There is a lot of talk these days in health circles about evidence-based decision-making, i.e. developing policy based on strong research, rather than on ideology, “anecdata” or economic expediency. Unfortunately, a lot of the talk is just that — talk. Take, for example, some recent Canadian developments in the world of midwifery.
The research into the safety, efficacy and cost-effectiveness of midwifery is well established (though you might not know it from the Little House on the Prairie image it still has in popular culture). Researchers have amply demonstrated that babies born with the assistance of midwives (at home, in hospital or a birthing centre) fare just as well as those born to mothers cared for by obstetricians (see this recent study by Eileen Hutton on the study she conducted into midwifery in Ontario). In fact, among women with low-risk pregnancies, a home birth with a midwife might actually be even safer. Data collected by the Ontario Ministry of Health and Long-Term Care indicates that women cared for by a midwife are subject to fewer obstetrical interventions, such as C-sections and episiotomies. And the cost? The ministry has itself indicated that midwives save the healthcare system between $800 and $1,800 per birth.
Even though the evidence shows that the outcomes for mama and baby are just as strong for women receiving midwifery care than not, obstacles remain to women who want to be seen by a midwife during their pregnancy. For example, availability of fully funded and publicly regulated midwifery services across the country is patchy, and there are three jurisdictions in Canada that don’t offer publicly funded, provincially regulated midwifery at all: the Yukon, New Brunswick and PEI. In New Brunswick, it can cost a woman anywhere from $1,500 to $3,000 out of pocket to have a midwife provide care.
Another issue is that the demand for midwives outstrips their numbers–though the growth in the profession over the past few years is considerable. Right now, there are about 500 registered midwives working in Ontario, but this is about 150 more than just a few years ago. (A personal aside: The demand for midwifery care is so intense that, when I told my doctor I was planning on having a baby, she responded, “When you find out you’re pregnant, don’t phone your husband, don’t phone your mom–phone the midwife.”). There are only 6 places in Canada where midwifery education programs are available, but the good news is that the programs are graduating larger numbers of students than ever before.
A third and very significant problem for women seeking midwifery care is the issue of hospital privileges. Obtaining hospital privileges for midwives has proven, in some cases, to be difficult. Take the case of two registered midwives who recently opened a clinic in Orangeville, Ontario. After months of providing midwifery services in the community, they still cannot get privileges to practice at a local hospital. This forces women in their care to have to drive 30 – 60 minutes away to get care from a midwife in a hospital setting. The restriction of hospital privileges completely goes against the philosophy of evidence-based decision-making in healthcare.
With fewer and fewer doctors delivering babies, midwives are prepared to step into the breach (no pun intended). But the demonstrated advantages of midwives for the entire healthcare system can only be fully realized with a coordinated effort among provincial health ministries, midwifery working groups and organized patient/consumer groups. Recent developments, such as Ontario’s Ministry of Health and Long-Term Care permitting new midwifery registrants to find work immediately upon graduating, is one such positive step. Canadian women need more steps like these to ensure universal, quality maternity care for all.