When Samara Grace Chadwick decided to move back to Atlantic Canada from the U.S. four years ago, her birth plan was a major factor in her decision.
Born in New Brunswick, she longed for a similar community that cares and advocates for each other, so her family moved to the South Shore.
Not only was she pregnant with her first child, but it was also the height of the pandemic. When she learned about the care offered by midwives here, she felt incredibly fortunate.
“There’s something quite distinctive about the South Shore,” she says.
“Services like midwifery are key to that. It’s changed my life, and it’s changed so many people’s lives. It’s a beautiful, fundamental act of care that is sewn into the fabric of our community, and that’s why we fight for it. But I wish it wasn’t a fight.”
The practice of midwifery can be traced back to 40,000 B.C. Yet, its integration into healthcare systems differs drastically from culture to culture and even from community to community.
In Nova Scotia, midwives are currently only available in the HRM, Lunenburg County and Antigonish County.
Even in these regions, a shortage exists, and many birthing parents do not benefit from informed choice – a key tenet of midwifery – because parents’ wishes can conflict with the health authorities that employ midwives.
Sarah Ravlic worked with midwives for her first child, born in British Columbia, and her second child, born in Nova Scotia.
She noticed a difference in how her midwives were integrated into the hospital teams in Nova Scotia – saying the home visits were very helpful, especially the post-partum aftercare.
However, it was more difficult in the hospital to advocate for her choices. She had hoped for a home birth for her second child, but two midwives were required to be present for a home birth, and there wasn’t the capacity to accommodate this request. Having less ability to advocate for the birth experience she desired resulted in a traumatic delivery. It was a far cry from the ideal birth Samara Grace Chadwick had experienced.
Chadwick says she had two great experiences guided by local midwives, describing her second child’s recent home birth as a “dream birth.”
She and a group of parent advocates in Lunenburg County say experiences like hers demonstrate the power of midwives, and more families should benefit from their services.
Local parent Kyle Melnick, whose partner had a midwife-guided birth, says Nova Scotia needs to do more to attract and recruit midwives and hold the system accountable for a report the Department of Health and Wellness commissioned 13 years ago to advise about Nova Scotia’s midwifery program and site-specific recommendations, many of which have still not been implemented.
The 2011 report cites an overall need for more midwives (there were seven at the time, now there are 16) and operational changes to ensure “there is clear separation of the operational/administrative component of midwifery from the oversight of professional practice.”
It also recommends the province hire an experienced midwifery clinical leader to serve as an interprofessional liaison to prevent or resolve many integration issues.
CJ Blennerhassett, Vice President of the Association of Nova Scotia Midwives (ANSM), says the South Shore is the only site of the three in Nova Scotia that still needs to implement that position.
“The system works best when everyone works together as a team,” Blennerhassett says.
“Midwives are highly skilled primary care providers who work autonomously but are employed by their district health authorities. We advocate for midwifery representation in leadership roles to create a collaborative environment prioritizing patient choice.”
The ANSM also launched the #NovaScotiaNeedsMidwives campaign this spring after the provincial budget was devoid of any midwifery spending despite an ongoing shortage in which Blennerhassett says they “turn away more people than they take into care.”
Another recommendation from the report was to provide funding for non-midwife second attendants to assist the primary midwife in home births so two midwives would not be required, which could have allowed Ravlic to have her desired birth at home.
The report also called for another health district to start offering midwifery. The South Shore is fortunate to have these services, but it also serves a vast region, notably since the Annapolis Valley lacks midwives. The report specifically called out the need to serve more diverse communities, such as Indigenous communities in Cape Breton and throughout Nova Scotia.
Here on the South Shore, Melnick plans to advocate for midwife representation in hospital administration, more midwife positions, and better integration into the healthcare system, and encourages others to join these efforts and learn more by emailing midwifery.advocacy@gmail.com.
Midwife care is based on three principles:
- Continuity of care: Midwives provide care before, during and after pregnancy.
- Informed choice: Women are the active decision-makers in the care they receive.
- Choice of birthplace: Women choose where they want to give birth, whether in the hospital with a midwife and care team, or at home.
Midwives graduate from rigorous, four-year degree programs, provide evidence-based care for birth and sexual and reproductive health services, and are registered through their province’s governing bodies. By visiting families in their homes or a space comfortable for the parent(s), they safely and non-judgmentally provide care and can bridge access barriers faced by vulnerable populations.
