Since the implementation of midwifery legislation in 2008 in Saskatchewan, there have been advocates pressing for expanded midwifery services within the province. It is easy, however, to dismiss the demand as an issue of preference. After all, most babies in Canada are healthy at birth, and most deliveries are attended by doctors. Therefore, some may assume midwifery care is a fringe service, the gravy on the meat and potatoes of maternity care.
Recent research has shown, however, that not all maternity services may be meeting the needs of women equally. Pregnant women living in poverty, those with addictions or mental health issues may need more emotional support, education, counselling and time with their maternity provider, and midwifery care may be just what the doctor orders.
A large study conducted in British Columbia by a team including U of S researchers has shown a 41 per cent reduction in preterm births for midwifery versus GP patients living in poverty, and a 29 per cent reduction in babies born small for their age. Likewise, midwifery clients with mental illness and/or substance use were much less likely to have premature or small babies than those in the care of obstetricians.
This research points to the individual and societal benefits of midwifery care, including diminished strain on the health care system when serious, potentially lifelong medical issues are averted. So although midwifery care is a choice (depending on availability), it is a choice that may be having a positive impact on us all — more like the vegetables of maternity care, than the gravy.
As noted by the president of the Midwives Association of Saskatchewan, at minimum one out of every five women seeking midwifery services are declined. But keep in mind, midwifery services are only available in four regions of the province. For women residing beyond the reach of these services, 100 per cent of those wanting a midwife are being denied care.
When demand exceedingly overshadows supply, we need to question, “Who is least likely to be receiving the services?” Women who are late in initiating prenatal care; those who do not know that midwifery care is an option, or those who do not know that it is covered under provincial health care insurance are among those missing out. Women lacking economic resources and information have a considerable disadvantage. Yet these are the same women who could reap the greatest benefits from midwifery care.
The current investment in midwifery services is a good start, if midwifery is simply an alternative brand of care. With the latest evidence suggesting health benefits beyond emotional satisfaction in care, it is time to reconsider the value of midwifery care in promoting equitable health and reducing the societal and financial burden of poor birth outcomes. Investment in maternity care needs to reflect these urgent priorities.