Midwifery access lags in New Brunswick

Fredericton — Joanna Killen is expecting her first child in October. She wants a midwife to deliver her baby in Saint John, but there are no midwives in the province’s largest city. She is left with no other choice but to have her baby delivered by one of the seven doctors at the St. Joseph’s Hospital Women’s Clinic.

Midwifery care is a preferred choice of many women as it involves care from pregnancy up to 6-8 weeks postpartum; lengthy appointments that allow time for informed discussions; and choice of birthplace — hospital or home. “If I have any concerns about my pregnancy I do not have the option to get in touch with a doctor,” says Killen, who fell when she was 9 weeks pregnant.

“The clinic did not have any doctors on duty on the day that I fell,” says Killen. “I ended up with a 6-hour ordeal which first took me to St. Joseph’s Hospital — only to be told they don’t deal with maternity issues there, and was then sent out to the much busier Regional Hospital. It seems as though having someone solely dedicated to my pregnancy and birth could have averted such an ordeal.”

The New Brunswick Midwifery Act, introduced in May 2008 by then Health Minister Michael Murphy, and proclaimed in January 2011, will regulate the practice of midwifery in the province. However, midwives and expecting mothers in New Brunswick will now have to wait at least another year with the Alward government’s decision to not fund midwives this fiscal year.

This is unfortunate news for midwife Nathalie Pambrun who recently moved to New Brunswick from Manitoba where she has worked for the past seven years as a publicly funded midwife. Under the current conditions in New Brunswick she would have to carry her own liability insurance and women would have to pay for her services out of pocket.

Lindsey Reinhart, a member of Birth Matters, a midwifery advocacy group in the province, says, “While the Midwifery Council of New Brunswick has done a lot of work so far, we need to see some action now at the Regional Health Authority level. At the very least, a midwife should be brought on board to help with the education and implementation process.”

Midwifery is now covered by legislation in all regions of Canada except New Brunswick, PEI and the Yukon. Nova Scotia became the first Atlantic province to regulate and fund midwifery in 2009. Reinhart points out, “New Brunswick can learn from the challenges and successes experienced in Nova Scotia, but without a government committed to publicly funding midwives, things are not going to move forward here.”

Killen stresses the need for midwives in the public health care system, “The birthing experience does not have to be one of interventions and complicated medical surroundings. It seems to me that if midwives were funded and properly endorsed and funded by the province, they could save on the cost of hospital births.”

According to studies by the University of British Columbia in 2009 and the World Health Organization, midwifery is a safe and cost-effective care option for low-risk pregnancies.

Beth McGinnis, Executive Director of the Midwifery Council of New Brunswick — a body within the Department of Health, says that the lack of midwifery education programs east of Quebec presents a serious challenge in recruiting midwives to Atlantic Canada.

The Midwifery Council is doing what it can to talk with midwives who show an interest in moving east. It is also developing policies and guidelines to facilitate the integration of midwives into maternal child health care teams in hospitals and communities. “When midwives are licensed and ready to practice in New Brunswick, they will provide enhanced maternal child care to New Brunswickers,” says McGinnis.