On moving to Fort St. John and learning she was pregnant, Darryn Wellstead immediately looked for a midwife in the region to be her primary care provider.
But she soon learned that in the Peace, there is not a single midwife.
“I used to live in Vancouver and I was pregnant a previous time – unfortunately it ended in a pregnancy loss, but I was very impressed with the care and treatment I received with a midwife,” said Darryn Wellstead, one of the administrators of the Peace River Midwifery Supporters Facebook group.
Wellstead had her daughter Rory in January. Although she emphasized that she was very happy with the care she received from doctors, she said the lack of birth options is a shared concern of many in the region.
The local support group formed this winter in response to the Midwives Association of British Columbia’s (MABC) release of an ambitious vision to increase the number of midwife-assisted births in the province.
“Within a few days of opening up the ... Facebook group, we had over 100 likes – I think we’re over 150 now, and this has only happened in the last month,” said Wellstead. “The response was quite positive and quite fast,and people have been quite vocal about it.
“The things that people are really attracted to with midwifery care, one is a continuity of care – having the same care provider throughout your whole pregnancy – and this is an issue that is a challenge for people all over the place.”
In Fort St. John in particular, a prenatal clinic was opened due to a lack of doctors, meaning mothers see a different doctor at prenatal visits and then are delivered by whichever doctor is on duty at the time.
“With a midwifery care model, you’re seeing the same care provider the whole time, and in addition to having that continuity of care is a more holistic perspective and holistic orientation towards pregnancy and the birth experience,” said Wellstead.
MABC released their vision statement in January. Vice-president Kelly Hayes said the key is to close the maternity care gap.
“Especially in places like Dawson Creek, Fort St. John, so much of this gap is rural B.C. where there isn’t reasonable access to maternity care in a timely fashion,” said Hayes.
The vision includes an increase in midwife-assisted births from the current provincial level of 17 per cent, to 35 per cent by 2020 and integrating midwifery services into the healthcare system.
Northern Health’s Perinatal Program medical lead Dr. Brian Galliford said that in Prince George – where all but two of the North’s nine midwives operate – the number of midwife-assisted births is approximately 7 per cent.
While the north currently lags behind the provincial average, Hayes said that 35 per cent overall is a very realistic number, with countries such as Australia, New Zealand and parts of Europe seeing more than 70 per cent of births through midwives.
“When we say 35 per cent, we actually know there is growth beyond that. The reality is, midwives are experts in low-risk pregnancy, labour, delivery, postpartum: we are experts in that field. Just like you’d see an expert if you were having a heart problem, you’d go to a cardiologist, midwives are the experts in low-risk birth,” said Hayes. “Low-risk births make up 70 per cent of the population, in terms of women coming into care.”
Galliford said he was a skeptic of midwifery when he started practicing 25 years ago, but has completely changed his opinion.
“I think it’s a very good idea,” said Galliford. “The new sort of concept of collaborative care is coming out, which is going to involve doctors, obstetricians, doulas, nurse practitioners and of course midwives: midwives are going to be very important in this process.”
Hayes said that they have yet to begin formal negotiations with the government, but that the Minister of Health, Terry Lake, is well aware of the vision and they have a very positive working relationship.
“Midwives are a valuable part of our healthcare system, and the pregnancy, labour and delivery choices B.C. women have,” Ministry of Health spokesperson Kristy Anderson wrote in an email response. “Pregnant women having low-risk pregnancies can choose to birth with a midwife or a doctor in the hospital, or a midwife at home; all of these choices are fully covered by the Medical Services Plan.”
This is all good news for many in the Peace Region who have sought out the care of a midwife; some have even gone so far as to take on the financial burden of essentially camping out in Prince George for childbirth with a midwife.
Like doctors in the North, Wellstead said that midwives in Prince George are also heavily booked up. If one does get taken on, she said, it is up to the client to travel there for all appointments and remain in the city for the weeks surrounding the birth.
“Midwives, they’re not there to be in opposition of doctors – they’re there to support women giving birth, and I think by taking some of the burden off of doctors,” said Wellstead. “In the last few days, Fort St. John announced the walk-in clinic is closing. That’s just more evidence of how pressed we are here for healthcare providers.”
Midwifery has been a regulated profession since 1998, which Hayes explained means that a midwife becomes the primary maternity care provider, alleviating the pressure on doctors.
