Saskatchewan is the only western province that does not allow midwives to practise.
Most births in Saskatchewan, other than in the north, must be handled in hospitals in larger towns and cities rather than in the woman’s community or home, as is allowed in several other provinces.
Although legislation was passed five years ago to make midwives legal, the Saskatchewan government has never proclaimed it, so the practice is still illegal.
“I guess the government doesn’t really want to bother,” said Cathy Ellis, a midwife who last month moved from Regina to Vancouver.
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She said it’s too bad because midwives who attend births instead of a doctor are “a good cost effective option that women like.”
The Saskatchewan health department says it has not proclaimed the law because there are not enough midwives in the province to undertake the administration of a self-regulating professional college. The college would ensure the midwives have appropriate training and officially register them.
Ellis is now teaching midwifery at the University of British Columbia, which is training 10 students annually in a four-year course that will see its first graduating class this year.
Gisela Becker, president of the Midwives Association of the Northwest Territories and Nunavut, told a national conference last month that “midwives are the only maternity care provider group whose numbers are growing rather than declining.”
Ellis estimated that 100 midwives practise in B.C., which legalized the profession in 1998. She said there are several hundred in Ontario, which allowed midwives about 15 years ago.
She said one of the advantages of midwives is the time they spend with women before a birth, passing on information and heading off problems. Ellis, who also attended the national midwifery conference, said new areas of work for midwives are with teenaged mothers, immigrant women and those with addictions.
“Those who need more time and care. The benefit is they don’t go to the emergency room all the time.”
However, she said the other 75-80 percent of women aren’t at risk in deliveries and could use a midwife because they don’t need the special services of an obstetrician.
Betsi Dolin, the Manitoba Health official in charge of that province’s midwifery program, said the department is just starting to look at the costs of having a midwife versus a doctor for births.
“It’s difficult to say. It’s so new. It’s a different focus than obstetrical care.”
Dolin said midwives don’t just take blood pressures; they also ask how the woman is living, what she’s eating and how she is preparing for the baby’s arrival. They also visit her home after the birth to see how mom and baby are coping.
“A lot of the savings come through the preventative care. It’s a long-term effect.”
Manitoba legalized midwifery in 2000 and about 28 women now practise in the province, half in Winnipeg and the others in rural and northern areas. Manitoba, as do B.C., Ontario and the Northwest Territories, funds midwife care through the medicare system.
Alberta legalized midwives in 1998 but the province doesn’t pay for the service. It allows the health regions to pay the cost, if they want, but Patty Lenstra, president of the Alberta Association of Midwives, said only one rural region does so, in the Stony Plain area.
“Right now, people who can afford it pay for midwives,” she said.
The Alberta association is campaigning for the province to pick up the costs of the service.
Because they are privately funded, most of Alberta’s 18 registered midwives work out of urban areas where there are more clients who can afford them and where two or three midwives can cover for each other in a clinic. Other than Stony Plain, the only other rural midwife is in Rocky Mountain House, Lenstra said.
“We need to increase our numbers so women in rural areas can access our care.”
She said another problem in maintaining midwives is the cost of the four years of training. The closest training schools other than UBC are in Ontario or the United States.
Ellis, who is a nurse and trained as a midwife in Mexico, said she has attended about 1,200 births in her career.
“I worked illegally for 25 years as a midwife. But if we hadn’t done that, then there wouldn’t be midwives. It was a social movement. It’s not breaking an ethical law as long as you’re not doing harm to anybody.”
