I have been a midwife for more than 40 years, having helped establish both the first legally recognized midwifery service in British Columbia in the 1980s and the midwifery program at the University of British Columbia in 2000.
Today, while I am the President of the Royal College of Midwives in the United Kingdom, I still hold a keen interest in the state of midwifery and maternity care in British Columbia.
Based on my decades of experience, and on good evidence, the midwifery model practised in British Columbia is first class and clearly one of the best in the world. It offers women and newborns very high quality care provided by highly educated midwives in a well-regulated system.
However, having recently returned to B.C. for a visit, I was surprised and disappointed when former colleagues informed me the B.C. government’s approach to midwifery is falling behind that of other provinces.
Rather than fostering the growth of midwifery, B.C.’s Ministry of Health is making it more difficult for midwives to practise and fulfil the potential of the profession, particularly at a time when midwives offer a ready solution to the maternity care challenges B.C. and other Canadian provinces face.
In many countries, midwifery is the primary form of maternity care. For example, in Great Britain there are more than 45,000 registered midwives (25,000 working in the National Health Service) and government policy is “every woman needs a midwife; some need a doctor too.” Every woman has midwifery care.
Perhaps it is time for this to be the path for women in B.C., especially given the sophisticated model of midwifery that already exists.
The failure of the B.C. government to create an environment for the expansion of midwifery is wasting powerful potential; this wasted potential has broad implications for the health care system and for families.
There is strong evidence of the benefits of midwifery to women and their babies as midwifery care is safe and effective.
The pre-term birthrate for women under midwife-led care is much lower. As well, midwifery-led care is associated with lower intervention rates. Women in midwife-led care settings had around 50 per cent fewer C-sections than women under the care of a physician.
As midwife-led care is more cost effective than medical-led care, midwives provide an impetus for the health care system to offer more midwifery care services.
At the same time, midwifery care can help alleviate social family disruption for those women and families lacking access to maternity care in their own community.
Having lived in northern B.C., I know the long journey many women who live in small, sometimes isolated communities often faced in order to get maternity care, often several months in advance of their delivery date.
Today, with fewer physicians practising obstetrics and fewer rural maternity care practices operating, more and more women have to make the lonely journey from their home community to give birth to their child.
Research shows that women who leave their communities to receive maternity care experience increased stressors and health risks for both themselves and their babies. And you can be sure this increases costs for the family and the health care system.
Midwives are a solution to meeting the needs of women and families in those communities that are underserved or don’t have access to appropriate maternity care at all.
But they are also a cost-effective solution that helps to reduce costs all around. There are a multitude of studies conducted in the UK, the U.S., Canada and other developed and developing countries that point to the financial benefits of midwifery.
Based on my years of experience in B.C. and current observations, midwifery offers the province’s health care system, and your treasury department, some low-hanging fruit to reduce costs and trim future spending.
Midwifery has come a long way in B.C. during the last 30 years. There is tremendous potential for midwives to take on a bigger, more important role in maternity care. to work collaboratively with other health care providers to improve access to maternity care and improve health outcomes through a more personalized and women-centred approach.
This requires government to take actions that are forward-thinking and to realize the costs of being penny-wise and pound-foolish are detrimental to the maternity care system; especially to the more than 44,000 women and families who depend on it each year.
Professor Lesley Page is president of the Royal College of Midwives. She was the first professor of midwifery in the UK at Thames Valley University and Queen Charlotte’s Hospital. She is a renowned international academic, advocate and activist for midwives, mothers and babies with more than 40 years’ midwifery experience.