Like any mother of two toddlers, Sarah Bjorgan knows what a whirlwind life can be even when you stay put in your own home. But since September, the Saanich resident has added full-time midwifery studies to the mix, complete with commuting to Vancouver during the week to attend the University of B.C.
"I have incredible support," she says. If it weren't for her husband, Jonathan, and parents Stephen and Jean, who live around the corner, her midwifery studies would not be possible.
One other factor makes them possible: The B.C.
Ministry of Health increased UBC funding by $1.9 million to bring five new midwifery students on stream this year, and five more next year, doubling the class size to 20.
The number had been held to 10 a year for the program's decade of existence, despite significant increases in the number of women requesting midwife-assisted births.
Bjorgan, a registered massage therapist, had applied twice before - along with 125 to 150 others each go-round, but never made the very tiny cut.
Now she flies over on Tuesday mornings and catches a ride and ferry back on Friday afternoons with another Victoria student, with whom she shares a basement apartment during the week.
"No, I don't feel overwhelmed," she says.
"I'm really excited. I'm getting some broad-strokes concepts of midwifery in the first year. It's like an appetizer and I'm looking forward to what's to come."
UBC asked for the staggered admission because doubling the midwifery class size in one year would require too many clinical placements for students, said interim director Elaine Carty.
All of this fall's new students have previous degrees and range in age from about 21 to 40.
"It's wonderful that the educational program at UBC is expanding," said Jane Kilthei, registrar of the College of Midwives of B.C.
At the same time, however, Kilthei is worried that if the college can't get a firm commitment from the province to support a development program that integrates immigrant midwives with differing educational backgrounds into the B.C. system, there will be little net gain in midwife numbers.
The program brings international midwives up to speed in areas outside the work they did in their homelands.
For instance, they might have trained for only labour and birth rather than a full pregnancy. They may not be familiar with writing letters to obstetricians for consultations, or may have practised as employees rather than independent professionals, as is the case in B.C.
This is the last year of federal funding for most of the $4-million annual cost of the training project and it's up to the provinces to step in with operating costs to keep it running, she said.
B.C. midwives were told by the province in the spring not to expect support for seven spaces for immigrant midwives at a cost of about $30,000 each, she said.
"Without B.C. purchasing seats, it won't survive," she said, because it needs support from all the western provinces. Saskatchewan is on-side to buy several seats, with Manitoba and Alberta close to paying their share.
"We're hopeful that the B.C. government will help us to find a way," she said.
There are 190 registered midwives in B.C. and another 39 on leave - mostly unpaid maternity leave - according to numbers from the College of Midwives of B.C.
Eighty-four midwives are listed on the Island, including 38 in Victoria. But the actual number of practising midwives is lower.
Luba Lyons Richardson, co-head of the midwifery program for Vancouver Island Health Authority South, said in an e-mail there are now 24 midwives in Victoria and 56 actively practising on the Island.
Health Minister Dr. Margaret McDiarmid, who took over in September, said she will look into the immigrant-midwife program funding issue. "What I need to do is to ... have a talk with the ministry and a talk with the College of Midwifery," she said.
The college has been "incredibly constructive partners, so we'll spend some time talking about this," she said.
"Not every province has the depth and breadth of training that we have here and we've actually increased it and put [in] more funding."
Ganga Jolicoeur, executive director of the Midwives Association of B.C., said the UBC funding for more graduates is "a very positive move and one that we've been waiting for a long time."
But she, too, says the international bridging program is "a pretty pivotal part of the equation."
For Bjorgan, the fact that women can access midwifery care without worrying about the ability to pay is critical.
Massage therapy was rewarding but she was conscious of how many people who needed help could not pay for her services, which were de-listed from the Medical Services Plan in 2002.
Midwives have been funded in B.C. since 1998. Currently, they are paid $3,042 to care for a woman's entire pregnancy and longer, minus business costs, which can account for one-third of their fees.
"I want something that is important and imparts dignity and respect for people innately, which is the philosophy of midwifery, and that gives me a steady income," Bjorgan said.
Bjorgan chose midwives for her pregnancies with children, Evelyn, 3, and Malcolm, 1, and wants the chance to provide the same kind of pregnancy care for other women.
Evelyn was delivered with the help of a physician - the only 20 minutes of physician care in Bjorgen's first pregnancy.
She beat her midwife to Victoria General Hospital for Malcolm's birth, arriving just in time to have one of three nurses "catch" him.
"Midwifery is so much more than catching babies," she says.
In fact, the care lasted six weeks after the birth, including home visits.
"I had never experienced women-focused, client-focused health care."
MIDWIFERY BY THE NUMBERS
1. The B.C. Ministry of Health spent about $1.9 million on midwifery services in 1998-99, its first year of publicly funding midwifery. By 2010, the province was paying 10 times as much, $19.3 million.
2. In the first year of funding, midwives delivered only 825 babies. Last year, there were 1,364 planned home births assisted by midwives, with 983 actually taking place.
3. Midwives attended nearly 15 per cent of births in B.C. in 201011 - 6,421 of 43,530 births.
4. B.C. midwives receive $3,042 for each full course of care to a pregnant woman, extending six weeks after birth. The MSP fee was $2,250 in 1998.
5. Midwives cannot bill more than 60 full courses per year, with 40 to 60 births considered full-time.
6. Practice expenses range from 32 to 37 per cent of their annual full-time fees, resulting in pre-tax earnings ranging from $76,600 to $124,100.
7. Midwives pay liability insurance of about $2,000 per year.
8. There were only 50 registered midwives in the province in 1999; that's nearly quadrupled to about 190 now.
9. There were nine midwives in Victoria in 1998; today, there are 38 listed with the college and 24 actively practising.
10. B.C. research published in the Sept. 15, 2009, issue of the Canadian Medical Association Journal compared all 2,889 planned home births in B.C. attended by a registered midwife from 2000 through 2004 to 5,331 physician-attended planned hospital births in the same period and found "very low" risk levels. "Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician," the CMAJ concluded.
Sources: Midwives Association of B.C.,Canadian Midwifery Consortium Regulators, College of Midwives of B.C., Times Colonist files and Victoria Midwifery Group
