Where have all the midwives gone? The Newfoundland and Labrador Experience

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By Catherine de Cent

At the last turn of the century in Newfoundland and Labrador, the majority of babies were born into the hands of midwives. As we prepare to turn yet another century, women looking for a midwife in this Atlantic province may be surprised by what they find.

When Laurie Whitley became pregnant with her second child it was only natural for her to choose to have a midwife-attended home birth just as she had when her first daughter was born in Calgary.

But, at the time her baby was due, there were only three practicing midwives in the St. John's area. Two practitioners were nurse midwives who could not attend home births, partly because their nursing union's policy, although supportive of nurse midwives, does not support home birth.

The third practitioner, a lay midwife, felt that two midwives or another trained birth attendant should be present at all home births. Laurie's solution, (the solution of several St. John's families who have had children born at home in the past few years), was to fly in a midwife from the mainland.

Ask any Newfoundlander of a certain generation about midwives and you will often hear the same reply: "Ah yes, all my brothers and sisters were born at home with a midwife" or "My Gran used to attend to pregnant women around the Bay".

Midwifery was so commonplace that in 1920 a Midwifery Act was legislated and a board was established to regulate the admission, education, examination and licensing of midwives in the province. By 1924 the Grace Hospital in St. John's had begun an eighteen month training program modelled on the British midwifery system and licensed midwives were attending births at home and in small cottage hospitals throughout the province.

Midwives continued to practice well into the 1950s but in 1958 the Hospital Insurance Act was passed. The act provided women with free deliveries if the baby was born in the hospital and attended by a physician. At that time a midwife-attended birth cost one hundred dollars, a large expense for many families.

By 1961 the midwives board was no longer appointed and midwifery licenses ceased to be given.

Memorial University of Newfoundland continued to provide a nurse midwifery program up until 1986 with many of its graduates serving the outport areas of the province. In fact, a midwife can legally catch your baby only if you live in St. Anthony, Goose Bay or along the Labrador coastline. This special arrangement between the Association of Registered Nurses, the Department of Health and the Newfoundland Medical Board was formed in recognition of the fact that few doctors are willing to work in the north, making the use of alternatively trained care providers necessary.

However, midwives still cannot practice their profession in the south due to lack of legislation. The Midwifery Act was never repealed, but since it is not used to regulate midwifery, it effectively makes midwifery illegal.

There is, of course, a demand for midwives in the rest of the province. A 1994 Provincial Advisory Committee on the Status of Midwifery stated in its report that "midwifery is safe, cost-effective and a means of providing quality care for child-bearing women and their families in Newfoundland and Labrador."

In June of 1994 a consumer group, frustrated with the lack of midwifery options despite the 100 trained midwives living in this province, formed Friends of Midwifery. Since then the group has lobbied the government to implement midwifery again.

Last January, Friends of Midwifery evolved into the Midwifery Coalition of Newfoundland and Labrador and, together with the Newfoundland and Labrador Midwives Association, presented the case for midwifery to the St. John's public health board.

The years of lobbying seem to be paying off. After meeting with Health Minister Joan Marie Aylward last year, the Minister announced her intention to strike an implementation Task Force, the first step towards legislating midwifery. It will be chaired by a member of the public health board.

Legalized midwifery is still several years away. In a province where over 70% of pregnant women see an obstetrician during their pregnancy because so few family doctors take maternity patients, midwives with hospital privileges that allow them to catch their clients' babies are sorely needed.

As it stands, if you have hired a midwife in the St. John's area, once you enter the hospital they are regarded as "labour support" only. Still, the demand for midwives and their specialized personal care surpasses the number of midwives available for women and their families.

Those who do offer prenatal and postpartum support, as well as attending the birth and providing breastfeeding care, are few and far between and are not legally recognised.

Laurie Whitley was able to have the home water birth of her dreams because her family could afford bringing in a second midwife, an option that may not be available to many. Growing community support and awareness through such events as International Midwives Day celebrations (May 5th), letter writing campaigns, sharing birth stories and supporting local midwives all make a difference in Newfoundland and Labrador.

With a little luck this long period of transition may be coming to an end and the final push will bring midwifery back home.

For more information, contact:
The Midwifery Coalition of Newfoundland and Labrador
PO Box 1973
Station C
St. John's NF A1C 5R4 Canada

Catherine de Cent is a lay midwife in St. John's who flew to Ontario with her partner so their daughter could be born into the hands of a midwife.

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