After the initial buzz of the province’s 2016 announcement of a pilot project has died down, you may still find yourself asking: what is a midwife? What’s the difference between a midwife and a doula? Does having a midwife mean you must have a home birth? These are important distinctions to understand as New Brunswick enters the era of providing midwife services through our healthcare system.
For some answers, we’re turning this post over to Elizabeth LeBlanc. Elizabeth is from Moncton, having graduated from Mathieu-Martin High School and l’Université de Moncton. (She’s also a former co-worker and an all-around lovely woman with mad knitting skills!) She’s currently studying in the Midwifery Education Program (MEP) at Laurentian University, in Sudbury, Ontario. This is a four-year, highly-competitive program; nearly 350 people applied for the 30 spots available in 2016. Here’s what Elizabeth wants you to know about midwifery and what it will mean to New Brunswick. (You can find more details on the province’s plans to introduce a midwifery pilot project here.)
What is a midwife? A midwife in Canada is a primary healthcare provider for low-risk women and their babies throughout pregnancy, labour, birth, and 6-weeks post-partum. In Ontario, the midwifery model of practice emphasizes informed choice, choice of birthplace, woman-centered care, appropriate use of technology, birth as a normal process, and continuity of care.
What does all this mean? Don’t midwives only offer natural homebirths? Don’t doulas do this? Absolutely not! Midwives are not doulas, and doulas are not midwives. Doulas are birth partners offering well needed support during labour and birth. Midwives are primary healthcare providers. This is where I find the public needs to understand more about what midwives are qualified to do.
Midwives complete four years of midwifery-specific university education. We study biology, anatomy and physiology, biochemistry, life sciences and pharmacology and, of course, reproductive health. We train in emergency obstetrical skills, CPR, neonatal resuscitation and intubation, and clinical skills related to prenatal, intrapartum, and postpartum care. We complete nearly three years of student placements in labour and delivery hospital units, neonatal intensive care units, obstetrical and gynecological clinics (with Obstetricians and Gynecologists), as well as midwifery clinics in Ontario. Registered Midwives can order blood work, ultrasounds, write prescriptions (within our scope of practice), and even provide care in the delivery room at the hospital, because midwives have hospital admitting privileges. Yes, you read that correctly! A pregnant woman can have a hospital birth with a midwife! You can even have an epidural while under the care of a midwife. And it will be no different for midwives who will soon practice in New Brunswick.
But what happens if there are complications? Giving birth is serious and there are risks. This is why it is crucial to underline the midwifery scope of practice. Midwives offer care for women who have low-risk, normal pregnancies. If any medical issues arise during prenatal care we consult with physicians and obstetricians. If serious problems arise, for example signs of severe pre-eclampsia, we have strict protocols to transfer care to appropriate healthcare providers who are trained to deal with these pregnancy-related complications. There are standards to which we must adhere. This is why is important to regulate midwives into the healthcare system. Interprofessional collaboration is essential for providing the best possible maternity care and health outcomes in New Brunswick.
Midwives in Ontario are regulated by the College of Midwives of Ontario. The College “sets the standards of the profession which describe the minimum expectations for midwives in Ontario. These standards are developed through an iterative process of research, consultation, and evaluation.” Basically, the College makes sure the interests of the public are best served by the practice of midwifery. This includes protocols for consultations and transfer of care, codes of ethics, interprofessional collaboration, hospital births, homebirths, and many other specific publications.
What about all this I hear about homebirth? Isn’t it too risky to give birth at home? In 2015, the Canadian Medical Association Journal published evidence-based research on low-risk hospital and homebirth outcomes in Ontario. “In Ontario, midwives attend a small proportion of all births in the province (10%), and about 20% of the births they attend take place at home.” The study looked at 11,493 planned hospital births and 11,493 planned home births attended by midwives in a jurisdiction where home birth is well-integrated into the healthcare system. The conclusions show that that “women with low-risk pregnancies who are planning home-births (…) attended by midwives should not anticipate any increased risk of perinatal morbidity or death compared with planning a hospital birth.” There is therefore no reason to believe that in New Brunswick, with the same well-integrated system, outcomes would be any different.
But why midwifery care if we have family doctors and obstetricians who offer the same care? Because there is a demand for it! There is a place for obstetrical care, just like there is a place for midwifery care. Women today simply want to have a choice in the care they receive. The key word here is “choice”. There is a need for all types of experts in the maternity care spectrum and there is no denying that there is a demand for more midwifery services. In 1994, when midwifery was integrated into the Ontario healthcare system, 70 midwives were practicing. Today, there are over 700 midwives practicing in Ontario. Even so, 40% of women are turned away and unable to receive midwifery care because of a shortage of midwives. I strongly believe that this may become an issue in New Brunswick as well, just as it has in British Columbia, Quebec, Nova Scotia, and Manitoba, where securing the services of a registered midwife is like winning a lottery.
Hopefully one day there will be enough midwives practicing in collaboration with other healthcare professionals in New Brunswick to fulfill the demand of pregnant women. Congratulations to New Brunswick for adding the exciting profession of midwifery to the healthcare system.