N.S. midwifery facing 'collapse,' report finds

A report on Nova Scotia's midwifery program released Wednesday raises serious concerns about the program's future.

Regulated midwifery was introduced in Nova Scotia in 2009 and the publicly funded services were rolled out at the IWK Health Centre in Halifax, the South Shore District Health Authority and the Guysborough Strait Antigonish Health Authority.

But the report by four independent experts for the Department of Health and Wellness found potentially critical problems.

"In our view midwifery in N.S. cannot long survive in its present state," the report says. "If nothing is done, the profession will collapse and the benefits of regulation will not be realized."

It says there are too few members to meet the increasing requests for midwifery care and provide services safely and effectively.

Halifax pilot plagued by conflict

The Halifax site in particular has been plagued with problems. Four midwives were originally hired for the three full-time equivalent positions at the IWK, but only one remains and that person now sees a full case load of low-risk patients in the perinatal centre and birth unit.

The program was suspended in December.

The report found "integration difficulties" had caused problems with the service. It attributed some of the problems to the short lead-in time to establish the service and some to the "awkward" fit of a hospital employment model with midwives who are accustomed to being autonomous.

"Inter-professional and interpersonal conflicts were both cause and effect for a widespread loss of trust and confidence among all parties," the report continued. "We discerned sadness, disappointment and regret across all sectors at the present circumstance coupled with a desire to re-establish midwifery at IWK."

It noted a commitment to rebuild midwifery at the hospital and a desire among Halifax women to see the service return. It says it will be challenging to do so because of the collapse of the previous effort.

Kristel Vom Scheidt, due with her second child in November, is one of a few dozen women currently using the lone midwife available to women living in the Halifax area.

"It's not ideal at all right now, she's doing a shared care model and so depending on when I go into labour I might get one of the other doctors or obstetricians, so if there are more midwives that are hired in the next couple of months it would be better, I'd be much happier to have a home birth assisted by a midwife," said Vom Scheidt.

Other areas faring better

At Guysborough, where no midwifery service existed prior to regulation, two midwives are employed. The report found better integration and relationships between professionals.

"We heard from the midwives and others that criticisms have been directed at them for working within the inter-professional model of service provision, but we also learned that women's responses to routine hospital surveys about their care have been very positive," the report says.

The south shore authority has two midwives. The Bridgewater-based practice is steadily growing and is at full capacity presently, the report found.

It praised the "experienced midwives who are highly committed to their mode of practice."

Most of the south shore problems arose from excess demand on the two midwives. Part of that overload comes from women in the Halifax area who want to travel to the south shore to access the midwifery service.

'Anxiety, uncertainty and loss of public confidence'

Overall, the report found the fact that the government has not announced a plan for the future of midwifery problematic.

"With only four midwives in practice, the present situation is marked by anxiety, uncertainty and a loss of public confidence in government's commitment to midwifery," it says.

It says the costs of setting up the regulatory structure and providing the service is considerable, but to be expected when launching a new profession.

"As well, the qualitative benefits to women of midwifery care are not easily measured and do not convert readily to dollars in economic analyses," it says. "We think midwifery in Nova Scotia has good potential and that investment in its future is fully warranted."

The report makes a number of recommendations. It says the government should stabilize and strengthen the existing service. It should also work with the local health authorities to implement organizational changes for midwives.

It also calls for a plan for growing midwifery in the province

Province 'committed to midwifery'

Maureen MacDonald, the Health and Wellness minister, requested the report. 

"For any mother, giving birth is one of the most important events in her life. For some mothers, the choice of health-care provider is equally important," she said in a media release Wednesday.

"Now that I have received the report, our department will carefully review the recommendations. I am committed to midwifery and want to ensure it is operating sustainably in the three district health authorities in which it is currently provided."

The full report can be read here.