Although contract negotiations between B.C.'s teachers and the province have dominated headlines this summer, another tense standoff in the public sector is quietly bubbling to the surface.
The Midwives Association of BC (MABC) have withdrawn clinical education services at UBC and issued a 90-day notice to the Ministry of Health to terminate its agreement with the province, effective Oct. 7.
The province has once again been using its 2014 Public Sector Bargaining Mandate to offer a contract increase of 5.5 per cent over the next five years–just as it has done for the BC Teachers' Federation and other public sector unions. But the MABC says offering that increase to every public sector worker is a one-size-fits-all approach that doesn't work.
"Because you're comparing apples and oranges," says Alix Bacon, a midwife who works at South Delta Midwifery in Ladner. "From a salaried worker in an established, well-supported profession versus maternity care. And you have to realize we have a maternity care crunch."
The MABC released a vision document earlier this year calling on the province to increase access to maternity care in rural, northern and First Nations communities. The net savings to the system would result in an estimated $60 million per year by 2020.
"There are tons of communities in Northern B.C. with no health care provider," says Bacon. "Women are travelling hundreds of kilometres for health care."
Many women come to the Lower Mainland and stay for weeks or even months for pre and post natal care before returning to their homes in the northern and rural parts of the province.
That's why the MABC wants the province to support rural midwifery locums and startups–A locum is like a substitute midwife when the existing one is on vacation, sick or otherwise unable to work–with funding beyond the 5.5 per cent offer.
Currently, the income of midwives vary based on where they work. Midwives are paid a fee of $3,000 for the entire pregnancy until six weeks postpartum. Urban midwives might be able to take in 40 clients a year, while rural midwives could take on 15 or fewer and be living below the poverty line.
In previous contracts the province enticed midwives and locums to go to rural parts of the province by offering rural practice startup grants and subsidized wages for locums, something conspicuously absent during these negotiations. Locum midwives are also forced to accept a "course of care" arrangement without taking into account the amount of hours they work.
"We've had that problem here," says Bacon. "One of our midwives was sick for two months. There was no one to hire to cover her shift so we just had to do two months of overtime."
Bacon says there are number of examples that highlight the lack of equity and profession supports in place between doctors and midwives:
• If doctors are part of a committee or consulting with the province on best practices the local health authorities receive a budget to compensate them for their time. Midwives are expected to volunteer.
• If a newly graduated doctor goes to a rural community they receive student loan forgiveness, while midwives do not.
• Obstetricians receive a bonus if they have to deliver a baby outside of normal working hours on evenings and weekends. Midwives do not.
"If we're at a birth and it's prolonged for 24 hours we don't get any more than if we'd been there for five," says Bacon.
The MABC has stated all current clients and will continue to receive midwifery care. But if a new contract isn't signed by Oct. 7, the organization may have to undertake certain job action.
Although Bacon says she can't speculate on what job action might take place, it could be withdrawing certain services that usually "lighten the load" on hospitals. She says Richmond Hospital has been overloaded with maternity care recently and been forced to relocate some patients to other hospitals via ambulance. Home births with midwives has reduced the need for such measures.
In the worst-case scenario the MABC could refuse to take on new clients. But Bacon doesn't think it'll come down to that.
"We're very devoted to taking care of the women in our communities."
To learn more about the MABC visit their website.