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More and more mothers in British Columbia are seeking midwifery care during their pregnancy but the current system will need to quickly adapt if it’s going to be able to keep up with the demand.

BC sees a higher percentage of midwives attending births than any other province in Canada. Yet, it’s still only half the amount of some of its European counterparts.

Despite being an ancient practice, midwifery has only been acknowledged in Canada as a regulated health profession since 1998. Since then, a growing proportion of BC mothers have opted to use midwives during and after their pregnancy. 

Yet, there is still a lack of awareness around the profession in Canada, Meghan MacKenzie, a professional midwife at Community Midwives Kelowna, told iNFOnews.ca.

“I would still say that there are still quite a few people who don't know what a midwife is or what our scope of care is or how we practice or that we are part of the medical care team, that we do have hospital privileges, that we work in the hospital,” MacKenzie said. “Although midwifery is such an old and ancient profession, it is new in terms of North America in that sense.”

According to the Canadian Encyclopaedia, First Nations peoples and the first European settlers relied heavily on midwives for childbirth.

Midway through the 20th century, childbirth transitioned from homes to hospitals. Yet it took nearly half a century after that transition for midwives to be acknowledged as legitimate healthcare providers.  

According to the University of British Columbia, the proportion of births that had a midwife present increased from 9.2 per cent in 2008 to 19.8 per cent in 2018.

Now, in BC, close to a third of all births are attended by midwives, the highest ratio for any province in the country.

However, Zoë Hodgson, Clinical Director at the Midwives Association of British Columbia, told iNFOnews.ca that she believes there are still not enough midwives in BC.

Hodgson also said that the current data fails to fully represent the care provided by midwives in the province.

“The way the data is captured in a sense undersells midwifery because we don't necessarily get to know about all of the care that midwives provide,” she said.

Midwives provide important and necessary maternal health care to mothers throughout pregnancy and after birth, Hodgson said.

“A single midwife or a small group of midwives are the people who look after a client during their pregnancy, birth and postpartum,” Hodgson said. “So, through that model of continuity, a client gets to know the people who are going to be present when the baby arrives. And through the way our model is structured, we're able to have more appointments and longer appointments with our clients to really enable the building of a relationship.”

More British Columbians becoming aware of midwifery has consequently put a strain on the provincial system currently in place.

To become a registered midwife, you have to take a four-year full-time undergraduate program to obtain a Bachelor of Midwifery degree.

Currently, the University of British Columbia is the only establishment in BC that offers this program.

“We'd love to expand the UBC programs to many, many more people, but we don't have the placements available due to the smaller number of midwives practicing BC,” Hodgson said.

There is therefore a limit on the number of students able to train in midwifery.

“We're in a situation where we can't expand the number of midwives beyond the number of practicing midwives because in training new midwives, a huge component of that training is reliant upon preceptorships with the existing midwives,” said Hodgson.

Due to their upward trend and rise in popularity, midwives, as with many other healthcare professionals, are also facing a serious burnout crisis.

Meghan MacKenzie said that in her small team of two, one midwife must be on call 24-7 for clients.

“When you think about that, you have to care for someone for that nine months of pregnancy and then that six weeks afterwards, and someone needs to be potentially on call throughout," Mackenzie said. “Whereas with maybe a family doctor, you might see that same family doctor at every visit, but then they might share a call with a group of like 10 or more physicians.”

The lack of compensation for on-call work is one of the biggest contributors to burnout, Hodgson said.

“I think the biggest contributor to burnout is time spent on call,” Hodgson said. “I think it's true for other maternity care professionals in general, but there's no compensation for the on-call hours that we work. And I think one of the issues has been that in order to make a sustainable income as a midwife… you're having to admit more clients into your care, (so) you're going to have to be up all night, you're going to be doing more days of clinic per week. So, with our payment model up until the ratification of the current agreement, it's been quite unsustainable for midwives.”

It is also part of the reason midwives are not unable to attend as many births as doctors, MacKenzie said.

“(That) is why we do take a very small client load compared to say our GP colleagues that are able to maybe see more people,” she said. “When you work in the model that we work right now as a team of two, full time for us would be about eight to ten clients a month compared to maybe like potentially twenty or more for a GP.”

However, new regulations are set to help alleviate midwife burnout as well as expand the current UBC program.

“Midwives are going to be better compensated and hopefully that's going to reduce burnout rates,” Hodgson said. “So, we're going to see more and more midwives practicing in BC.”

The new regulations will also see midwives receiving better compensation for their work.

“It's very hard to work on call,” Hodgson said. “It's very hard to work unsociable hours. But the compensation increases that have come through our current contract is hopefully going to mean that midwives may be able to adjust their working situation and still make sustainable income.”

The new contract is yet to be signed, but Hodgson said she is hopeful about benefits it will potentially reap for the midwifery profession.

“It's really going to aid to the sustainability of our profession,” she said. “Another thing that was negotiated for in our contract was different payment models to support midwifery practice.”

Until recently, midwives have been reliant on MSP billings. With the new contract, new payments options will be made available to them, she said.

The new contract will also review the scope of midwifery care, Hodgson said.

“We provide lots of reproductive and sexual healthcare to clients in pregnancy and postpartum, but many of the skills we acquire through being midwives, the training that we undergo to be midwives is applicable to people beyond the perinatal period,” she said. “Being able to contribute to primary care is going to help alleviate the primary care crisis facing British Columbians and also allow for midwives to work in models of practice that aren't necessarily reliant upon that on-call work. Therefore, a midwife would be much better able to maintain that work-life balance and hopefully keep them in the profession.”

— This story was corrected at 10:33 a.m. Tuesday, Oct. 3, 2023, to say the new regulations won’t include compensation for on call work.

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