Re-birthing a Solid System: NL Coming Full Circle with Midwifery

Though a newly regulated midwifery program is the news this week, Midwifery is nothing new in Newfoundland.

Though a newly regulated midwifery program is the news this week, Midwifery is nothing new in Newfoundland.

In fact, midwifery used to be a perfectly good solution to having so many communities without easy access to hospitals for childbirthing. A midwife can do for you what a hospital does, and in a 1-on-1 capacity. Midwifery also eases the workloads of hospital nurses and doctor … which saves us a buck in healthcare costs (Newfoundland’s #1 tax-dollar burden)

Back in 1892, when the famous Dr. Wilfred Grenfell arrived in our province, he immediately established hospitals staffed by British midwives, many of whom were also nurses.

Come 1920, things were regulated better when Government appointed a board to provide midwives with a license to practice. Most of these midwives worked in rural communities that didn’t have hospitals for childbirths.

Because these outports were responsible for paying the nurse or midwife’s salary, NONIA (a store now located on Water Street in St. John’s) was formed to fund midwifery in outport Newfoundland by selling crafts and knit wares. NONIA stands for The Newfoundland Outport Nursing and Industrial Association.

In the 1930s, the Department of Health started building “cottage hospitals” as alternatives to more expensive and expansive hospitals. Many women gave birth to many of our descendents in these nurse or nurse-midwife run cottage hospitals.

Women who were not nurses were brought to St. John’s to attend a 2-month training course at the Grace General Hospital. Essentially, every community had their own midwife, and as she neared retirement age, the community would choose and offer up an apprentice to help the midwife, while learning from her. Then off to the 2-month bootcamp at the Grace Hospital in town she went,  to get certified.

Midwives were equal parts healthcare professionals and entrepreneurs: families paid that what they could afford.

So What Ever Happened to Midwifery in Newfoundland?

Where midwifery starts to die off a little in our province’s history is in the years after we joined Canada.

Specifically, 1958’s “Hospital Insurance Act” essentially meant women no longer had to pay to be tended to during childbirth. Free care in hospitals, and enhanced transportation to hospitals, saw more women going to hospitals to give birth. By the 1960s, there were years of no new applications for midwifery licenses.

Government took a lack of uptake on midwifery certifications to mean midwives were a thing of the past, and folded the board assigned to certifying midwives. The problem-solving convinience and financial perks of midwifery and a renewed interest in reinstating it in NL has been re-gaining momentum here the last ten years.

In April of 2016, Newfoundland & Labrador’s minister of Health and Community Services announced the introduction of new regulations governing the practice of midwifery in Newfoundland and Labrador, and a new college has been struck up for training, the College of Midwives of Newfoundland and Labrador.

“These new regulations will facilitate the safe and responsible governance of midwifery in our province,” said Minister Haggie at the time. “These new regulations [outline] exactly what is required to practice here in Newfoundland and Labrador.”

The new regulations were developed based on national standards and in close consultation with stakeholders both provincially from across the country, and outline all educational, exams, and other certification requirements necessary for someone to practice regulated midwifery in NL now.

We Have a World-Renowned “Provincial Midwifery Consultant” Establishing a Solid Midwifery Program Here Now

As of this week, Gisela Becker has started work in her role as the Provincial Midwifery Consultant with the Department of Health and Community Services, making her the province’s first registered midwife under the Health Professions Act.

The Newfoundland and Labrador Council of Health Professionals will be the regulatory body responsible for registration, professional standards, quality assurance, and discipline of this profession. Becker’s role is not to actively practice midwifery in a clinical setting, but to lead the team that will introduce midwifery services into the public health care system.

Over the next year, Becker will work with the four regional health authorities, as well as the Association of Midwives of Newfoundland and Labrador, and the College of Midwives of Newfoundland and Labrador to set up these services. The first area of focus will be in central Newfoundland.

Becker completed her principal midwifery education in Germany in 1986. She has since practiced midwifery in a variety of settings in Germany and The Caribbean, and since moving to Canada in 1995, she’s practiced as a midwife in Nunavut, Alberta, Quebec, and the Northwest Territories. Her background, community involvement, and leadership roles in her discipline are expansive and impressive, including former presidency of the Canadian Association of Midwives.

Conveniently, Becker has extensive experience in rural and remote midwifery services, and collaborative maternity care.

Benefits of Midwifery in NL

The Association of Midwives of Newfoundland and Labrador (AMNL) has long had a vision for midwives in Newfoundland and Labrador to be publicly funded for providing midwifery care. It’s not too hard an argument to make, given some of the financial benefits midwifery brings to the healthcare table. After all, everything comes down to dollars and sense and “efficiencies” in governmental decision making.

According to AMNL, “Midwife-attended births are cost-effective for the health care system as a result of fewer interventions, such as c-sections and episiotomies, as well as shorter hospital
stays, and lower re-admission rates to hospitals.”

Midwives provide round-the-clock care for women and babies during the first few critical weeks of life, so “women are 60% less likely to be re-admitted to hospital.” There’s also a convenience factor: many of our communities do not have a hospital. It’s easier to provide communities with their own midwife than it is their own hospital.

Midwives provide support, advice, and care during pregnancy, labour, and the postpartum period, including overseeing the actual birth of the baby. This care includes preventative measures, the detection of complications in mother and child, and any accessing of medical care or appropriate assistance in the carrying out of emergency measures.

All of which takes a burden off of the workload of hospital doctors and nurses. And equally important, for every woman who wants to give birth in the safety of a hospital, there’s one that wants to give birth in the comfort and privacy of their home (or a clinic less hospital-y).

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