Before books like What to Expect When You’re Expecting became so popular, a pregnant woman went to her mother, a trusted aunt, or maybe her grandmother, for more than advice.
Less than a century ago, most Canadian children were born at home and they weren’t delivered by a doctor: A female relation, often taught by the mother before her, coached a woman through labour, employing ancient techniques to ease the pain and encourage the birth. She was called a midwife and catching babies was her calling.
With the advent of technology, particularly forceps to aid in difficult deliveries, fewer mothers and infants died, but more babies were born in hospitals.
The art shifted to science and doctors began doing more deliveries. Happily, modern medicine is a melding, making room for physicians and midwives.
As of 1998, the B.C. Medical Services Plan covers the cost of one primary caregiver — physician or midwife — to see a woman through pregnancy and birth.
In 2012, the government even doubled the number of spaces in UBC’s midwifery degree program, to 20 from 10.
Like physicians, midwives have hospital privileges and work as independent practitioners, often in clinics with colleagues who share their demanding 24-7 call.
Midwives have access to genetic testing, lab tests, ultrasounds, and referrals to specialists. They can write prescriptions, give pain relief during labour, and refer to obstetricians.
Most of all, for many women, midwives act like coaches, providing personal education and encouragement tailored for their clients’ wants and needs. They deliver at home, the hospital, even in specialized bathtubs.
What they don’t do is take the provincial government’s guff.
The Midwives Association of B.C. (MABC) recently announced the group’s intention to terminate their contract in October.
At issue are working conditions, access to maternity care (particularly in rural and First Nation populations) and the need for increased midwife services.
Midwives struggle to get locums to cover them for holidays, medical, and their own maternity leaves.
Their request for the government to expand the locum pilot project was rejected, with the government suggesting midwives pay for the service out of pocket.
MABC has since withdrawn clinical education services at UBC, where the group performed work with midwifery, medical, and nursing students that included phone calls, weekend debriefings, and driving students to and from births and home visits. In order to accommodate students, midwives must decrease their workload, claiming they lose $3,000 in income per semester.
They’re frustrated and concerned for the future of maternity care and family practitioner Dr. Michael Klein is backing them up.
He says 30 years of delivering babies has taught him the importance of the job, but he fears for the future of B.C. women — in fact, Canadian women in general.
In a recent letter to Victoria’s Times Colonist, the professor emeritus of family practice and pediatrics at UBC (and the former head of the department of family practice at B.C. Children’s and Women’s Hospital), suggested the province is out of line, and if politicians don’t get with it, the maternity care system will collapse in 10 years.
Ask a pregnant woman: if finding a family doctor is difficult; finding a physician who will deliver your baby is damn near impossible. Fewer GPs are including maternity in their practices and many are giving up hospital privileges altogether.
Klein points out the average age of an obstetrician is almost 58, meaning many will soon retire, further widening the maternity gap. With births projected to increase to more than 50,000 by 2020, it’s no surprise Klein fears for the future.
Though midwives may cost more in the short term (they are significantly better paid for their services than GPs), they claim to cost less in the long run. Malachite Midwives of Kelowna deliver half of their patients’ babies at home, saving on hospital stays (they say about $2,000 a day). Midwives working in rural communities keep women in their communities and save on transportation costs involved if mothers need to travel to bigger centers to deliver their babies.
According to the MABC, 18 per cent of midwife-assisted deliveries end in C-section, compared to 31 per cent for physician-assisted. With the Canadian Institute for Health putting the cost of a C-section at $5,000 (natural births run upward of $2,265), the statistics are hard to ignore.
Physicians argue their rate of C-sections in healthy pregnancies is the same as midwives, but because doctors deal with high-risk pregnancies (that midwives decline to take on or end up calling a doctor in to deal with during difficult labours) those statistics are skewed.
Regardless, it seems obvious midwives (who train for five years in specialized post-secondary degree programs) provide an invaluable service.
Perhaps Klein sums it up best: “While I am a family physician who strongly supports family-practice maternity care, I have also been an advocate for midwifery as being part of the solution.
“Public-policy decisions regarding health care, especially maternity care, need to be based, not on the vagaries of a year-to-year budget, but on the needs of women and their families, supported by sound evidence and analysis.”
— Shannon Linden, a Kelowna resident, writes blogs and magazine articles along with her Daily Courier medical column.