by: Connie Littlefield
West Chezzetcook
 
This is an exciting time for midwifery in this province! Midwifery has been legal in Ontario since January of 1994 and has  recently legislated in Quebec, Alberta, and British Columbia as well. 

Here in Nova Scotia, the Department of Health has recently formed a working group to look into ways to implement midwifery care. The working group is made up of representatives from all four Regional Health Boards, the Medical Society of Nova Scotia, the Registered Nurses Association of Nova Scotia, the hospitals, the Association of Nova Scotia Midwives (a professional association), Public Health Nurses, the Dept. of Health, and the Midwifery Coalition of Nova Scotia (a consumer group). This working group will make recommendations regarding the regulation of midwifery in the province. This will start the legislative process in motion, and hopefully midwifery will soon be a safe and free option for all Nova Scotian women and their families.

Currently midwives in Nova Scotia are alegal, meaning that while they are not operating illegally, neither are they supported by the system. Once the legislation is in place, their services should be covered by M.S.I. and they will have hospital and other medical privileges. It is important that individuals and communities speak up and make their feelings known to the working group so that midwifery can be implemented in a suitable way. There are many different models that could be followed, and different systems may fit different communities.

Many families may want to give birth at home, but for those who don't, a  birthing centre may be the solution when the hospital is a long way away. In Ontario, 90% of midwifery consumers choose to have their babies in hospitals or birthing centres. Will midwives in our community practice in their own clinics? Out of their homes? Or only from hospitals or birthing centres? Will they work alone or in teams? Where will they receive their education? How will they be paid? These are all questions that need to be addressed and the answers we come up with will have an impact on all of us in the years to come. Many people are confused about what a midwife does. It's not like the care you would receive from a doctor; in fact it's completely different.

The first job a midwife must attend to when she meets her new clients is to ascertain whether this pregnancy and the resulting birth are at all risky. A midwife would never conduct births on her own if there was any risk involved. The vast majority of births, however, are completely normal and there is no reason for medical intervention.  A midwife spends a lot of time with the expecting couple during the pregnancy helping to prepare the new parents for the big day-- and what comes after. Pre-natal care includes physical checkups and also a lot of discussion; all aspects of health are within her scope including the recommendation of exercises, supplements, reading material, baby care supplies, and anything else the expectant parents need.

After the birth, the midwife conducts post-natal visits to make sure feeding, healing, and infant care are all going well up to 6 weeks post-partum. Of course the big difference between midwifery and medical care comes during labour and birth. A doctor might check in on the laboring mother once or twice during labour, then show up in time to catch the baby. The remainder of the care is left to the nurses on shift and the birthing mother's own attendants, usually the father. A midwife, by contrast, arrives as soon as the labour is underway and stays throughout. During labour the midwife performs all the physical care that the situation requires including the administration of oxygen, episiotomy (if necessary), and administering immunizations (if chosen). She knows which spots can be rubbed to alleviate pain, which positions work most effectively, and how to spot trouble before it happens.

Mothers who give birth this way have far fewer stress-related problems during birth and the post-partum phase. Most couples who deliver with the help of a midwife report far fewer problems with bonding, breast feeding, and healing; and usually have higher birth-weight babies. It's difficult to quantify things like maternal and child health, breast feeding success, and stress reduction; but all indicators point to the relative cost-effectiveness of midwifery care compared to hospital delivery. This is one of the major reasons that Nova Scotia is on the verge of legalizing the midwifery profession.

The model of midwifery education for the province that seems most likely is for Nova Scotia to reserve a couple of places in Ontario's Midwifery Baccalaureate program. Eventually, our own school of midwifery could be established. There will likely also be allowances made for midwives who have received their training in other ways and who wish to begin or continue practicing here. Very soon, midwifery could be a career option for Nova Scotians; so now is the time to start thinking about how we want this to be handled.

Obviously, the best situation has midwives practicing in the communities they have chosen to live in; perhaps where they grew up and where their families live. For this reason and others, the onus is on every community to get involved in this process. I am also interested in meeting with any interested parties to discuss these issues: play group parents, breast-feeding support groups, boards of women's health organizations, shelters, and high school classes. I am also open to setting up "kitchen table" meetings, wherever two or more people would like to learn more about the midwifery model of care. 
Please call me at (902) 827-4644 for more information. 

My e-mail address is: 
aw279@chebucto.ns.ca Please contact me and find out how you can get involved in the new era in birthing options in Nova Scotia.