Locum program gives rural midwives a break

Locum program gives rural midwives a break

Midwife Natalie Kirby practises with Midwives Notawasaga in Collingwood, but provided locum coverage in Powassan, 30 kilometres south of North Bay, her hometown. Ministry of Health and Long-Term Care helps to fund the locum program.

A locum program operated by the Association of Ontario Midwives offers members with solo practices in Northern Ontario an all-important break, and provides their clients with uninterrupted midwifery services.

Midwife Natalie Kirby, who practices with Midwives Notawasaga in Collingwood but hails from North Bay, took a one-month leave of absence to relieve Ava Vosu, a solo practitioner based in Powassan.

“If I hadn’t been there, her clients would have had to transfer to either a family doc or obstetrical care,” said Kirby. “They wouldn’t have had the home visits and the opportunity to have a home birth.”

As a solo practitioner, “you’re on call 24/7. You’re it. You don’t have the luxury of saying ‘Oh, I’m not going to go to work today’ because there is no one else to cover for you. It’s very taxing, so it’s excellent for rural, solo midwives to have a little bit of relief.”

Kirby, a graduate of Laurentian University’s four-year program, performed four births and kept up with Vosu’s full clinic during the month-long placement.

“We had a lot of correspondence about clients who were due that month, but never got a chance to sit down because I went off call at 9 am, drove to North Bay and her flight was that same morning.”


It was a homecoming for both. Vosu returned to Europe to spend time with family while Kirby stayed with her parents in North Bay.

“It was beneficial for both of us because you meet a different set of clients and work in a hospital with different protocols. It was very educational for me.”

Kirby’s experience performing births at the North Bay Regional Health Centre was eased by her longstanding connection with the hospital, having served as a candystriper there for years.

“I know a lot of the nurses and did one of my placements at North Bay General. My mom works there and my sister and her husband are docs in North Bay.”

Kirby had also thought of becoming a doctor, but chose midwifery instead.

“I love that it’s women centred care and that you’re treating pregnancy as a normal physiological process.  It’s a really unique care model. I really fell in love with the philosophy of our care, having women as central decision makers and supporting them during a really unique time in their lives.”

Kim Cloutier-Holtz, a solo practitioner in Temiskaming Shores and a mother of two, was relieved in May by Toronto-based Tasha Macdonald, director of clinical practice guidelines with the Association of Ontario Midwives.


“I’m fortunate to have really good support from family physicians who are willing to share my patients’ care and offer call coverage for me when I need a break,” said Cloutier- Holtz. “However, when it comes to a larger stretch such as now when I’m on maternity leave, the locum program is tremendously beneficial. I’ve actually been able to keep the clinic doors open and keep the practice going by having locums come for one or two months at a time.

“One or two weeks are max for the docs to cover for me. I don’t want to strain those relationships and I want my clients to have the full scope of midwifery practice, including the option to have a home birth, which docs can’t do.

“Without the locum program, the longest break I’ve taken is a week or a week and a half. I’m fortunate to be able to do that. A lot of solo practices don’t have that kind of coverage. They don’t have any option other than to work 365 days a year.”

When she had her first child, a locum arrived less than 48 hours before she went into labour and was part of the delivery team.

Securing locum coverage for a full-year maternity leave is challenging.

“I have some clients who are in care and due in various months, so if I can get locum coverage, they’ll have access to a midwifery birth. If I can’t, they get transferred to their family doc for the actual birth, but I keep up with the pre and post natal care because I can bring my baby with me.”

Cloutier-Holtz performs approximately 25 of the 300 births a year in Tesmiskaming Shores, 40 to 50 per cent of which are home births.

She offers home births to lower-risk clients who live within a safe distance of the hospital and notifies Emergency Services to make sure they’re ready in the event of an emergency, or if her client requires something for pain relief.

“The big difference in midwifery care is the time we can spend with our clients because we don’t have a full family practice like a doctor, so our visits are often up to an hour in length,” said Cloutier-Hotz, who completed a four-year French language midwifery program at Laurentian in Sudbury.

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