Regulated midwifery: to push, or not to push …

The territory is considering regulating the age-old practice of midwifery. Whether that's a good or bad thing depends on whom you talk to. The Yukoners for Funded Midwifery, a coalition of midwives and their supporters, want all pregnant women to have access to a midwife.

The territory is considering regulating the age-old practice of midwifery.

Whether that’s a good or bad thing depends on whom you talk to.

The Yukoners for Funded Midwifery, a coalition of midwives and their supporters, want all pregnant women to have access to a midwife.

Right now, only women who pony up the $2,500 fee can do so.

Asheya Hennessey faced that dilemma with the birth of her first child. She wanted a midwife at her side, but lacked the money to pay for one so she gave birth to her first child in the hospital.

Because she couldn’t afford a midwife, she started the Yukoners for Funded Midwifery in 2006.

When Hennessey was pregnant with her second child she decided to hire a midwife regardless of the cost. Then she sent the bill to the territorial government along with a petition calling for public funding of midwifery.

Officials refused to pay her bill. The only way midwifery would be funded in the territory, they said, is if the industry is regulated. That was in 2008.

Two years later, the government is holding public consultations on regulating the industry. But Hennessey is hesitant about moving in that direction.

A regulated industry also means a restrictive industry, said Hennessey.

“I’m not convinced regulation should happen,” she said from her winter home in Costa Rica.

“When a profession is regulated it’s because the government feels it’s a public safety issue.”

That level of public scrutiny isn’t necessary for midwives in the Yukon, she said. The population is so small that midwives can self-regulate.

“It’s not like Ontario where there’s so many midwives that you want to keep tabs on everyone,” she said.

“In the Yukon there’s only two midwives and room for maybe four to six others.”

Currently 10 Canadian provinces and territories regulate midwifery, including the Northwest Territories and Nunavut.

Hennessey knows there’s benefits to regulation, such as officially recognizing midwives as primary caregivers. Regulation would also mean midwives would receive access to medical services, like blood tests and pregnancy screenings.

But she doesn’t like the government regulating which procedures midwives could perform.

In Ontario, for instance, if a mother is going to give birth to twins or have a breech birth (when a baby comes out feet first), the midwife has to involve a physician in the procedure.

“If the woman feels comfortable and the midwife feels comfortable then there shouldn’t be any restrictions on that choice,” said Hennessey.

“In the Yukon now, there’s a lot of opportunities for women to make choices that other jurisdictions have obliterated.”

But midwives in Ontario and British Columbia don’t necessarily see it that way.

Ontario was the first province in Canada to regulate midwifery. Robin Kilpatrick was one of the midwives who began lobbying the Ontario government to regulate the industry in 1983.

“At the time we were saying it was in the best interest of women that midwifery be regulated, and I still believe that,” said Kilpatrick, who is now deputy registrar of the College of Midwives of Ontario.

Even before the Ontario government’s regulations, midwives had a voluntary regulatory body and offered malpractice insurance to midwives.

Regulating the industry means more women have access to a midwife and the public is better protected when they access midwifery services, said Kilpatrick.

Women may have to consult a physician for a breech birth in Ontario, but physicians won’t necessarily take over the procedure from the midwife, she said.

That would depend on who is most skilled in doing breech births.

“The most skilled practitioner, in the best interest of the woman, would be the best person to attend the birth,” she said.

When midwives don’t have hospital privileges, and can’t access prescriptions and tests, it means the woman’s care is “fragmented,” said British Columbia midwife, June Friesen.

The benefit of hospital privileges far outweighs the restrictions placed on midwives, she said. And making the profession government-funded means more women now access the service.

Since British Columbia began regulating midwives in 1998, the number of women having midwife-assisted births has skyrocketed.

Only one per cent of babies used to be delivered by midwives. Now that number has grown to 10 per cent in just 12 years, said Friesen.

The same is true in Ontario where the demand for midwives is so great that one third of all pregnant women seeking a midwife get turned away, said Kilpatrick.

Increasing access is one of the most important things that has come out of regulation in other provinces – Hennessey doesn’t deny that.

If the Yukon does move towards regulating midwives, Hennessey hopes Yukoners for Funded Midwifery will be a part of the process of drafting regulations.

“I think regulation could be a good thing if the regulations in the end don’t restrict choices for women.”

The Yukon’s two midwives could not be reached for comment.

The government is seeking comments until April 30. Visit the Yukon’s Health and Social Services website for details.

Contact Vivian Belik at

vivianb@yukon-news.com

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