experience it's supposed to be," said Ashworth.

This article appeared in the Vancouver Courier, April 25, 2007.

UBC midwifery students sign on for African expedition

By Cheryl Rossi-Staff writer

Students Aisia Salo and Chloe Dayman work on a Ugandan woman last year as part of UBC's Midwifery Global Placement Initiative.

When Dr. Mickey Rostoker worked in Uganda last year, he noted how the hospitals there lacked modern equipment, medication and even basic medical supplies.

"There's a lot of international aid that's coming in," said the family physician, who splits his time between Vancouver and Regina . "But some of the places at the end of the line don't get fed some of that international money because it's spent elsewhere before it can even get there."

He noted some hospitals use razor blades to perform episiotomies, or surgical incisions involving a woman's vulva, and they make the incision without local anesthetic.

Rostoker was in Uganda last year with UBC's Midwifery Global Placement Initiative, a program his wife Cathy Ellis, who is a midwife instructor, started three years ago. He'll head there again this summer with Ellis, three midwifery students and medical supplies.

Student Chloe Dayman also took the trip last year and raised her own money to pay for it.

"They had hardly anything at all," she said. "Basically you go into the room and there'd be a bed with no sheets or anything like that. The woman would come with their own plastic sheets to deliver their baby on and then they dispose of it afterwards_ They had no blood pressure cuffs, nothing to take your temperature with."

The experience was invaluable she says, particularly because of the number of births they assisted while in Uganda . She and another student attended 60 deliveries in six weeks.

"We as midwives in B.C. usually do about four to eight births a month," she said.

Dayman also saw different attitudes when it came to delivery among Ugandan women.

"The women there pushed out their babies in 10 or 15 minutes, a first baby. That was really normal," she said. "If the baby wasn't coming out in 10 or 15 minutes, they'd start to do other things to try to get it going or start to get upset because it wasn't happening fast enough."

Rostoker, who's wife is in Kosovo following up a midwife training project there, said Ellis started the international placement program at UBC so her students could gain international, cross-cultural and midwifery experience. Working in Africa with her as part of the project gives him a chance to spend time with Ellis and teach technical skills to Uganda healthcare workers.

"I will also do some post-abortal work over there because although it's illegal, there are lots of women who undergo illegal terminations and then they end up coming quite sick to the hospital," he said.

Heather Nelson, a third year midwifery student, is one of five who are off to Africa this June. Three students will work in Uganda and two in Zambia .

She and another student have raised $4,500 to buy medical supplies, mostly soliciting family and friends. Ellis collected in-kind donations of knitted hats, booties and blankets.

May 5 marks the International Day of the Midwife. Nelson said those who want to honour the day could donate money to their project until mid-May so they can buy additional medical supplies.

For more information, contact UBC's midwifery department at 604-822-0352.

This article appeared in the North Shore News, July 25, 2004.

North Shore midwife marks a milestone

by Deana Lancaster

There has never been a better time to have a baby in Canada.

That's because these days, a woman has an array of choices, all covered by provincial health care, when deciding who will help her have a healthy pregnancy, labour and birth of her child. As well as her family doctor, she can choose the services of a maternity clinic, or of a midwife; and she can choose to have her baby in the hospital, or at home.

Canada came late to the idea of midwifery as a legitimate birth service, only making it legal and regulated in 1998. But it's catching on - there are now more than 65 midwives registered and practising in British Columbia.

Vera Berard is one of them.

On Wednesday, her practice: Midwifery Care North Shore, is celebrating a milestone by holding an open house for all of her past and present clients. Berard has cared for more than 200 women and their families since midwifery became legal and she began her private practice.

"I feel very privileged to have all these women share this special time in their lives with me," she says. Berard completed her initial midwifery and nursing education in South Africa. She immigrated to North America in 1982, and before 1998, was employed at Grace Hospital (now B.C. Women's Hospital) in the midwifery program there. When she decided to launch her own practice she did her research and decided to open her doors on the North Shore. She says it was the right choice.

"I have been so well treated here," she says. From nursing staff and doctors at Lions Gate Hospital, to staff at North Shore Health, Berard says the entire medical community has been receptive to her midwifery practice, and she wants to acknowledge them.

"I think we are part of the solution to the maternity care crisis we're having," she explains. "Midwifery really does have something to offer - not all on its own, but integrated into the health care system." Midwives are experts in normal pregnancy, childbirth and breastfeeding, explains Berard. They spend time with their clients in the prenatal period explaining what is happening and involving them in making decisions about their care. Normal birth without unnecessary or routine intervention is promoted, although sometimes intervention is necessary. Midwives also provide follow-up care after the birth. One of the biggest differences between maternity care by a midwife, and that by a general practitioner is time, says Berard. A midwife's caseload is capped by the Ministry of health at 40 births per year. That works out to three to five women due to give birth each month. "We have the time to spend with women," she says. "Pregnancy involves a mind/body connection . . . we have time for a woman to express her values, her fears. And we have time to listen, and to teach her." She adds that many doctors would like to have that same time with their patients.

"They recognize and respect that mind/body connection. But the system is not really set up that way."

As it has always been, informed choice is one of the main philosophies behind midwifery care.

"The women are the decision-makers. There is always some uncertainty, but we put everything on the table, and the woman is the primary decision maker." As well as being experts on uncomplicated pregnancy and birth, Berard says midwives are familiar with what is not usual, and will consult with doctors in those cases.

Recently, Berard moved her practice to the Quayside Village Co-Housing complex in Lower Lonsdale. With the added space, she is introducing group work. "The women in my practice have never been able to meet each other before," she says. "There is so much teaching that women will do for each other, and just see myself as a facilitator for that." The group work will include sessions on pregnancy and labour, breastfeeding and infant care, and will give pregnant women and new moms a chance to network with each other.

For more information on Midwifery Care North Shore, call 604-984-6960, or visit www.midwiferycare.ca.