“We work just the same as family physicians in the way that if a woman chooses to come into midwifery care, she doesn’t need a referral,” she said. “We become her primary caregiver – order all of the lab work, order the ultrasounds, order genetic screening, we do all of the same things she would be getting with other care providers.
“She has her monthly visits, then her every two-week visits, then her every week visits up until she goes into labour and delivery. If there are any complications during that course of care, just like with a family physician, we refer.”
Hayes said referrals could be to an obstetrician, pediatrician, cardiologist or any specialists that the midwife refers directly to, and then the client would in most cases return back into the care of the midwife.
“We’re seeing women up to about six weeks postpartum, and a lot of that care is done in the home, which is a huge benefit to the women, to the families and again to the system,” said Hayes. “And the cost savings, because we know research-wise when women are under the care of a midwife, the average hospital stay following a delivery is reduced by 18 hours because we’re seeing them at home so much sooner.”
Due to factors such as reduced hospital visits, MABC estimated a net cost savings of $60 million by 2020 and $20 million per year following that, should the vision come to fruition.
As well as continuity, the financial benefit and the undoubted needed for added supports in the medical community, Hayes pointed out the major health benefits of midwife-assisted birth, such as a significantly lower rate of Caesarean sections.
According to Northern Health’s statistics, over a five-year period ending in 2011, just under 30 per cent of births in the North Peace were by Caesarean section delivery, and nearly 27 per cent in the South Peace.
These numbers are both slighly lower than the overall average of Caesarean section deliveries in B.C. of approximately 30.5 per cent.
However, according to MABC’s vision, the rate of Caesarean sections in midwife-assisted births would be 19 per cent.
“Looking at the reduced number of C-sections under midwifery care – a lot of people would look at those and say that’s because you’re dealing with low risk, but these statistics are actually looking at the same demographic of women under midwifery care that would be under physician care,” said Hayes.
“Our rates are very low. We actually bring down the provincial average of C-section rate, which is much too high to begin with. And C-sections are expensive, so with that C-section reduction, there is again those cost savings.”
With the proposed increase of midwife-assisted births in the province, MABC suggests a cost savings of $6.6 billion by 2020 from C-section delivery reduction alone.
Galliford added that an increase in access to midwives would alleviate the need for travelling long distances for maternity care, which has proven to add stress to the pregnancy.
“Traveling back and forth with pregnancy is probably one of the more dangerous things, not only for the mechanical part of it, but a higher incidence of premature death as well,” said Galliford. “Whether this is due to the actual procedures, due to the increased anxiety associated with having to drive all over the place when you’re pregnant ... it’s certainly associated with poorer outcomes than when you deliver in your own community.”
Wellstead recognized that there are doctors that follow a midwifery care model, but noted that in a region with such a high birth rate, there is limited access to resources.
“Everywhere you go you see pregnant bellies and new babies, it’s kind of strange that we don’t have that option,” said Wellstead. “As someone who has recently had a baby and just knowing and in conversations with other new mothers, there is a real lack of options for maternity care in the North. I think that’s what a lot of people are looking to change.”
In Dawson Creek, change is already afoot. Two local doulas, Chvonne Hutchings and Brandi Noordhof of Labours Eve, are currently in a correspondence program to acquire midwifery accreditation through the Midwifery Institute of America.
“It’s been a passion of ours for a long time, and doing the doula work that we do, we see where we could be more helpful,” said Hutchings.
Doulas do not have the medical training of midwives, but assist with emotional and physical support through the pregnancy, delivery and afterwards with breastfeeding and other issues that arise. Hutchings said going through the midwifery program is bringing a great deal of dimension to their work as doulas, since starting the program in October 2013.
Noordhof said that since word has gotten out that they were in the program, they’ve had clients asking whether they are able to practice yet, showing there is a demand.
“We’ll probably be finished four years from now, by that time we’re able to do clinical and practice under other midwives,” said Hutchings.
As the international program is not provincially mandated, Noordhof said they are looking at taking a bridging program in Ontario. They should then be able to challenge an examination through the College of Midwives of British Columbia.
The University of British Columbia offered a pilot bridging program for internationally trained midwives between 2008 and 2013, but it is seeking funding to continue operating. Hayes noted that this is one of the major challenges for midwifery in the province.
Although their accreditation will be internationally recognized, Noordhof said her and Hutchings’ goal is to practice in the Peace Region. “We have the hospital and that is really all, so people who desired another option don’t really have that at all,” said Noordhof. “Our No. 1 goal is to bring it here.”