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Comment: Education needed into midwifery services

A recent call by the Midwives Association of B.C. for the expansion of midwifery services in the province focused on long-term savings to taxpayers and better access to care.

A recent call by the Midwives Association of B.C. for the expansion of midwifery services in the province focused on long-term savings to taxpayers and better access to care. Both are important outcomes for a healthy society, and healthy moms and babies.

If more families are going to embrace alternative birthing models, one needed first step is education.

As a doula and childbirth educator I am often perplexed that many childbearing families don’t know that midwifery care is both safe and free in B.C. I forget that not everyone shares my unconventional beginnings, or has been exposed to or had a reason to explore different kinds of maternity care.

I was born under the care of a midwife on the Sunshine Coast. The same midwife helped deliver four of my friends.

On my third birthday, my sister was born while I slept in the next room. Then at nine I watched my youngest sister being born in the kitchen of our Toronto home.

Back then, I did not realize that by choosing a midwife (privately paid and unregulated at the time), my mother was making a statement and an extremely unusual choice for that time. For a shy and quiet woman, she was fiercely certain about how and where she wanted to birth her babies. Luckily, she had the means and support to exercise that preference.

As an adult, I have an appreciation for and experience with a variety of birth practices and preferences among my clients and friends. Midwives are just one of a few excellent options for birthing moms. When I start a family, a midwife will be the obvious choice for me — not because a midwife is the better choice, but because a midwife offers the type of care that I feel familiar and comfortable with.

What strikes me is that most of my peers are not certain of what a midwife does. This is most evident when people ask me the difference between a doula (which I am) and a midwife.

I explain that a registered midwife in B.C. is a formally educated expert in low-risk pregnancies and births. Her practice is regulated by the College of Midwives of B.C. and her services are covered under our B.C. Medical Services Plan. She provides medical care for pregnant women, assesses their health and their babies’ health, orders tests, attends births in hospitals and homes, and offers six weeks of postnatal care for mother and baby.

Doulas do not do any of that. A doula does not give clinical care and she does not catch babies. What she does provide, however, is continuous emotional and physical support to a birthing mom and her partner throughout the entire labour and birth.

She is an optional part of the birth team for any mom, regardless of whether she has a doctor or midwife as her primary-care provider. For example, at a recent planned hospital birth, I helped one wonderful father attend to his wife as she laboured smoothly at home, then accompanied them to the hospital with their midwife when she was closer to giving birth.

An increasing number of influential people accept the strong evidence supporting midwifery care and are helping to raise awareness about and access to midwifery services. For example, in 2012, the provincial government invested almost $2.5 million to expand access to midwifery training and services in B.C. The government has also encouraged more women to give birth at home.

Why? Multiple studies confirm that planned home births for low-risk women with a registered midwife in attendance are just as safe as hospital births. And they cost a lot less, too.

Home births are not for everyone, but it is comforting to know that they are a safe option for those who wish to choose them.

Considering safe outcomes, significant reduction in health-care costs and more options for birthing moms, the idea of expanding midwifery services in British Columbia sounds like a reasonable and responsible goal to me. But that expansion needs a greater awareness about what a birth with a midwife, in a home or a hospital, is really like.

Interestingly, the Vancouver Foundation issued a grant to the B.C. Women’s Foundation last year to identify and explore factors that impede or facilitate women’s access to midwifery, including public perception of what midwives do, and limited access in rural communities.


Shona Boisvert is a doula, childbirth educator and communications consultant in Victoria.