by: Connie Littlefield
This is an exciting time for midwifery in this province! Midwifery
has been legal in Ontario since January of 1994 and has
recently legislated in Quebec, Alberta, and British Columbia
Here in Nova Scotia, the Department of Health has recently
formed a working group to look into ways to implement midwifery
care. The working group is made up of representatives from
all four Regional Health Boards, the Medical Society of Nova
Scotia, the Registered Nurses Association of Nova Scotia,
the hospitals, the Association of Nova Scotia Midwives (a
professional association), Public Health Nurses, the Dept.
of Health, and the Midwifery Coalition of Nova Scotia (a consumer
group). This working group will make recommendations regarding
the regulation of midwifery in the province. This will start
the legislative process in motion, and hopefully midwifery
will soon be a safe and free option for all Nova Scotian women
and their families.
Currently midwives in Nova Scotia are alegal, meaning that
while they are not operating illegally, neither are they supported
by the system. Once the legislation is in place, their services
should be covered by M.S.I. and they will have hospital and
other medical privileges. It is important that individuals
and communities speak up and make their feelings known to
the working group so that midwifery can be implemented in
a suitable way. There are many different models that could
be followed, and different systems may fit different communities.
Many families may want to give birth at home, but for those
who don't, a birthing centre may be the solution when
the hospital is a long way away. In Ontario, 90% of midwifery
consumers choose to have their babies in hospitals or birthing
centres. Will midwives in our community practice in their
own clinics? Out of their homes? Or only from hospitals or
birthing centres? Will they work alone or in teams? Where
will they receive their education? How will they be paid?
These are all questions that need to be addressed and the
answers we come up with will have an impact on all of us in
the years to come. Many people are confused about what a midwife
does. It's not like the care you would receive from a doctor;
in fact it's completely different.
The first job a midwife must attend to when she meets her
new clients is to ascertain whether this pregnancy and the
resulting birth are at all risky. A midwife would never conduct
births on her own if there was any risk involved. The vast
majority of births, however, are completely normal and there
is no reason for medical intervention. A midwife spends
a lot of time with the expecting couple during the pregnancy
helping to prepare the new parents for the big day-- and what
comes after. Pre-natal care includes physical checkups and
also a lot of discussion; all aspects of health are within
her scope including the recommendation of exercises, supplements,
reading material, baby care supplies, and anything else the
expectant parents need.
After the birth, the midwife conducts post-natal visits to
make sure feeding, healing, and infant care are all going
well up to 6 weeks post-partum. Of course the big difference
between midwifery and medical care comes during labour and
birth. A doctor might check in on the laboring mother once
or twice during labour, then show up in time to catch the
baby. The remainder of the care is left to the nurses on shift
and the birthing mother's own attendants, usually the father.
A midwife, by contrast, arrives as soon as the labour is underway
and stays throughout. During labour the midwife performs all
the physical care that the situation requires including the
administration of oxygen, episiotomy (if necessary), and administering
immunizations (if chosen). She knows which spots can be rubbed
to alleviate pain, which positions work most effectively,
and how to spot trouble before it happens.
Mothers who give birth this way have far fewer stress-related
problems during birth and the post-partum phase. Most couples
who deliver with the help of a midwife report far fewer problems
with bonding, breast feeding, and healing; and usually have
higher birth-weight babies. It's difficult to quantify things
like maternal and child health, breast feeding success, and
stress reduction; but all indicators point to the relative
cost-effectiveness of midwifery care compared to hospital
delivery. This is one of the major reasons that Nova Scotia
is on the verge of legalizing the midwifery profession.
The model of midwifery education for the province that seems
most likely is for Nova Scotia to reserve a couple of places
in Ontario's Midwifery Baccalaureate program. Eventually,
our own school of midwifery could be established. There will
likely also be allowances made for midwives who have received
their training in other ways and who wish to begin or continue
practicing here. Very soon, midwifery could be a career option
for Nova Scotians; so now is the time to start thinking about
how we want this to be handled.
Obviously, the best situation has midwives practicing in
the communities they have chosen to live in; perhaps where
they grew up and where their families live. For this reason
and others, the onus is on every community to get involved
in this process. I am also interested in meeting with any
interested parties to discuss these issues: play group parents,
breast-feeding support groups, boards of women's health organizations,
shelters, and high school classes. I am also open to setting
up "kitchen table" meetings, wherever two or more people would
like to learn more about the midwifery model of care.
Please call me at (902) 827-4644 for more information.
My e-mail address is:
Please contact me and find out how you can get involved in
the new era in birthing options in Nova Scotia.