Like many first-time moms, Shannon Wilcox had no idea what to expect when she became pregnant with daughter Gabrielle six years ago.
At the advice of her family doctor, she sought prenatal care from a maternity clinic in Richmond, made up of several obstetrician/gynecologists, whom she would rotate through upon each visit.
At the time, Wilcox didn’t put much thought into choosing a care provider through this exciting – and often nerve-racking – time. Nor was she aware of any alternatives in her community.
“I didn’t even know there were other options available,” the Surrey resident said. “When I thought of a midwife, I thought: ‘OK, someone boil some water, let’s go out into the bush.”
Wilcox’s pregnancy progressed free of complications but, when her baby became overdue, labour was induced.
When her labour fully kicked in, her doctor-on-call was nowhere to be found; Wilcox was told by nurses that her physician was at a dinner party and wouldn’t leave until her labour had progressed further.
After the party, and when it came time for Wilcox to push, she asked if she could shift positions to her side.
The doctor refused, saying she had a bad back, Wilcox recalled.
“The whole experience, it felt like a medical procedure and that I wasn’t a part of the process at all.”
With the memory of her first child’s birth tarnished by questionable bedside manner, Wilcox knew she wanted to take a different route next time. Three years later, pregnant with daughter Aaliyah, she decided to meet with a local midwife, just to ask some questions about what they do.
“They told me right away, ‘we’re here to help you, we’re OK with using medicine and we’re here to advocate for you,’” Wilcox explained. “I knew I was going to be going in with someone who would speak for me, and have the same person taking care of me the entire time.”
The experience, Wilcox said, was the complete opposite of her first delivery.
“When you go into labour, there’s no more vulnerable state than that,” she said. “I felt like I was in control of my body, as if my own instincts were good enough.”
• • •
Midwifery in B.C. has been regulated and publicly funded since 1998, and there are now 196 practising midwives registered in the province.
More than 14 per cent of the province’s newborns – around 6,000 a year – are delivered by midwives.
The University of B.C., which runs a four-year degree training program for midwives, announced last year a massive expansion that would see its capacity double over the next several years.
It’s a move that will help families across the province in prenatal and delivery care, but also postpartum care, which is sometimes not properly addressed, according to registered midwife Debbie Harding.
Harding, who has been practising for more than 30 years, currently at Surrey’s Sage Midwifery, explains the role midwives play throughout a woman’s experience of welcoming a baby.
“In our health-care system, we really front-load our care for pregnancy and birth, and it really drops off when it comes to postpartum care,” she said. “(Midwives) provide care for women and families during pregnancy, during labour and birth and during that transition as a mother and a growing family in the postpartum period, which is very important.”
Midwives, Harding explained, conduct prenatal checkups with moms-to-be at regular intervals throughout the pregnancy, much like a doctor does. However, they take an approach of promoting wellness as much as possible, she said.
“We put a lot of time into looking at each individual person’s circumstances – lifestyle, family circumstances, diet and exercise, stress…”
Diagnostic tests, lab requests, ultrasounds and certain prescriptions – should they be required – are all ordered by midwives.
“Once labour becomes established, we stay with them and help them through the birth and the initial first few hours after birth,” Harding explained.
During the first week of postpartum care, midwives conduct home visits to assess both baby and mom – the number and frequency of visits depend on how things like breastfeeding and healing are progressing. Mom and baby then visit the midwifery clinic for additional checkups, until six weeks after birth.
Not every pregnancy is suitable for midwife care, however; The College of Midwives of B.C. has set forth strict guidelines governing when a women’s care needs to be transferred to an obstetrician.
There are occasions, Harding pointed out, when a mother-to-be can return to the care of her midwife, if the issue that arose has been dealt with and the obstetrician is in agreement.
It’s just one example of the symbiotic relationship that many midwives in this province share with obstetrician/gynecologists.
“We enjoy very collaborative relationships with OBs,” Harding explained, noting that the working relationship has taken time to develop in recent years.
“Any time you’re working together, you need a trusting relationship. You need to be collaborative and you need to be willing to listen to each other and to discuss things.”
Dr. Gary Jackson, a White Rock obstetrician/gynecologist who practised for close to 30 years before retiring last year, said he feels the legalization of midwifery in B.C. has been a positive step for women and their families, and agreed with Harding that doctors share a good working relationship with midwives.
“It’s been pleasant and encouraging to see midwifery become legalized and formalized in this province,” the former Peace Arch Hospital doctor said.
“In my experience, I don’t think there have been any doctors who are upset or have had conflicts, and the midwives when I was working at our hospital, who worked with us there, were a great addition to the department.”
Jackson said midwifery is a “viable” option for women, especially those who are hoping to have a familiar face in the delivery room with them, explaining that a woman whose family doctor does not practise obstetrics may seek treatment at a maternity-care clinic, where a number of doctors are on rotation.
“You don’t necessarily know who would be delivering your baby,” he said.
As long as guidelines are followed regarding any risk-factors in a woman’s pregnancy – Jackson noted situations like multiple gestation, diabetes and issues with hypertension would require an OB/GYN to become involved – he said he sees no disadvantages to a woman opting for midwifery care over that of a doctor.
“Certainly, it’s a personal decision that a woman would make. And as long as it’s a low-risk pregnancy, I don’t see any drawbacks,” he said. “It’s a woman’s choice, as it should be.”
• • •
For midwives in B.C., it’s been a long road getting to the point of being a recognized health-care practice, according to Harding, who was actively involved in the legalization process, which spanned nearly two decades.
Harding was one of the midwives appointed to the first board of the College of Midwives of B.C. in 1995, which led to the official legislation and regulation of midwifery in 1998 – 18 years after the campaign to for legalization was first launched.
And while midwifery has come a long way since Harding first became involved, she admitted there are still a number of misconceptions.
Many women aren’t aware that midwifery care is covered by the province’s Medical Services Plan, and people often assume that a midwife-assisted birth automatically equates to a home delivery.
“I would say about 75 per cent of (our clients’) births take place in the hospital,” Harding noted.
Opting to deliver with a midwife also doesn’t restrict a women’s access to pain medication while in labour – a range of natural and pharmaceutical pain-relief options, including access to epidurals, are made available for mothers-to-be, with an emphasis on thorough communication and educations.
It’s just one example of how midwives strive to empower women throughout the exciting, challenging and life-changing experience of childbirth.
“I enjoy helping women develop the confidence, if they don’t already have it, in their ability to give birth, and to appreciate how satisfying it is to have a baby and be a full participant in the care,” Harding said.
“Women are profoundly changed by the experience of giving birth and becoming a mother. As a society, we really need to support them as much as we can.
“It’s not just a physical act, it’s so much more than that.”