A pregnant woman’s best friend: An in-depth look at midwifery

According to Midwifery in Ontario “[m]idwife means ‘with woman’. To midwives and their clients, pregnancy and birth are normal, healthy life events. Midwifery promotes normal childbirth and the prevention of health problems.” Let’s start with numbers. In Ontario, 84.5 per cent of births are delivered by obstetricians; 9.1 per cent, by family doctors; and 6.4 per cent, by midwives. The rate of births by Caesarean (C-section) is lower when it comes to births delivered by midwives. It actually costs the government less to pay for the services of a midwife as opposed to a hospital birth: it’s $2,500 for a vaginal birth with no complications and no pre- and postnatal care as opposed to $2,700 to $3,300 for whole-term pregnancy care, birth and postnatal care by a midwife. ("Midwifery services are completely funded by the Ministry of Health and Long-Term Care, so women do not pay for care out-of-pocket. Women who are not currently covered by OHIP can still receive free midwifery care.”)

Most of the statistics used in this article come from the Toronto Star article Ontario Midwives Call for Birth Centres for Low-Risk Pregnancy and Infant Delivery, which, among other issues, discusses discrepancies between traditional (hospital) births versus ones at birth centres versus home births. It’s a timely issue since there’s a significant push to bring more midwifery services to the province. “In the past year, the Association of Ontario Midwives has ramped up its campaign. The group has urged the province to invest $12 million in a two-year pilot project that would open five birth centres for women with low-risk pregnancies. Two would be in Toronto, one for Aboriginal women (in June 2012, two birth centres were confirmed in Toronto). The other three haven’t been determined, but midwives in Peterborough, Thunder Bay, Ottawa, Kitchener-Waterloo, Kingston, St. Jacobs and Barrie have all indicated they could have centres up and running within a year,” the article says.

Things are looking up for midwives in Ontario. Recently, Canada acknowledged its first male midwife, Otis Kryzanauskas, who had already assisted in approximately 100 births by the time he graduated with a Bachelor of Health Sciences (B.H.Sc.) degree in midwifery from McMaster University.

What does a midwife do?
Birth is a unique event — full of expectations, anxiety and, of course, joy. Most parents have some kind of an idea about how they would like this event to occur but they don’t always get their wish. Medical intervention is sometimes a necessity and things rarely go exactly as planned. But there’s a lot of misunderstanding — for, example, it is still argued that epidural anesthesia increases the rate of C-sections (this is not necessarily the case, as according to studies). Yet, women who don’t want epidurals get them, women who were hoping to give birth standing up, are told to lie down, etc. There’s a lot of controversy over medical intervention during birth. This is where a midwife comes in very handy. A midwife often serves as a sort of a birth coach — she can either assist a birth at home or in a hospital setting (or in a birth centre in Quebec), she can schedule appointments, ask questions on behalf of a woman, use her vast experience of working with other mothers, and so on.

A midwife is considered a primary caregiver of a pregnant woman. During the time of pregnancy a midwife “provides physical examinations and assessments, support and information,” according to the Association of Ontario Midwives document. Prenatal appointments last 30 to 45 minutes and happen once a month “for the first 28 weeks, every two weeks until 36 weeks and then once a week until [the] baby is born. Most women will see their midwife 11-12 times before they go into labour.” It’s important to note that “[i]f medical problems develop during pregnancy, labour, birth or postpartum, midwives work closely with specialist physicians and nursing staff,” as according to Midwifery in Ontario.

A midwife also helps the woman pick the best place to give birth in — hospital, home or a birth centre if that option is available. They also refer women and babies to doctors and specialists, such as obstetricians and pediatricians. The Midwifery in Ontario article reminds us that “[e]ven if care is transferred to a doctor at the birth, midwives will remain involved in the care as a support to the mother and baby.”

Midwives can also give medication during pregnancy, labour and birth as well as postpartum. They are also trained to examine the newborn and care for mother and child for six weeks after the birth.

Midwives don’t work alone. A pregnant woman is typically under the care of two to four midwives and usually two midwives will attend her birth. Midwives are also in touch with community services, other midwives, doctors, nurses and other professionals to ensure the best care possible.

Education
In Ontario, midwifery is a regulated profession, according to the Canadian Midwifery Regulators Consortium. (Note that “[t]here are exceptions for Aboriginal midwives and healers in the Midwifery Act and the Regulated Health Professions Act, respectively. These exceptions allow Aboriginal midwives to provide traditional midwifery services to Aboriginal persons or members of an Aboriginal community and to use the title Aboriginal midwife.”)

In order to work as a midwife you need to finish a four-year Bachelor of Health Sciences degree. There are seven education midwifery programs available in Canada, according to the Canadian Association of Midwives. In Toronto, Ryerson University offers a Midwifery Education Program that’s divided between theory, practice, midwifery clinical placements and two different levels of interprofessional placements (placements within a setting where women give birth, such as a hospital). This is to say that the program is very hands-on and prospective students will be very much involved in working with clients, in hospital and home settings. A future midwife will be expected to demonstrate increasing competence in clinical and communication skills, clinical judgment and professional behaviour. In the final clinical placement of the program a student is expected to work independently as a midwife.

Outlook
People want and need more midwifes. Consider this: in June 2011, according to The Grid, Toronto parents gathered at Queen’s Park to demand higher salaries for midwifes, who currently make an average of between $81,713 and $104,847 in Ontario. The article reported, “In Toronto, expectant parents clamour to get on midwife waitlists — some will even lie about their due dates to get a coveted appointment.” Currently, according to Ontario Midwives, although “midwifery care has grown exponentially since 1994, demand for midwives from women still outstrips supply, and four out of 10 women wanting midwifery care can't access it.”