BY ADELLE LARMOUR

The walls of misperception around the midwifery practice are crumbling as more people chose this specialized care.
Since the enactment of the Midwife Act January 1, 1994, midwives have
been a regulated health profession
funded by the Ontario government.

All midwives in Ontario work under the regulations set out by the College of Midwives of Ontario, the governing organization for midwifery. They provide prenatal and six weeks postnatal care to low-risk pregnant women, offer choice of birthplace, and deliver babies either at home or in hospital.

Midwifery is a specialized profession requiring a four-year Bachelor of Health Sciences degree followed by one year of mentored practice, similar to a residency for a medical student. Only Laurentian, McMaster and Ryerson universities offer the program. Midwives are continually undertaking professional development courses as required by their governing college.

Education and word of mouth from satisfied clients have helped the profession gain recognition and popularity throughout the province. Currently, more than 400 midwives practice in Ontario, and that number is expected to double in another four years, according Joanna Zuk, senior communications officer of the Association of Ontario Midwives. Midwives are performing between eight to 10 per cent of the province’s total births. However, in parts of the North, the number is considerably higher.

There are a total of 13 midwives in Sudbury who work out of two clinics. In 2008, they collectively performed close to 25 per cent of the more than 1,900 births in the city, according to Buffy Fulton-Breathat, midwife and registered nurse at Sudbury Community Midwives.

Eileen Abbey, midwife at the Maternity Care Midwives Thunder Bay, said the two clinics there are also averaging 25 per cent of the average 1,650 annual births.

Melanie Guerin, sole midwife in Hearst, is also above her regular caseload this year, performing 40 of the average 80 to 100 births in this small community. The loss of two family physicians last year has impacted her work.

As the demand for midwifery services increases, acceptance within the medical community has also grown.

Hearst
Guerin, originally from Hearst, wanted to return home and give back to her community. Now she shares an office with family physician Dr. Richard Claveau, who also acts as her consultant. “He takes my calls when I’m away and I take his calls when he’s unavailable,” she said. “You don’t really see that anywhere else.”

In Thunder Bay, health-care providers established The Maternity Centre in an effort to increase obstetrics and maternity care for “orphan” clients. Located in a building on hospital grounds, midwives, family physicians and obstetricians united in a collaborative effort to fill the void.

“The dream is not fully realized yet and still is a work in process,” Abbey said. The centre also offers social services, dietary and lactation consultation, and exercise therapy.

Fulton-Breathat said they are now viewed as a member of Sudbury’s health-care team. “Our skill sets and practice are well known by medical professionals.”

However, there are still misperceptions among the general public about what a midwife does.

“We’ll still encounter people who are not aware that they can have a hospital birth,” Fulton-Breathat said. “They still think it is only a home birth when, in fact, about 80 per cent of our births are in hospital. Many still think if you have a midwife, then you can’t have an epidural, when the principle is informed choice prior to birth.”

She also said a lot of people are unaware that the service is funded through OHIP and can be initiated by self-referral.

“We take anyone from the community,” Abbey said. “If someone is a refugee with no OHIP, or if there is some good reason why they don’t have coverage, there is a provision in the contract between midwives and the Ministry to provide services to these women. Physicians do not have this provision.”

Midwives work collaboratively in group practices specializing in pre- and post-natal care. Because midwives are not paid on a fee for service basis like general practitioners, their appointment times range between 30 and 45 minutes, and include clinical examinations, counselling and education. Prenatal visits are once a month for the first 28 weeks, every two weeks until 36 weeks and then once a week until the baby is born. They are also available by pager 24 hours a day.

Besides choice of birth location and type of birth, midwives will provide continuous attendance during active labour and three hours after the birth. A second midwife is often present to assist.

“The goal is you get personalized care from one or two people,” Fulton-Breathat said.
Home births are performed within 30 minutes travel time of a hospital (dependent upon weather), because if a complication occurs during a C-section, it takes between 30 and 60 minutes to collect a team and set up for the procedure in the hospital, said Fulton-Breathat.

Water births
Water births have increased in popularity for clients planning home births. “We’ve purchased six La Bassine waterbirth pools,” she said. “Women who use them purchase a disposable liner for infection control.”

Every hospital in the United Kingdom has to have facilities for women to labour in water, because it gives “tremendous pain relief,” according to Fulton-Breathat.

Midwives also practice early discharge for hospital births, which helps alleviate space challenges in post neonatal units.

Women seeking midwifery care are screened initially. “There are only a few reasons why a woman would not come into a midwifery practice for prenatal care,” Fulton-Breathat said.

Those who experience renal failure, have pre-existing hypertension, and insulin-dependent diabetes are among those who would be referred to an obstetrician.

It is also within their scope to provide pain relief with epidurals and to run an induction, a medical intervention to start labour. That said, some hospitals impose limitations both on family physicians and midwives with respect to the aforementioned, thus undermining the scope of the profession. As well, in some areas midwives don’t have hospital privileges, according to Abbey.

These challenges, along with continued education of the general public and physicians, are ongoing. Although acceptance of the practice is not uniform throughout the province, collaboration is occurring. Waiting lists exist for the three above practices and their number of deliveries is above the provincial average.

“The more you open your doors on both sides, the more you’ll have collegial relationships,” Abbey said.